放射性粒子置入近距离照射治疗脊柱肿瘤

Radioactive seeds implantation brachytherapy in the treatment of spinal tumors

目的:探讨放射性粒子置入近距离照射治疗脊柱肿瘤的方法和初步结果。方法:2002年10月～2004年5月对收治的13例脊柱肿瘤患者在CT监测下经皮穿刺活检明确病理诊断,确定肿瘤对放疗敏感后应用125I粒子置入近距离照射治疗。依术前的计算机模拟计算结果确定粒子置入的数量和三维间隔,2例术中在C型臂X线机监视下于残存肿瘤内置入粒子;11例于CT监测下经皮穿刺在肿瘤病灶内置入粒子。随访观察治疗效果。结果:术中无并发症发生。平均随访25个月。术后4～11d起效,疼痛缓解9例(VAS评分<20mm),减轻4例(VAS评分20～40mm),疗效持续3～19个月。3例肿瘤生长得到抑制。2例分别于术后3个月、9个月死于肝脏衰竭,1例于术后6个月死于肺转移,1例术后16个月死于多器官衰竭,其他9例患者末次随访时仍存活。随访中无放射性脊髓神经病发生。结论:对于不宜采用手术治疗或术中无法全切而又对放疗敏感的脊柱肿瘤患者采用瘤体内置入放射性粒子近距离照射治疗可以延缓肿瘤生长、缓解疼痛,保持生活质量、减少手术治疗并发症;是治疗晚期脊柱肿瘤的一种新方法。

Objective：To evaluate the method and its preliminary results of radioactive seeds implantation brachytherapy on spinal tumors.Method：Thirteen cases with spinal tumors which obtained definite diagnoses by CT-guided biopsy and were sensitive to radiotherapy underwent ^125I seeds implantation from October 2002 to May 2004.The numbers and distribution of the implanted seeds were calculated by the computer system before operation.Two cases underwent the implantation during operation by the guidance of C-arm fluoroscopy and the other 11 cases by the guidance of CT.Result：The effects were observed 4-11 days after the implantation.9 cases had complete pain relief（VAS scores 〈20mm）,4 cases had partial pain relief（VAS scores were between 20-40mm）,The curative effect lasted 3-19 months.The time of follow-up averaged 25 months.The tumor growth was restrained in 3 cases.Two cases died of hepatic failure at 3st and 9st months respectively after implantation.One case died of lung metastasis 6 months later.One case died of multiple organs failure （MOF） 16 months later,The other 9 cases were alive at the final follow-up.No complications occurred during the implantation,and no radioactive myelopathy were observed during the course of follow-up.Conclusion：Radioactive seeds brachytherapy for the treatment of the spinal tumors is a good alternative for patients who are not suitable for operation while sensitive to radiotherapy,It can restrain the growth of tumor,relieve pain,improve life quality and reduce complications.It is a new method for treating terminal spinal tumors.