^(125)I粒子植入在一线EGFR-TKIs治疗后无进展的EGFR基因敏感突变寡转移非小细胞肺癌治疗中的价值  

Value of^(125)I seed implantation for patients with oligometastatic EGFR-mutant non-small cell lung cancer without progression after first-line EGFR-TKIs treatment

作　　者：王猛[1] 周志刚[1] 杜可朴[1] 李帅[1] 李亚丹[1] 高飞[1] 高剑波[1] Wang Meng;Zhou Zhigang;Du Kepu;Li Shuai;Li Yadan;Gao Fei;Gao Jianbo(Department of Radiology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院放射科,郑州450052

出　　处：《中华核医学与分子影像杂志》2023年第7期402-406,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的探讨CT引导^(125)I粒子植入在一线表皮生长因子受体(EGFR)-酪氨酸激酶抑制剂(TKIs)治疗后无进展的EGFR基因敏感突变(EGFRm+)寡转移非小细胞肺癌(NSCLC)患者治疗中的价值。方法回顾性分析2015年1月至2019年1月符合纳入标准的郑州大学第一附属医院NSCLC患者[89例,其中男38例、女性51例;年龄(62±11)岁],根据治疗方法分为局部巩固治疗组(A组,32例),即一线EGFR-TKIs治疗无进展后对原发和转移病变行CT引导^(125)I粒子植入术,术后继续原EGFR-TKIs维持治疗;维持治疗组(B组,57例),即EGFR-TKIs治疗至疾病进展。应用Kaplan-Meier方法及log-rank检验对比2组肿瘤无进展生存(PFS)和总生存(OS),同时观察A组的并发症发生率。结果A组、B组随访时间分别为36.5(31.0,43.3)个月和30.0(24.0,35.0)个月。2组中位PFS分别是15.0(95%CI:12.8~17.2)个月和12.0(95%CI:10.9~13.1)个月,A组长于B组(χ2=8.80,P=0.003);中位OS分别为37.0(95%CI:33.9~40.1)个月和31.0(95%CI:28.9~33.1)个月(χ2=7.15,P=0.007)。CT引导^(125)I粒子植入常见并发症为气胸、咯血,A组总的并发症发生率为21.9%(7/32);有1例行胸腔闭式引流治疗,其余患者均经保守治疗好转,无手术相关死亡病例。结论CT引导^(125)I粒子植入可作为巩固性治疗用于一线EGFR-TKIs治疗后无进展的EGFRm+寡转移NSCLC患者,可延长患者PFS和OS。Objective To explore the clinical efficacy of CT-guided^(125)I seed implantation in patients with oligometastatic non-small cell lung cancer(NSCLC)harboring epidermal growth factor receptor(EGFR)activating mutations(EGFRm+)without progression after first-line EGFR-tyrosine kinase inhibitors(TKIs)treatment.Methods From January 2015 to January 2019,89 eligible patients(38 males,51 females;age:(62±11)years)in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed.They were divided into 2 groups according to different treatment methods.The^(125)I seeds were implanted for oligometastatic lesions and/or primary tumors without progression after first-line EGFR-TKIs therapy in local consolidation treatment group(Group A,n=32).The maintenance treatment group(Group B,n=57)only received EGFR-TKIs until disease progression.The progression-free survival(PFS)and overall survival(OS)of the 2 groups were estimated by Kaplan-Meier curves,and were compared by using log-rank test.Complications in Group A were observed.Results The follow-up time of the group A and group B were 36.5(31.0,43.3)months and 30.0(24.0,35.0)months respectively.The median PFS and OS in group A were 15.0(95%CI:12.8-17.2)months and 37.0(95%CI:33.9-40.1)months,both of which were significantly longer than those in group B(12.0(95%CI:10.9-13.1)months and 31.0(95%CI:28.9-33.1)months;χ2 values:8.80,7.15,P values:0.003,0.007).In Group A,the total incidence of complications in CT-guided^(125)I seed implantation was 21.9%(7/32),and the common complications and adverse events were pneumothorax and hemoptysis.Only 1 patient underwent chest tube insertion,and the rest were treated with conservative treatment.No operation related death occurred.Conclusion CT-guided^(125)I seed implantation is safe and feasible for patients with EGFRm+oligometastatic NSCLC without progression after first-line EGFR-TKIs treatment,and can prolong the PFS and OS of patients.

关 键 词：癌 非小细胞肺 近距离放射疗法 碘放射性同位素 受体 表皮生长因子 

分 类 号：R734.2[医药卫生—肿瘤]