CT引导下放射性碘-125粒子植入治疗不可切除晚期胰腺癌的疗效分析及剂量学研究

Efficacy analysis and dosimetry study of CT-guided radioactive iodine-125 seed implantation in the treatment of unresectable advanced pancreatic cancer

目的研究CT引导下^(125)Ⅰ粒子植入术治疗晚期胰腺癌的近期疗效及远期生存期,采用计算机三维治疗计划系统(treatment plan system,TPS)评价晚期胰腺癌局部病灶的最佳剂量。方法回顾性分析2016年1月-2021年12月郑州大学附属肿瘤医院收治的54例晚期胰腺癌患者的临床资料,所有患者均经病理确诊为胰腺癌,临床分期Ⅳ期。治疗方案经院内多学科会诊,确认无法行外科手术切除治疗和因有严重心脑血管方面疾病或血生化化验指标重度异常无法行常规放化疗治疗,患者在CT引导下行^(125)Ⅰ粒子植入术,植入术前在TPS系统设计治疗计划,然后,在CT引导下穿刺按计划植入相应粒子,粒子活度14.8~29.6 Mbq;术后定期随访,对所有患者随访6~24个月,评估局部植入病灶疗效,包括比较治疗前后病灶大小变化、相关肿瘤标志物水平变化;记录腹部疼痛、黄疸等并发症改善情况;记录患者生存状况,绘制生存曲线。按治疗后验证剂量分组,分为120~140 Gy组和<120 Gy组,以随访结果为依据比较两组治疗效果。结果54例患者共植入^(125)Ⅰ粒子1682颗。植入术后6个月,植入病灶完全缓解5例,部分缓解31例,稳定11例,进展7例,有效率为66.8%。以术后验证D90剂量分组,剂量120~140 Gy组有效率(75.7%)明显高于剂量<120 Gy组(47.1%),差异有统计学意义(χ^(2)=4.29,P<0.05)。治疗后患者病灶体积、糖类抗原199(carbohydrate antigen 199,CA199)水平较术前显著降低,差异有统计学意义(P<0.05)。随访6~24个月,通过Kaplan-Meier法检验分析晚期胰腺癌患者^(125)Ⅰ粒子植入治疗后中位生存期12个月,平均生存期(13.03±0.67)月。^(125)Ⅰ粒子植入治疗不良反应率低,患者术后腹部疼痛症状缓解率为78.6%,黄疸症状缓解率为66.7%。结论^(125)Ⅰ粒子植入治疗晚期胰腺癌局部控制疗效确切且安全性高,可改善腹部疼痛、黄疸等并发症相关临床症状,治疗最佳疗效处方剂量为D90120~140 Gy。

Objective To analyze the short-term local efficacy and long-term survival of iodine-125 seed implantation for advanced pancreatic cancer under CT guidance.A computerized three-dimensional treatment planning system(TPS)was used to determine the optimal dose of^(125)Ⅰparticle implantation for local lesions of advanced pancreatic cancer.Methods A total of 54 patients with advanced pancreatic cancer admitted to The Affiliated Cancer Hospital of Zhengzhou University from January 2016 to December 2021 were retrospectively analyzed.Pancreatic cancer(clinical stage IV)was confirmed by pathologic examinations in all patients.The treatment plans were confirmed by the hospital multidisciplinary team.The patients were not surgical candidates and were not eligible for radiation therapy or chemotherapy due to severe cardiac and vascular diseases and a blood biochemical assay index 4.Before CT-guided^(125)Ⅰparticle implantation,the optimal dose was determined using the TPS.Then,CT-guided puncture was performed and the^(125)Ⅰparticles were implanted according to plan.The particle activity was 14.8-29.6 Mbq.All patients were followed regularly after surgery for 6-24 months to evaluate the efficacy of local implantation on lesions,including a comparison of changes in lesion size and the tumor marker levels before and after treatment.Improvement in complications,such as abdominal pain and jaundice,was recorded.Patient survival was recorded and survival curves were drawn.According to the verified dose after treatment,patients were divided into 120-140 and<120 Gy groups,and the treatment effects of the two groups were compared based on the follow-up results.Results A total of 1682^(125)Ⅰseeds were implanted in 54 patients.Six months after implantation,5 patients were in complete remission(CR),31 were in partial remission(PR),11 had stable disease(SD),and 7 had progressive disease(PD).The treatment effective rate was 66.8%.According to the D90-dose group verified postoperatively,the effective rate in the 120-140 Gy group(75.7%)was significantly higher than the<120 Gy group(47.1%;χ^(2)=4.29,P<0.05).The lesion volume and CA-199 level decreased significantly after treatment(P<0.05).The patients were followed for 6-24 months.The Kaplan-Meier method was used to analyze the survival of^(125)Ⅰseed implantation for advanced pancreatic cancer.The mean survival was(13.03±0.67)months,and the median survival was 12 months.The adverse reaction rate to^(125)Ⅰseed implantation was low.The remission rates of abdominal pain and jaundice were 78.6%and 66.7%,respectively.Conclusions^(125)Ⅰseed implantation is effective and safe for local control of advanced pancreatic cancer,and can improve clinical symptoms,such as abdominal pain,jaundice,and other complications.The optimal prescription dose for treatment is D90120-140 Gy.