CT引导下^(125)I粒子近距离挽救性放射治疗高级别脑干胶质瘤探讨  

CT-guided ^(125)I seeds brachytherapy salvage treatment for high-grade brainstem glioma

作　　者：姜涵[1,2] 王乐婷 神岳明 胡禾颖 刘士锋[2] 王从晓 胡效坤[2] 邢东明 JANG Han;WANG Leting;SHEN Yueming;HU Heying;LIU Shifeng;WANG Congxiao;HU Xiaokun;XING Dongming(Qingdao Medical College, Qingdao University, Qingdao 266000, China;Department of Interventional Medical Center, The Affiliated Hospital of Qingdao University, Qingdao 266555, China;Department of Pharmacy, Qingdao Municipal Hospital, Qingdao 266000, China;General Medicine Department, The People’s Hosiptal of Pinyi County, Linyi 273300, China;Qingdao Cancer Institute, Qingdao, 266000, China)

机构地区：[1]青岛大学青岛医学院,山东青岛266000 [2]青岛大学附属医院介入医学中心,山东青岛266555 [3]山东省青岛市市立医院药剂科,山东青岛266000 [4]山东省平邑县人民医院全科医生科,山东临沂273300 [5]山东省青岛肿瘤研究院,山东青岛266000

出　　处：《医学影像学杂志》2022年第3期375-378,共4页Journal of Medical Imaging

基　　金：国家重点研发计划项目(编号:2019YFE0120100)。

摘　　要：目的探讨对高级别脑干胶质瘤患者行^(125)I粒子近距离治疗的安全性和可行性及近期疗效。方法选取我院诊断为高级别脑干胶质瘤的8例患者,均有不同程度的神经功能症状,术前行颅脑MRI增强检查评估病变范围,颅脑CT增强检查确定病变与毗邻血管的空间位置关系,应用放射性粒子近距离治疗计划系统制定术前计划,术中基于CT引导,按照术前计划行^(125)I粒子永久性植入。结果8例肿瘤平均体积为11.8(5.6~25.2)ml,植入^(125)I粒子平均数量为22.5(10~40)颗,平均粒子密度为1.9粒/ml。8例患者术后KPS与术前基本相同,3例患者术后出现因颅内水肿加重引起的原有症状加重表现,给予对症处理后症状好转。围手术期内无颅内出血、无严重神经功能损伤,无死亡患者,6个月生存期100%。结论在高级别脑干胶质瘤患者的治疗中,基于CT引导下^(125)I粒子近距离放射治疗是一种安全可行的治疗方法,短期疗效满意,值得进一步探讨。Objective To explore the safety,feasibility and short-term efficacy of ^(125)I seeds brachytherapy for patients with high-grade brainstem glioma.Methods A retrospective analysis was conducted on 8 patients diagnosed with high-grade brainstem glioma from January 2015 to June 2021 who were used as observation and research subjects.Among the 8 patients,3 were males and 5 were females,with an average age of 48.4(16~68)years old,all had neurological symptoms of varying degrees.Preoperative MRI enhancement of the brain was performed to assess the scope of the lesion.The enhanced CT scan of the brain was used to determine the spatial position relationship between the lesion and the adjacent blood vessel.The radioactive seed brachytherapy planning system was used to formulate the preoperative plan.During the operation,the preoperative plan was performed based on CT guidance.^(125)I seeds are permanently implanted.Results The average volume of 8 tumors was 11.8(5.6~25.2)ml,the average number of implanted ^(125)I seeds was 22.5(10~40),and the average density was 1.9 seeds/mL.The postoperative KPS of 8 patients was basically the same as that before the operation,and 3 patients experienced aggravation of the original symptoms caused by aggravated intracranial edema after the operation,and the symptoms were improved after symptomatic treatment.During the perioperative period,there were no cases of intracranial hemorrhage,no cases of severe neurological damage,no one death,and a survival period was 100%in 6 months.Conclusion In the treatment of patients with high-grade brainstem glioma,CT-guided ^(125)I seeds brachytherapy is a safe and feasible treatment method with satisfactory short-term effects,which is worthy of further discussion.

关 键 词：高级别脑干胶质瘤 ^(125)I粒子 近距离治疗 体层摄影术 X线计算机 介入性 放射学 

分 类 号：R814.42[医药卫生—影像医学与核医学] R739.4[医药卫生—放射医学]