放射性粒子^(125)I与缓释化疗粒子联合应用靶向治疗复发性直肠癌

Radiochemotherapy with interstitial implantation of ^(125) I seeds and 5-FU slow-release seeds for recurrent colorectal adenocarcinoma.

目的 探讨应用放、化疗粒子联合植入法综合治疗复发性直肠癌的可行性、安全性及短期疗效。方法 北京铁路总医院自 2 0 0 1年 12月至 2 0 0 3年 8月 ,应用放、化疗粒子联合植入法综合治疗复发性直肠癌 19例 ,均为直肠癌Mile’s术后盆腔复发病人。在治疗计划指导下 ,交替植入 5 FU缓释化疗粒子和放射性12 5I粒子。放射性粒子的肿瘤匹配周边剂量 (Matchedperipheraldose ,MPD)为 90～ 130Gy。平均每例使用12 5I粒子 11粒 ,5 FU6 0 0mg。结果 19例病人手术均顺利完成 ,未发生出血、感染等并发症 ,经盆腔摄片证实放射性粒子的位置无变化。疼痛缓解率为 85 7% (12 / 14 ) ,平均疼痛缓解时间为 5～ 9d。于术后 3～ 6个月CT复查肿瘤变化 ,提示瘤体不同程度缩小 ,其中 2例完全缓解 ,12例部分缓解 ,4例稳定 ,局部控制率为 74 %。随访 6～ 2 8个月 ,中位生存期为 17个月 ,最长 1例随访时间为术后 2 6个月 ,现仍存活。 1例术后 6个月死于全身广泛转移。结论 放射性12 5I粒子和 5 FU缓释化疗粒子联合应用局部植入技术具有安全、微创及并发症发生率低的特点 。

Objective To investigate the combined treatment technological feasibility,security and short term efficacy with interstitial implantation of ^(125) I seeds and 5-FU slow-release seeds for recurrent colorectal adenocarcinoma. Methods From December 2001 to August 2003, 19 cases of recurrent colorectal adenocarcinoma were treated with radiochemotherapy. They were all patients with recurrent colorectal adenocarcinoma after Mile's procedure. We implanted alternately ^(125) I seeds and 5-FU slow-release seeds by guiding of treatment planning system. The MPD of ^(125) I seed implantation were 90-130Gy. The mean 11granules of ^(125) I seeds and 5-FU 600mg were used in every patient. Results Fully operating procedure was accomplished for all the patients. No operating complication occurred. Pelvic X-ray found no displacement of ^(125) I seeds. The relieved rate of the pain was 85.7%(12/14).The relief last 5-9 days avevagely CT scan showed that the reduced size of tumor changed in different degree 3-6 months after the operation. The CR was 10.52%(2/19). The PR was 63.16%(12/19). The PD was 33.33% (4/12). Following up 6-28 months, the median survival stage was 17 months. Only 1 case died from bone and lung metastases in 6 months postoperatively. Conclusion Using radiochemotherapy with interstitial implantation of ^(125) I seeds and 5-Fu slow-release seeds is safe , minimally invasive and effective for treatment of recurrent colorectal carcinoma.