一种经消化内镜植入碘-125粒子进入胃肠腺癌的组织间放疗法

Brachytherapy of gastric and colorectal adenocarcinoma implanting ^125-Iodine seeds into cancer tissue via digestive endoscope

目的 评价一种新的经消化内镜植入低能碘-125粒子进入胃肠癌组织方法的疗效。方法 15例病人，其中贲门癌4例、残胃癌3例及结直肠癌8例。按照UICC胃癌分期的原则，2例Ⅱ期，5例Ⅲa期，Dukes结直肠癌分期为5例B2期、3例A期。首先经内镜下切除胃肠癌的表面部分，然后通过消化内镜活检孔道的植入器将4～15粒／人，碘-125粒子植入到残留的癌组织中。每粒碘．125粒子为0．9mci。术后拍X线片或CT片以便证实粒子的位置及数量。结果 经消化内镜成功地为15名病人植入碘-125粒子到癌组织中。X片或CT片证实粒子的位置恰当。一个半衰期后，内镜可顺利地通过贲门癌的贲门处进入到胃腔内。恶性肿瘤治疗的有效率为73.3％。15例病人的平均生存期为12.2个月（5-23）这些病人未发生出血及穿孔并发症。结论 经过消化内镜可顺利地将碘-125粒子植入到腺癌组织中，是一种新的有效的消化道腺癌组织间放疗法。

Objective To evaluate effect of a new brachytherapy method of low-activity ^125Iodine（^125I） seed implanted into the gastric or colorectal adenocarcinoma tissue via digestive endoscope. Methods 15 male patients including 4 cases with cardiac cancer, 3 cases with stump of stomach-anastoma carcinoma and 8 cases with colorectal carcinoma were treated. Stage and grade of gastric cancer （UICC） were classified as following： 2 lesions in stage Ⅱ, 5 in stage IIIa and 5 of colorectal cancer in Dukes stage B2, 3 patients in stage A At In＇st, the part of gastric cancer or colorectal cancer was resected with endoscopic resection, and then 4-15 seeds of ^125I were implanted into the residal cancer tissue with implantater via the forcep channel of digestive endoscope. A 125I seed is 0.9 millicuries （1 m C i=3.7 ×10^7 Bq）. After the implantation, the patients were took X-ray film or CT scan to observe the location and number of seed. Results The ^125I seed had been successfully implanted into the carcinoma tissue of 15 patients via digestive endoscope. The seed placed in the cancer were proved to located in the proper district by the X-ray or CT. After one T1/2, the endoscope could pass through the cardia into gastric lumen in patients with cardiac cancer. The effective rate was 73.3% for malignant tumor therapy. The average survival timeof 15 patients was 12.2 m （5-23 m）. In these cases, there was no complication such as hemorrhage and perforation, Conclusion The ^125I seed could be implanted smoothly into the denocarcinoma with implantater via digestive endoscope for brachytherapy. This is a new effective brachytherapy for adenocarcinoma of digestive tract.