^125Ⅰ粒子置入辅助治疗原发性肝癌肝外转移的疗效评价

Efficacy of ^125Ⅰ seed implantation as an adjunctive therapy for extrahepatic metastasis of primary hepatacellular carcinoma

目的了解^125Ⅰ粒子置入在原发性肝癌合并肝外转移治疗中的效果。方法回顾性分析26例原发性肝癌合并肝外转移患者的临床资料。26例患者肝内病灶31个。肝外肺转移14例，32个病灶；骨转移6例，8个病灶；肝门区及腹膜后淋巴结转移6例，8个病灶。采用经动脉化疗栓塞（TACE）联合射频消融（RFA）或经皮无水乙醇注射（PEI）治疗肝脏病灶，CT引导下^125Ⅰ粒子置入治疗肝外转移病灶。肝内病灶治疗结束后1个月增强CT扫描复查，肝外转移病灶治疗结束后3个月增强CT扫描复查，根据影像检查结果评估疗效。患者首次治疗后半年内每1个月复查1次，包括胸、腹部或病变部位CT，X线胸片检查；半年后电话追踪随访患者生存状况，每3个月随访1次，直至失访，评价患者近期平均生存期。结果肝外病变完全缓解16例，部分缓解3例，稳定4例，进展3例。肝脏病灶完全缓解11例，部分缓解4例，稳定6例，进展5例。26例患者随访期内均存活，随访时间7．0—24．0个月，中位生存期14．5个月。结论^125Ⅰ粒子置入辅助治疗原发性肝癌合并肝外转移灶，可明显改善患者生活质量，有助于延长生存时间，是一种有效的辅助治疗手段。

Objective To evaluate the efficacy of ^125Ⅰ seed implantation for extra-hepatic metastasis of primary hepatocellular carcinoma （HCC） treatment. Methods The clinical records of 26 patients with primary HCC and extrahepatic metastasis were reviewed. Twenty six patients had 31 primary hepatic lesions, 14 patients had 32 lung metastasis, 6 had 8 bone metastasis and 6 had 8 hepatohilar or retroperitoneal lymphatic metastasis. The hepatic lesions were treated by combination of transcatheter arterial chemoembolizatiou（TACE） and radiofrequency ablation（RFA） or percutaneous ethanol injection （PEI） and were followed up by contrast-enhanced CT （CECT） after 1 month. The extra-hepatic lesions were treated by ^125Ⅰ seeds implantation and were followed up by CECT 3 months after treatment. The treatments were evaluated by imaging examinations. The patients were followed up every 1 month during the first half year, including CT examinations of chest, abdomen and lesions and chest films. Telephone follow-up were performed every 3 months after the 6th month till they were lost and the survival time were calculated. Results Of the extra-hepatic lesions, 16 cases were complete response （CR）, 3 cases were partial response （PR）, 4 cases were stable disease （SD） and 3 were progressive diseases （PD）. Of the hepatic lesions, 11 were CR, 4 were PR, 6 were SD and 5 PD. The 26 patients are survived at the time of end of follow-up （7. 0 to 24. 0 months）. The median survival duration was 14. 5 months. Conclusions ^125Ⅰ seed implantation integrated interventional and minimally invasive therapy could improve the life and survival and it is an effective adjunctive therapy for primary hepatocellular carcinoma with metastasis outside the liver.