CT引导下植入125I放射性粒子治疗胰腺癌的疗效观察

CT-guided Iodine-125 Seed Implantation for the Treatment of 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。方法：2004年12月至2007年10月对21例手术不能切除的晚期胰腺癌作了CT引导下植入^125I放射性粒子治疗。采用TPS（Treatment Planning System）重建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O．5—0．8mCi／颗，相隔1．0～1．5cm植入，避开血管和胰管等周围重要脏器。结果：2004年12月至2007年10月全组21例中，男13例，女8例，年龄40～89岁，中位年龄67岁。肿瘤平均直径为5．9cm。治疗后随访2～25个月，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）2例，部分缓解（PR）12例，无变化（NC）5例，进展（PD）2例。总有效率（CR＋PR）为61．9％。全组中位生存期为8．7个月，3个月、6个月、12个月累计生存率分别为100％、71．4％、28．6％；其中Ⅱ＋Ⅲ期粒子植入术后中位生存期为11个月，6个月、12个月累计生存率分别为91％、55％；IV期粒子植入术后中位生存期为6个月，6、12个月生存率分别为50％、0。12例患者CA19-9升高，术后1～3个月复查CA19—9降低8例，其中6例CA19—9水平下降超过50％。1例患者术后随访发现2颗粒子迁移到肝脏内。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严重并发症。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，能改善患者的生活质量，是一种安全、有效、并发症少的微创治疗方法。

Objective： To assess the clinical efficacy of CT-guided radioactive iodine-125 seed implantation in treating pancreatic cancer. Methods： CT-guided radioactive 1-125 seed implantation was applied in 21 patients with end-stage unresectable pancreatic cancer. Treatment Planning System was used to reconstruct a 3-dimensional image of the tumor and to define the quantity and distribution of 1-125 seeds. Iodine-125 seeds （0.5-0.8 mCi/seed） were introduced into pancreatic tumors under CT guidance, 1 to 1.5 cm apart, avoiding puncturing vessels, pancreatic tubes or adjacent structures. Results： Of the 21 patients involved, there were 13 males and 8 females. Patient age ranged from 40 to 89 years, with an average of 67. The median diameter of the tumors was 5.9 cm. Post-treatment follow up duration was 2 to 25 months. Patients reported pain relief at 2 to 5 days after implantation. Repeated computed tomography performed 2 months later revealed complete relief （CR） in 2 cases, partial relief （PR） in 12 cases, no changes （NC） in 2 cases and progression （PD） in 5 cases. The overall effective rate （CR＋PR） was 61.9%. Median survival time was 8.7 months for all patients, 11 months for patients of stage Ⅱ and Ⅲ, and 6 months for patients of stage Ⅳ. The cumulative survival rates at 3, 6 and 12 months were 100%, 71.4% and 28.6%, respectively. The 6- cumulative survival rates for stage Ⅱ ＋Ⅲ and stage Ⅳ patients were 91% and 55%, respectively; the 12-month cumulative survival rates were 50% and 0%, respectively. Of the 12 patients with elevated Ca-199 at baseline, 8 cases had lowered Ca-199 levels after intervention, and 6 of them had levels decreased to less than 50% of the original. Two seeds of 1-125 migrated to the liver in 1 patient. There were no serious complications such as GI bleeding, pancreatitis, pancreatic fistula formation or radiation colitis during follow-up. Conclusion： CT-guided 1-125 seed implantation is a safe, effective and less complicated treatment option for advanced pancreatic cancer, achieving pain relief and improvements in short-term quality of life.