CT导引下^(125)I粒子植入在治疗恶性肿瘤中的应用

CT-guided percutaneous permanent ^(125)I implantation for patients with malignant tumor

目的 评价CT导引下瘤体内12 5I粒子植入治疗恶性肿瘤的可行性、安全性及其疗效。方法 10例 13个病灶行CT导引下瘤体内12 5I粒子植入 ,其中原发肿瘤 4例 ,转移瘤 6例 (9个病灶 )。患者男 4例 ,女 6例 ,年龄 5 4～ 6 2岁 (平均 5 6 .9岁 )。依据粒子植入术前 15d内CT图像应用计算机治疗计划系统制定粒子植入计划 ,按治疗计划在CT导引下穿刺植入12 5I粒子。植入术后立即CT扫描及术后 5～ 10个月CT扫描观察粒子在瘤体内的分布、有无并发症发生及疗效。结果 10例粒子植入均顺利完成 ,粒子分布满意 ,单个瘤体内植入12 5I粒子数为 1～ 4 4粒 (平均 18.6粒 )。未见急性并发症和治疗相关的放射损伤。全部 4例疼痛患者粒子植入术后疼痛均有明显减轻。随诊CT检查示 3个病灶消失 ,8个病灶明显缩小 ,其余 2个病灶大小无明显变化。植入术前及植入术后随诊显示病灶平均大小分别为 3.15和 2 .0 6cm(t =5 .12 7,P <0 .0 0 1)。结论 CT导引下12 5I粒子植入近距离放射治疗对原发及转移性恶性肿瘤是 1种安全、可行、有效的治疗方法在恶性肿瘤的治疗中外照射起着重要作用 ,但由于外照射放疗的准确性较差 ,对周围正常组织损伤明显 ,效果常常不太理想。病灶内放射性粒子植入近距离治疗恶性肿瘤是 1种新的放疗手段 。

Objective To evaluate the feasibility, safety, and efficacy of CT-guided permanent iodine-125 implantation for malignant tumors.Methods Thirteen lesions in 10 consecutive patients with malignant tumor were treated with CT-guided iodine-125 permanent implantation brachytherapy, of which four cases were primary unresectable carcinoma and six cases were metastases. There were 4 males and (6 females,) the mean age was 56.9 years (range 54 to 62 years). Based on the CT imaging within two weeks before the implantation of the seeds, a computer-based treatment planning system was used to determine the optimal seed distribution. Subsequent CT-guided needle placement and seed implantation were carried out. Post-implant CT scans were performed immediately and five to ten months after the implantation in all cases to assess seed distribution, complication, and curative effect. Results CT-guided iodine-125 permanent implantation was accomplished smoothly in all cases. This technique offered a better seed placement. The number of seeds implanted in one lesion was 1 to 44 (mean 18.6). No acute complications and late toxicity related to the implantation were observed. Pain relief was obtained in all four patients (100%) presenting with pain. Follow-up CT demonstrated that 3 of 13 lesions disappeared completely, eight lesions diminished, and the remaining 2 lesions had no significant change in size. Mean lesion size of pre-implant and post-implant were 3.15 cm and 2.06 cm, respectively (t=5.127, P<0.001). Conclusion CT-guided iodine-125 permanent implantation is a feasible, effective, and safe method in the treatment of both primary unresectable carcinoma and metastases.