CT导向下^(125)I粒子植入治疗纵隔区残留或复发转移淋巴结

Efficacy of CT-guided Radioactive Seed ^(125)I Implantation on Residual or Relapsing Metastatic Lymph Node of Mediastinum after Multi-modality Treatment

【目的】纵隔转移淋巴结治疗比较困难。本研究评价CT导向下125I粒子植入治疗晚期肿瘤纵隔转移淋巴结临床价值。【方法】回顾分析2003年11月至2008年4月间,中山大学肿瘤防治中心收治的15例经病理确诊为恶性肿瘤的患者,接受CT导向下125I粒子植入治疗纵隔淋巴结的临床资料。转移淋巴结共计16个,直径1.0～4.0cm;其中直径<2cm8个(50%),2～3cm6个(37.5%),>3,≤4cm2个(12.5%)。采用计算机立体定位计划系统计算布源,在CT导向下将(2.2～3.3)×107Mq活度的125I粒子相隔1.0～1.5cm平面播植。手术结束后2～3月复查CT。【结果】治疗前3例有疼痛症状患者中2例于术后5～14d内疼痛缓解,有效率66.7%。15例患者中淋巴结完全缓解(CR)13例(86.7%);部分缓解(PR)2例(13.3%);总有效率100%。并发症为少量出血3例(20%),少量气胸3例(20%)。【结论】CT导向下125I粒子植入治疗纵隔转移淋巴结效果好,安全性高,创伤小,并发症发生率低。

[Objective] Lymph node metastasis of mediastinum is difficult to treat. This study was to investigate the clinical value of CT-guided radioactive seed ^125I implantation in treating metastatic lymph node of interpleural space. [Methods] From November 2003 to April 2007, 15 patients with pathologically confirmed malignant tumors received CT-guided radioactive seeds ^125I implantation to treat a total of 16 metastatic lymph nodes. The diameter of these metastatic lymph nodes ranged from 1.0 to 4.0 cm： 8 （50%） of them with diameter of 〈 2.0 cm, 6（37.5%） with diameter of 2.0 - 3.0 cm, 2 （12.5%） with diameter of 3.1 - 4.0 cm. Treatment planning system was used to design the distribution of seed ^125I. Under CT guidance, ^125I seeds of （2.2-3.3）× 10^7 Mq were implanted into the metastatic lymph nodes at a distance of 1.0- 1.5 cm. CT re-examination was performed at 2 or 3 months after seed ^125I implantation. [ Results ] Three patients had pain caused by metastatic lymph nodes and 2 of them had the pain relieved 5-14 clays after the implantation, with a response rate of 66.7%. Of the 15 patients, 13（86.7%） achieved complete remission （CR）, 2（13.3%） achieved partial remission （PR）, the overall response rate was 100%. The major complication was slight hemorrhage developed in 3 patients （20%）, and small amount of pheumothorax developed in 3 patients （20%）. [ Conclusion] CT-guided radioactive seed ^125I implantation is effective and safety in treating metastatic lymph node, with minimal damage and few complications.