^(125)I放射粒子植入治疗晚期胰腺癌和放射粒子对正常胰腺组织损伤的实验研究

^(125)I implantation for unresectable pancreatic carcinoma and empirical study of normal pancreatic tissue radiation damage

目的探讨125I放射粒子植入术治疗浸润性胰腺癌的临床疗效、影响因素和正常胰腺组织放射损伤处理。方法对不能手术切除的浸润性胰腺癌27例,根据治疗计划实施125I放射粒子植入术,比较分析了术后肿瘤局部控制率、生存率、临床受益反应及其影响因素;24只家兔随机分为A、B两组,正常胰腺、肠系膜血管边缘植入125I放射粒子,植入后第40天及第80天分别处死,取粒子植入处直径1cm范围内胰腺组织和部分肠系膜血管,HE染色评定胰腺组织及肠系膜血管慢性放射性损伤情况。结果⑴本组病例中,CR2例(8%);PR8例(32%):SD12例(48%);PD3例(12%);有效率40%;疼痛缓解率为92%。本组病例术后6个月,12个月及18个月生存率分别为81%、29%和7%,术后中位生存时间为11.2个月。肿瘤体积大、植入粒子总活度高、术后未追加局部放疗显示术后生存率降低。本组2例(7.4%)发生术后胰腺炎,其中1例出现胰腺假性囊肿。⑵家兔胰腺慢性放射损伤呈逐渐恢复趋势。血管内膜上皮细胞的损伤性改变出现较晚,肌层变性及肌紊乱有明显修复。结论125I放射粒子植入术是治疗浸润性胰腺癌的一种有效、安全、并发症较少的姑息治疗方法,其胰腺并发症能够预防。

Objective To evaluate the surgical technique and the outcome of ^125I interstitial implantation for pancreatic carcinoma and the treatment for normal pancreatic tissue radiation damage. Methods Twenty-seven patients with biopsy proven unresectable adenocarcinoma of pancreas were treated with ^125I implants during laparotomy. The survival rate, effective rate and relative factors of patients after treatment were compared and studied; 24 rabbits were divided into groups A ＆ B. Normal pancreatic tissue and margins of mesenteric blood vessel were implanted with ^125I seeds. The animals were sacrificed after 40 and 80 days respectively. HE staining was used to evaluate the chronic radiation injury to pancreas and blood vessel. Results （1）The effective rate of ^125I brachytherapy showed that there were 2 CR cases （8%）; 8 PR cases （32%）; 12 SD cases （48%） and 3 PD cases （12%） with pain relief in 92%. The 6, 12 and 18-month actuarial overall survival rates were 81%, 29% and 7% respectively. The median survival time was 11.2 months. Overall survival was better for patients with smaller volume implants, a lower total activity implanted and postoperative radiation therapy. Pancreatitis occurred in 2 cases （7.4%）; （2）The chronic radiation injury to rabbit pancreas showed a gradual repairing tendency. The impairment of endothelial cell appeared later and the denaturation of muscular layer was obviously restored. Conclusions ^125I radioactive seed implantation was safe. A high local control, minimal damage and satisfactory pain palliation could be achieved without significant complications for malignant pancreatic tumor.