食管^(125)I粒子支架姑息治疗晚期食管癌剂量学参数与疗效的关系  

Relationship between dosimetric parameters and efficacy of esophageal^(125)I seed stent in palliative treatment of advanced esophageal cancer

作　　者：袁倩倩[1] 杨森[1] 白云玲 刘斌[2] 王强[3] 张开贤[1] 王俊杰[4] YUAN Qianqian;YANG Sen;BAI Yunling;LIU Bin;WANG Qiang;ZHANG Kaixian;WANG Junjie(Oncology Department,Tengzhou Central People􀆳s Hospital,Tengzhou,Shandong 277599,China;Surgery Department,Tengzhou Central People's Hospital,Tengzhou,Shandong 277599,China;Radiotherapy Department,Xuzhou Cancer Hospital,Xuzhou,Jiangsu 221005,China;Cancer Radiotherapy Department,Peking University Third Hospital,Bejing 100191,China)

机构地区：[1]滕州市中心人民医院肿瘤科,山东省滕州市277599 [2]滕州市中心人民医院外科,山东省滕州市277599 [3]徐州市肿瘤医院放疗科,江苏省徐州市221005 [4]北京大学第三医院肿瘤放疗科,北京市100191

出　　处：《中南医学科学杂志》2022年第1期63-66,共4页Medical Science Journal of Central South China

基　　金：江苏省青年医学重点人才课题(QNRC2016396)。

摘　　要：目的观察食管^(125)I粒子支架姑息治疗Ⅲ~Ⅳ级吞咽困难初治食管癌患者的疗效,分析剂量学参数与预后的关系。方法采用食管^(125)I粒子支架置入姑息治疗吞咽困难食管癌患者28例。粒子活度0.4~0.8 mCi,术前处方剂量60~80 Gy。术后行CT扫描并行剂量验证,评估90%、100%肿瘤体积接受的处方剂量(D90、D100)、计划靶区接受90%、100%处方剂量的体积百分比(V90、V100)。按照粒子活度将患者分为低中活度组和高活度组,按照D100将患者分为D100<30 Gy组和D100≥30 Gy组,比较各组吞咽困难缓解维持时间、总生存期(OS),并分析其关系。结果全组28例均成功完成支架植入,术后吞咽困难缓解维持时间为150天(95%CI 65~234),OS为173天(95%CI 66~280)。多因素分析提示,粒子低中活度组有吞咽困难缓解维持时间的优势(χ^(2)=5.413,P=0.020),术后D100≥30 Gy有吞咽困难缓解维持时间优势和生存优势(χ^(2)=5.496/4.035,P=0.019/0.045)。结论食管^(125)I粒子支架姑息治疗晚期食管癌有效,低中剂量粒子活度0.4~0.6 mCi、术后D100≥30 Gy有利于提高患者吞咽困难缓解维持时间和总生存期。Aim To observe the efficacy of esophageal stent loaded with^(125)Iodine seeds for the treatment ofⅢ~Ⅳlevel dysphagia esophageal cancer,and assess the relationship between efficacy and dosage parameters.Methods Twenty-eight advanced esophageal carcinoma patients with progressive dysphagia were treated with esophageal stent loaded with^(125)Iodine seeds for palliative treatment.Seed activity:0.4~0.8 mCi,Prescription dose:60~80 Gy.Postoperative CT scan and dose validation were performed to evaluate the prescription dose received at 90%and 100%tumor volume(D90 and D100)and the volume percentage of the planned target area receiving 90%and 100%prescription dose(V90 and V100).Patients were divided into low and medium activity group and high activity group according to particle activity,D100<30 Gy group and D100≥30 Gy group according to D100.Maintenance time of dysphagia relief and overall survival(OS)in each group were compared,and the relationship was analyzed.Results All the 28 patients in the whole group were successfully implanted with esophageal seed stent.The median time for relief of dysphagia was 150 days(95%CI 65~234).The median OS was 173 days(95%CI 66~280).Multivariate analysis showed that low and medium seed-activity group had dysphagia relief time advantage(χ^(2)=5.413,P=0.020).Postoperative D100≥30 Gy had dysphagia relief time and survival advantage(χ^(2)=5.496/4.035,P=0.019/0.045).Conclusion Esophageal stent loaded with^(125)Iodine seeds is an effective treatment in primary treatment of esophageal cancer for advanced esophageal dysphagiaⅢ-Ⅳlevel.The recommended seed activity is 0.4-0.6 mCi.Postoperative D100≥30 Gy may be beneficial to improve the relief time and overall survival of dysphagia.

关 键 词：食管癌 ^(125)I粒子支架 有效性 剂量学 

分 类 号：R735.1[医药卫生—肿瘤]