CT引导下^(125)I籽源植入近距离放射治疗多发性椎体转移癌

CT-guided permanent ^(125)I seed brachytherapy for vertebral metastatic cancer

目的探讨^(125)I籽源植入近距离放射治疗多发性椎体转移患者的价值。方法15例癌症多发椎体转移患者(共43个椎体)进行了CT引导下^(125)I籽源植入近距离放射治疗。肺癌术后椎体转移7例,乳腺癌术后椎体转移4例,肝癌术后椎体转移2例,前列腺癌术后椎体转移1例,左肾癌术后椎体转移1例。共43个椎体转移,每例椎体转移数为2～5个。在CT引导下按共轴针法投放籽源,视病变情况采取椎弓根入路、侧方入路、前入路等3种方式将^(125)I籽源植入椎体病变区,籽源呈倒V形、X形或平行分布,籽源距椎体后缘3～10mm。^(125)I籽源总活度由公式(长+宽+高)(cm)/3×5mCi计算或"放射性粒子源植入治疗计划系统"计算获得,单椎体植入剂量8～22mCi。椎旁软组织病变内同时植入^(125)I籽源。结果术后随访3～30个月,平均12.3个月,15例患者术后均未出现脊髓、神经损伤等并发症,未出现放射相关不良反应。11个没有疼痛的部位未出现新的疼痛,18/32部位症状体征消失,14/32部位部分消失。最短术后第3天觉得症状已有缓解。影像表现,10例患者29个椎体影像回访,治疗3个月以后7例17个椎体CT可见病灶稳定,边缘形成硬化环。4个椎体病变进展,见硬化环不完整,破坏区有扩大。3例8个椎体MRI显示骨水肿明显减轻,病变区T_2WI信号减低。结论^(125)I籽源植入近距离放射治疗多发性椎体转移癌具有疗效高,创伤小,并发症发生率低等优点,是一种较好的微创治疗方法,不仅适合于未经治疗的患者,也适合于放射治疗后复发的患者,具有较高的耐受性和安全性。

Objective To evaluate the functional outcome, predicting response and toxicity of CT- guided permanent implanted ^125I seed branchytherapy for metastatic cancers in vertebrae. Methods Forty three vertebrae with metastatic cancer were treated by CT-guided percutaneous permanent implanted ^125I seed branchytherapy in 15 patients. There were 8 male and 7 female patients with average age of 54.6 years and 2 to 5 vertebrae involved in this group. According to the size of tumor, the optimal activity and quantity of seeds were calculated by TPS and correlative formula, ^125I seeds were implanted percutaneous puncture under CT- guidance with coaxial needles to pass the normal osseous tissue for approaching the lesions including 3 routes of pedicular lateral and anterior ways. The distance between seeds and posterior border of vertebral body was over 3 mm （3 - 10 mm）. Permanent ^125I seed implantation brachytherapy for paraspinal metastatic lesions were also taken place. Results Mean follow-up time was 12.3 months （range 3 - 30 months）and outcome was evaluated clinically and radiographically in 10 of 15 procedures, with 5 only on clinical data. No new pain occurred at 11 sites with no previous complaint. The pain was completely controlled at 18/32 sites, partial control at 14/32 sites. No complications correlated to the radiotherapy damage of nerve and spinal cord were found. Conclusion The procedure of CT-guided permanent implanted ^125I seeds brachytherapy for vertebral metastatic cancers is a safe effective and minimal invasive method with few complications. It is beneficial not only for pretherapeutic metastasis but also for recurrent tumors after radiotherapy; bearing rather high tolerance and safety.