术中超声引导放射性^(125)Ⅰ粒子植入治疗胰腺癌

Iodine-125 seed implantation for unresectable pancreatic carcinoma guided by intraoperative ultrasound

目的探讨术中超声引导放射性125Ⅰ粒子组织间植入治疗胰腺癌的疗效。方法22例无法切除晚期胰腺癌患者11例先行胃肠或胆肠短路术,2例行支架植入术。术前根据CT扫描图像行治疗计划计算需要剂量、需要植入粒子活度和个数。125Ⅰ粒子活度为0.40～0.70mCi/颗,肿瘤匹配周边剂量(MPD)为65～145Gy。粒子针插植,间距1～1.5cm,边缘包括肿瘤外1～1.5cm。Mick枪植入125Ⅰ粒子。粒子间距1cm。5例患者术后4周加三维适形外放疗,2～3Gy/次,5次/周,总吸收剂量39～50Gy,1例加紫杉醇增敏,1次/周,60mg/次,共3次。5例患者术后加健择化疗2周期,每21天为1个周期。结果15例伴有上腹部疼痛患者,粒子治疗后有12例疼痛完全缓解,2例部分缓解,1例无明显缓解,有效率93.33%,平均显效时间2～3d。全组患者6例术后因复发而死亡,复发率为27.27%。全组中位生存时间6个月,其中Ⅲ期中位生存时间8个月。50%患者死于远处转移。3例术后1个月复查时发现5颗粒子迁徙到肝脏。未见出血、感染、胰腺炎和胰瘘等并发症。结论放射性125Ⅰ粒子组织间植入治疗胰腺癌具有很好的姑息止疼疗效,部分局部晚期患者可获得长期生存,而且并发症发病率较低。

Objective To investigate the surgical technique, efficacy and side effects of ^125I seed interstitial implantation for pancreatic carcinoma. Methods A total of 22 patients with biopsy proven unresectable adenocarcinoma of pancreas were treated with ^125I implants during laparotomy. Of them 11 patients were treated previously by a combination of bypass surgery. The stent was implanted in 2 cases 2 weeks before and 4 weeks after seed implantation. Seed needles were implanted parallelly to each other,with 1-1.5 cm apart. Mick applicator was being connected to each needle to implant seed. The radioactive activity ranged 0.40-0.70 mCi,the matched peripheral doses were 65-145 Gy. The mean number of ^125 Ⅰ seed was 11-78. Five cases received external beam irradiation with 3D-CRT, the doses were 39-70 Gy and 5 patients received 2 cycle of gemcitabine chemotherapy at 1000 mg/m^2 on dl and d8. Results Pain was completely relieved in 12 cases, partially relieved in 2 cases, and no response was noted in one case, so the response rate was 93.33% , The median time was 2-3 d. Altogethe 27.27% of the cases died from local recurrence of pancreatic carcinoma and 50% from metastasis. The median survival time in these patients was 6 months, with a 2-year survival rate of 9.09%. The seed immigrated to liver in 3 cases. There were no serious side effects such as infection, pancreatitis, pancreatic fistula, etc. Conclusion Radioactive seed implantation was safe, high local control, minidamage, satisfactory palliation of pain and without significant complications.