CT引导下植入^(125)I放射性粒子治疗胰腺癌的临床应用

Clinical Efficacy of CT-guided Iodine-125 Seed Implantation Therapy in Patients with Advanced Pancreatic Cancer

目的探讨CT引导下125I放射性粒子植入治疗胰腺癌的临床疗效。资料与方法对31例手术不能切除的晚期胰腺癌患者行CT引导下植入125I放射性粒子治疗。采用放射性粒子治疗计划系统(TPS)重组胰腺肿瘤的三维立体图像,计算出125I粒子植入的数量和剂量分布率,在CT引导下将125I粒子植入胰腺肿瘤内,采用125I粒子活度为0.5～0.8mCi/颗,相隔1.0～1.5cm植入,避开血管和胰管及周围重要脏器。10例同时行吉西他滨和5-氟尿嘧啶(5-Fu)动脉灌注治疗,3～4周期。结果31例的肿瘤平均直径为5.8cm。治疗后随访2～25个月,术后患者顽固性疼痛症状明显缓解(P<0.05),Karnofsky评分显著提高(P<0.05)。平均术后2～5d疼痛开始缓解。术后2个月CT随访,肿瘤完全缓解(CR)3例,部分缓解(PR)16例,无变化(NC)9例,进展(PD)3例,总有效率(CR+PR)为61.3%。全组中位生存时间为10.31个月。Ⅱ、Ⅲ及Ⅳ期粒子植入术后中位生存期分别为14、11及6个月;6个月和12个月累计生存率分别为89%、70%、58%和44%、30%、0%。10例术后行吉西他滨和5-Fu动脉灌注治疗3～4周期,其中3例合并肝转移患者,则同时行化疗栓塞术。2例术后随访发现2颗粒子迁移至肝脏。在随访过程中未见上消化道出血、胰腺炎、胰瘘及放射性肠炎等并发症。结论CT引导下植入125I放射性粒子治疗胰腺癌,近期疗效确切,具有很好的姑息止痛疗效,是一种安全、有效、并发症少的微创治疗方法,远期疗效尚待进一步随访和观察。

Objective The purpose of this study was to examine the clinical efficacy of CT-guided radioactive iodine- 125 （I-125） seeds implantation treatment in patients with unresectable pancreatic cancer. Materials and Methods 31 patients with unreseetable pancreatic cancer were enrolled in this study. Treatment Planning System （TPS） was used to reconstruct 3 Dimensional image of pancreatic tumor and to define the quantity and distribution of 1-125 seeds. Iodine 125 seeds with the activities ranged from 0.5 to 0.8 mCi/seed were implanted into pancreatic tumor under CT guidance. During the procedure, vessels, pancreatic tube and other nearby organs should be avoided hurted with 1 to 1.5 cm space of each seed.. In addition, 10 patients received concurrent chemotherapy with arterial infusion of gemcitabin and 5-fluororacil （5- Fu） , 3 to 4 cycles in total. Results of the 31 patients involved in this study, 18 were male, 13 were female, and age ranged from 40 to 89 with 65.5 on average. Median diameter of the tumors was 5.8 cm. Follow-up period was 2 to 25 months. Symptoms of refractory pain were significantly resolved post interventionally （P 〈 0.05） , and Karnofsky score increased dramatically （ P 〈 0.05 ）. The pain relieved at average 2 to 5 days after implantation. Tumor response which was demonstrated on follow up CT images 2 months after treatment revealed completed relief （CR） in 3 cases, partial relief （PR） in 16 cases, no change （NC） in 9 cases and progression （PD） in 3 cases. Overall responding rate （CR ＋PR） for patients turned out to be 61.3%. Median survival time for all patients was 10.31 months, while for stage II, stage III, and stage IV were 14 months, 11 months and 6 months respectively. The 6 -month and 12 -month cumulative survival rates ofstage subgroups were 89%, 70% , 58% and 44% , 30% , 0% . After implantation, 10 patients received 3 to 4 cycles con- current chemotherapy with arterial infusion of gemcitabin and 5-fluororacil （5-Fu）. Among them, 3 cases with liver metas- tasis were combined with embolic chemotherapy perfusion. 2 seeds of radioactive 1-125 found to migrate to liver in 2 pa- tients. There were no serious complications such as upper GI bleeding, pancreatitis, pancreatic fistula formation and radia- tion colitis detected during follow up. Conclusion This study suggested that CT guided brachytherapy using 1-125 seeds implantation is a safe, effective and less complicated method. 1-125 seeds implantation can produce adequate pain relief for treating unresectable pancreatic cancer. However, this result requires further validation to determine its long term efficacy.