CT引导下^(125)I粒子植入治疗复发性直肠癌的临床应用

Clinical application of CT-guided ^(125)I seed interstitial implantation for recurrent rectum carcinoma

目的观察CT引导下125I粒子植入治疗复发性直肠癌的安全性和临床疗效。方法对20例直肠癌术后复发患者,在CT引导下植入125I粒子治疗。术前采用治疗计划系统(TPS)重建肿瘤三维立体图像,计算出125I粒子植入的粒子数目、空间分布和剂量率分布。125I粒子的肿瘤匹配周边剂量(MPD)为80～130 Gy。粒子活度0.5～0.8 mCi/颗,中位植入粒子48颗(25～95颗)。术后即刻行CT扫描进行粒子质量验证。观察全组患者疼痛缓解程度、肿瘤疗效评估和术后并发症。结果治疗后随访2～28个月,平均术后3～7 d疼痛明显缓解。术后2个月CT随访,肿瘤完全缓解(CR)2例,部分缓解(PR)13例,无变化(NC)3例,进展(PD)2例,CR+PR为75%。全组中位生存期18.8个月。1、2年生存率分别为75%、25%。2例死于肿瘤恶化,3例死于全身广泛转移。全组患者随访期间未见尿频、尿痛、血尿、直肠出血、感染等并发症。结论CT引导下植入125I粒子治疗复发性直肠癌,近期疗效确切,具有较好的姑息止痛疗效,是一种安全、有效、并发症少的介入治疗方法。

Objective to explore the safety and clinical efficacy of CT-guided radioactive seed implantation in treating recurrent rectum carcinoma. Methods CT-guided ^125I radioactive seed implantation was carried out in 20 patients with recurrent rectal carcinoma. Treatment planning system was used preoperatively to reconstruct three dimensional image of the tumor and to calculate the estimated seed number and distribution. The tumor matched peripheral dose （MPD） of the radioactive seeds was 80 - 130 Gy. The radioactivity of the seeds was 0.5 - 0.8 mCi/seed and the median implanted seeds was 48 （range 25 - 95） in number. CT scan was made immediately after the implantation to check the quality of the seeds. Change of pain score, tumor size and complications were recorded during the follow-up period. Results Twenty cases composed of 12 males and 8 females, aged 38 to 78 years （median age of 62 years）. The follow-up period lasted 2 - 28 months. On an average, 3 to 7 days after the procedure patients experienced significant pain relief. CT scan performed 2 months after the procedure revealed that complete relief （CR） of the tumor was seen in 2 cases, partial relief （PR） in 13 cases, no change （NC） in 3 cases and progression （PD） in 2 cases. The total effective rate （CR ＋ PR） was 75%. The median survival time was 18.8 months. The survival rate of 1 and 2 years was 75% and 25% respectively. Two cases died of tumor deterioration and 3 cases died of extensive metastases. No complications such as frequent micturation, pain on urination and hematufia occurred during the follow-up period. Conclusion CT-guided ^125I radioactive seed implantation is a safe and effective interventional treatment for recurrent rectal carcinoma with reliable short-term efficacy and excellent anti-pain effect.