CT导引下^(125)I粒子植入治疗胰腺癌

CT guided radioactive seed ^(125)I implantation in treatment of pancreatic cancer

目的评价CT导向下125I粒子植入治疗胰腺癌的临床价值。方法回顾性分析2003年6月至2004年5月中山大学肿瘤防治中心26例经CT导向下125I粒子植入治疗胰腺癌患者的临床资料,重点总结此手术的经验和技巧。本组26例中,男21例,女5例,年龄47~73岁。中位年龄为60岁±13岁。病灶平均直径为6·1(1·0~8·5)cm。其中腹痛较剧者15例,黄疸10例。全部病例经CT、MRI检查(14例)或病理穿刺活检(12例)后临床诊断为胰腺癌。病理分期(TNM,pTNM)Ⅱ期3例,Ⅲ期20例,Ⅳ期3例。采用计算机立体定位计划系统(treatment plan system,TPS)计算布源,在CT导向下将125I粒子植入胰腺瘤灶内,采用(2·2~3·3)×107Mq活度的125I粒子相隔1·0~1·5cm平面播植。125I在1·7cm内具有杀灭肿瘤的作用。结果9例患者疼痛完全缓解,2例部分缓解,4例无效,平均术后3~7d疼痛缓解。4例死于局部进展,2例死于远处转移,全组中位生存时间11个月。2个月后CT复查,完全缓解(CR)2例;部分缓解(PR)13例;无变化(NC)5例;进展(PD)6例。总有效率(CR+PR)57·7%。2个月随访过程中发现3粒粒子(2例患者)迁徙至肝脏内;白细胞轻度下降1例。未见胰瘘、胰腺炎、肠出血、腹腔内脓肿等严重并发症。结论CT导向下放射性粒子植入治疗胰腺癌创伤小,并发症发生率低,生活质量改善明显,近期效果好,具有很好的姑息止痛疗效,是一种治疗中晚期胰腺癌的简单、安全、有效的方法。

Objective To investigate the clinical value of CT guided radioactive seed ^125I implantation in treatment of pancreatic cancer. Methods Twenty-six patients with pancreatic cancer 6. 1 cm in size on average, 21 males and 5 females, aged 60 ± 13 （47 -73）, underwent CT guided radioactive seed ^125I implantation. Of the 26 patients 15 had the symptom of severer abdominal pain and 10 had jaundice. Three of them were in the TNM （pTNM） stage Ⅱ , 30 in the stage Ⅲ, and 3 in the stage Ⅳ. Treatment plan system was used to design the distribution of the seed ^125I needed. Under CT guidance, the ^125I seeds of （2.2 -3.3） Mq were implanted into the pancreatic cancer at a distance of 1.0 - 1.5 cm. A follow-up for 3 - 12 months was conducted. Results Complete relief （CR） of the symptoms was seen in 9 patients, partial relief （PR） in 2 patients, and no change （NC） in 4 cases with an effective rate of 73.4%. The abdominal pain was relieved 3 - 7 days after the implantation. CT performed 2 months after implantation showed CR in 2 cases, PR in 13 cases, NC in 5 cases, and progression in 5 cases with an overall effective rate of 57.7%. Four patients died of local progression and 2 patients died of distant metastasis. Migration of the seeds into the liver was seen in 3 patients and slight decrease of white blood cells was seen in 1 patient during the 2-month follow-up. No severe complications, such as pancreatic leakage, acute pancreatitis, intestinal hemorrhage, etc, were found. Conclusion Safe and with minimal damage and few complications, CT guided radioactive seed ^125I implantation is effective in treatment of pancreatic cancer.