^(125)I放射性粒子双链胆道引流管近距离放疗联合经动脉灌注化疗序贯治疗局部进展期胰腺癌

Biliary drainage tube with double-chain ^(125)I seeds brachytherapy combined with transarterial infusion chemotherapy for sequential treatment of locally progressive pancreatic cancer

目的观察^(125)I放射性粒子双链胆道引流管(简称引流管)近距离放射治疗(简称放疗)联合经动脉灌注(TAI)化学治疗(简称化疗)序贯治疗局部进展期胰腺癌伴梗阻性黄疸的安全性和有效性。方法对30例局部进展期胰腺癌伴梗阻性黄疸患者经胆管途径置入引流管,行近距离放疗联合TAI序贯治疗,每3周重复一次TAI化疗,并于近距离放疗8周后拔出引流管,植入胆道支架;评价技术成功率,观察治疗期间不良反应、2次TAI化疗后肿瘤局部控制情况,记录患者生存状况。结果均顺利置入引流管,技术成功率100%。近距离放疗期间3例发生轻微胆管炎及少量出血;化疗期间多数出现1~2级血液和消化系统不良反应,少数发生3~4级不良反应。经2次TAI化疗后,1例肿瘤局部完全缓解,19例部分缓解,7例稳定,3例进展,肿瘤局部控制率为90.00%(27/30);中位随访时间12.73个月,中位支架通畅时间8.56个月,中位无进展生存期6.42个月,中位总生存期14.48个月;1年、2年生存率分别为79.10%、30.60%。结论^(125)I放射性粒子双链胆道引流管近距离放疗联合TAI化疗序贯治疗局部进展期胰腺癌安全且短期疗效好。

Objective To observe the safety and efficacy of biliary drainage tube with double-chain ^(125)I radioactive seeds brachytherapy(abbreviated drainage tube)combined with transarterial infusion(TAI)chemotherapy for sequential treatment of locally progressive pancreatic cancer with obstructive jaundice.Methods Thirty patients with locally progressive pancreatic cancer with obstructive jaundice were sequentially treated with brachytherapy combining with TAI chemotherapy.The drainage tubes were placed via biliary route,and TAI chemotherapy was repeated every 3 weeks.Eight weeks after brachytherapy,the drainage tube was removed and biliary stent was implanted.The technical success rate of treatment was evaluated,and the complications during brachytherapy and adverse reactions during TAI chemotherapy were recorded.The local tumor control after 2 sessions of TAI chemotherapy was observed,and patient's survival status was followed up.Results Drainage tube was successful placed in all 30 patients,and the technical success rate was 100%.During brachytherapy,mild cholangitis and a small amount of bleeding occurred in 3 patients,while during TAI chemotherapy,most patients had grade 1 to 2 bleeding and gastrointestinal adverse reactions,and a few had grade 3 to 4 adverse reactions.After 2 sessions of TAI chemotherapy,complete response was detected in 1 case,while partial response in 19,stable disease in 7 and progression disease in 3 cases,respectively,and the local control rate of tumor was 90.00%(27/30).The median follow-up time was 12.73 months,median stent patency time was 8.56 months,median progression free survival was 6.42 months,median overall survival was 14.48 months,and the 1-year and 2-year survival rate was 79.10%and 30.60%,respectively.Conclusion Biliary drainage tube with double-chain ^(125)I radioactive seeds brachytherapy combined with TAI chemotherapy was safe in sequential treatment of locally progressive pancreatic cancer with good short-term treatment effect.