腹膜后转移瘤放射性125I粒子植入治疗的靶区剂量研究  

Dosimetric study on target area of radioactive 125I seeds implantation brachytherapy for retroperitoneal metastasis

作　　者：梁百武 何闯 梁清华 李良山 李廷源 黄学全 刘兴华 LIANG Bai-wu;HE Chuang;LIANG Qing-hua;LI Liang-shan;LI Ting-yuan;HUANG Xue-quan;LIU Xing-hua(Department of Oncology,Dazhou Integrated TCM &Western Medicine Hospital,Dazhou Sichuan 635000,China;Department of Minimally Invasive Intervention,First Affiliated Hospital of Army Medical University,Chongqing 400038,China;Department of Radiology,Three Gorges Hospital Affiliated to Chongqing University,Chongqing 404000,China)

机构地区：[1]达州市中西医结合医院肿瘤科,四川达州635000 [2]陆军军医大学第一附属医院微创介入科,重庆400038 [3]重庆大学附属三峡医院放射科,重庆404000

出　　处：《局解手术学杂志》2021年第1期58-61,共4页Journal of Regional Anatomy and Operative Surgery

基　　金：重庆市技术创新与应用发展技扶贫专项(CSTC2019jscx-KJFP0005)。

摘　　要：目的探讨放射性125I粒子植入治疗腹膜后转移瘤的临床疗效,并分析其靶区剂量与局部控制的相关性。方法回顾性分析陆军军医大学第一附属医院52例(57个治疗靶区)腹膜后转移瘤患者的临床资料,均进行放射性125I粒子植入治疗。应用视觉模拟量表(VAS)评价患者手术前后疼痛情况,根据实体瘤临床疗效评价标准(RECIST)评价靶区局部控制情况并分为CR+PR+SD组(CPS组)和PD组,通过受试者工作特征(ROC)曲线分析术后靶区D90预测局部控制的临界值,采用K-M曲线分析靶区局部持续控制时间,多因素COX回归分析靶区局部持续控制时间的危险因素。结果术后靶区D90验证剂量大于平均处方剂量。术后靶区D90的ROC曲线下面积为0.762,D90对局部控制率的预测敏感性为67.3%,特异性为80%,临界值为9229 cGy。局部持续控制中位时间为12个月,局部控制率为92.9%;与PD组相比,CPS组靶区D90剂量更高(P=0.023),且靶区D90是局部持续控制时间的主要危险因素(P=0.025)。与术前比较,术后3个月VAS评分显著降低(P=0.005)。结论放射性125I粒子植入治疗腹膜后转移瘤是一种有效的治疗方式,术后靶区D90剂量不低于9229 cGy可获得较高的局部控制率。Objective To investigate the clinical value of radioactive 125I seeds implantation brachytherapy for retroperitoneal metastasis and analyze the correlation between radiotherapy target dose and local control rate.Methods The clinical data of 52 patients(57 target areas)with retroperitoneal metastasis treated by radioactive 125I seeds implantation brachytherapy from First Affiliated Hospital of Army Medical University were analyzed retrospectively.The pains before and after operation were evaluated by visual analogue scale(VAS),the local control of target areas was evaluated by response evaluation criteria in solid tumors(RECIST),and the patients evaluated as complete response(CR)+partial response(PR)+stable disease(SD)were included into the CR+PR+SD group(CPS group)and those evaluated as progressive disease(PD)were included into the PD group.The receiver operating characteristic(ROC)curve was used to determine the cut-off value of dose received by 90%of the target(D90)after operation to predict the local control.The local control duration was analyzed by the K-M curve and the risk factors of the local control duration on target areas were analyzed by multifactor COX regression.Results The target validated D90 after operation was larger than the average prescription dose.The area under the curve of ROC for the target validated D90 after operation was 0.762,the predictive sensitivity and specificity of D90 to local control rate were 67.3%and 80%respectively,the cut-off value was 9,229 cGy.The local control duration was 12 months and the local control rate was 92.9%.The dose of target D90 in the CPS group was higher than that in the PD group(P=0.023),and target D90 was the main risk factor of local control duration(P=0.025).The VAS scores 3 months after operation were lower than those before operation(P=0.005).Conclusion Radioactive 125I seed implantation is an effective method for the retroperitoneal metastasis,which can achieve a high control rate when the target dose of D90 was 9,229 cGy or more.

关 键 词：放射性125I粒子 近距离治疗 腹膜后转移瘤 

分 类 号：R735.4[医药卫生—肿瘤]