^(125)I粒子术中植入治疗胶质母细胞瘤

Implantation of ～(125)I Seeds During Operation Improve Glioblastoma Therapeutic Effect

目的:观察放射性粒子组织间近距离照射对颅内胶质母细胞瘤的治疗效果。方法:选择125I放射性粒子采用术中植入的方法,首先在手术显微镜下尽可能全切肿瘤,随后在肿瘤残腔表面植入125I,术后常规给予外放射治疗,观察患者无进展生存时间(TTP)和总生存时间(OS),并对比同期单纯手术、外放疗胶质母细胞瘤患者的治疗效果,观察其统计学表现。结果:共观察19例初次发病的患者,平均年龄51.2岁,植入粒子8～20枚;术后肿瘤残腔周边的平均治疗剂量为31.6Gy,外照射剂量42～54Gy;粒子植入组平均TTP为42.1±2.4w(95%可信区间为37.2～46.5w),非粒子植入组为27.1±2.7w(95%可信区间为24.3～31.8w);粒子植入组平均OS为66.3±3.2w(95%可信区间为61.9～70.4w),非粒子植入组为47.7±2.6w(95%可信区间为44.4～50.5w),统计学分析显示明显差异。结论:通过粒子植入的方法能够明显延长胶质母细胞瘤患者的生存时间,术中植入的方法能够迅速减少肿瘤体积,并减少粒子的植入总数,避免过量照射,但本研究观察样本少,术中植入在肉眼下进行,不能保证粒子准确排列,与外放射治疗的结合仍需要进一步摸索总结。

Objective： To evaluate the therapeutic efficacy of radioactive seeds on gliohlastoma through interstitial irradiation. Methods： Nineteen patients with average age at 51.2 year old and diagnosed with glioblastoma for the first time participated in this study. All patients underwent microsurgical operation to remove the tumor as complete as possible followed by routine post-operative radiotherapy with close range at 42-54Gy. Among 19 patients, some were selected and received a total 8 to 20 radioactive ^125I seeds at mean dose 31.6Gy implantation on the tumor bed apart from each other during the operation. The time of progression free survival （TTP） and overall survival （OS） of patients received surgery and post-operative radiotherapy comparing with the patients received additional ^125I implantation during surgery was statistically analyzed. Results： The average TFP of patients with seeds implantation was 42.1±2.4w （95%confidence interval was 37.2～46.5w） in contrast with 27.1±2.7w （95%confidence interval was 24.3～31.8w） in control group. The average OS was 66.3±3.2w （95%confidence interval was 61.9～70.4w） for patients with implantation and 47.7±2.6w （95% confidence interval was 44.4～50.5w） for patients without implantation. These data were stalistically significant. Conclusion： ^125I implantation during operation could rapidly reduce the tumor volume, limiting dose of radioactive seeding and exposure, so it provide more efficient therapeutic outcome and prolonged survival time. Because of small number of samples involved in this study, and inaccuracy during implantation which was performed under naked eyes, our data need to be further confirmed and evaluated.