手术联合^(125)I粒子永久性植入治疗肝癌的临床研究

Operation combined with ^(125)I radioactive seeds implantation therapy on liver cancer

目的:评价术中联合放射性125I粒子植入治疗原发性及继发性肝癌的安全性、疗效及剂量。方法:48例术前评估有手术指征的肝癌患者用计算机三维治疗计划系统术前或术中制定治疗计划,术中依据所制定的剂量,应用瘤体内植入或平面插植技术将125I粒子永久性植入,平均每例26粒,肿瘤匹配周边剂量为90-120Gy,术后验证和质量评估;观察治疗前后病人血象、免疫指标、临床症状、脏器功能(ALT、AST)、肿瘤标记物(AFP、CEA)、肿瘤影像学(CT)等的变化。结果:中位随访期23个月,瘤体积≤20cc者治疗有效率75.6%,瘤体积21-64cc者有效率69.6%,1、2、3年生存率分别为72.9%、47.9%、25.0%;术前、术后1周及术后3个月血象虽有显著差异,但均在正常范围,免疫指标前后变化无统计学意义;治疗后病人临床症状缓解率为93.2%(41/44),ALT、AST由异常降至正常水平者占80.0%(32/40),AFP、CEA降低超过原数值50%者占75.0%(15/20)、73.1%(19/26);无相关死亡,无放射相关严重并发症;术后验证和质量评估满意。结论:术中联合放射性125I粒子植入治疗原发性及继发性肝癌疗效显著、方法简便、使用安全,采用粒子活度0.5-0.8mCi、肿瘤匹配周边剂量90-120Gy合理可行。

Objective：To evaluate the effect and dosimetry of operation combined with ^125I brachytherapy in primary and metastatic liver cancer. Methords： Between 2002 and 2006,48 patients with unresectable or residual disease after surgical resection for intrahepatie malignancies underwent 90 - 120Gy permanent ^125I braehytherapy. Before and after treatment, differences of hemogram, immunity index, clinical symptom, ALT, AST, AFP, CEA and CT were compared. Results： The median length of follow -up was 23 months. The 1 -year,2 -year, and 3 -year overall survival rates were 72.9% ,47.9% and 25% , respectively. Before and after treatment, hemogram had significant difference, but all were normal. Immunity index had not changed. After treatment clinical symptom remission rate was 93.2% （41/44）. ALT and AST were reduced to normal level in 80% of patients （32/40）. AFP and CEA decreased more than 50 % of originally numerical value,which was occurred in 75% of patients （15/20） and 73.1% of patients （19/26） respectively. The effective rate was 75.6% for tumor volume ≤20cc and 69.6% for tumor volume 21 - 64cc. No death occurred. Radiation - related complications were minimal. The quality evaluation was good after implantation. Conclusion： Treatment of primary and metastatic liver cancer by operation combined with permanent implantation ^125I seeds is simple, safe and effective. With single activity 0.5 -0.8mCi, the matched peripheral dose （MPD） on 90 -120Gy is reasonable and feasible.