CT导引下植入^(125)I粒子治疗19例晚期胰腺癌的疗效观察

CT-guided radioactive ^(125)I-seed implantation for the treatment of pancreatic carcinoma:a clinical observation of 19 cases

目的探讨CT引导下125I放射性粒子植入治疗晚期胰腺癌前后血清肿瘤标志物的动态变化和疗效。方法对19例手术不能切除的晚期胰腺癌施行CT引导下经皮植入125I放射性粒子。采用治疗计划系统(TPS)重建胰腺肿瘤的三维立体图像,计算出125I粒子植入的数量和剂量分布率,在CT引导下将125I粒子植入胰腺肿瘤内。并用放射免疫方法测定125I放射性粒子植入治疗胰腺癌前后的血清肿瘤标志物CEA、CA19-9、CA50的浓度。结果治疗后平均2～5d疼痛开始缓解。治疗后1个月CT随访,总有效13例,有效率68.4%;术后3个月CT随访,总有效率为63.2%(12例)。125I粒子植入1个月后,胰腺癌患者血清中CEA、CA19-9、CA50等肿瘤标志物水平与植入前比较明显降低(P<0.05)。在CA19-9检测中,植入前、CR、PR、SD、PD各组间差别有统计学意义(H=15.349,P<0.05)。结论 CT引导下植入125I放射性粒子治疗胰腺癌,临床近期疗效确切,具有很好的姑息止痛疗效,是一种安全、有效、并发症少的介入治疗方法 ;且能有效降低多项肿瘤标志物水平,肿瘤标志物水平对临床疗效有一定的提示作用。

Objective To explore the dynamic changes of serum tumor markers after CT-guided radioactive ^125I-seed implantation treatment in patients with pancreatic carcinoma and to assess the therapeutic effectiveness of ^125I-seed implantation.Methods CT-guided radioactive ^125I-seed implantation was performed in 19 patients with unresectable advanced pancreatic cancer.Treatment planning system was used to reconstruct 3-dimentional images of the tumor,and the quantity and distribution of ^125I-seeds to be implanted were thus determined.Under CT guidance ^125I-seeds were embedded into pancreatic cancer.Before and after the ^125I-seed implantation the levels of serum tumor markers,including CEA,CA19-9 and CA50,were determined by using radioimmunoassay method.The clinical effects were observed and the therapeutic results were statistically analyzed.Results The pain stared to be relieved 2 to 5 days after implantation.The total effective rate（CR ＋ PR） at one and three months after treatment was 68.42%（13 /19） and 63.16%（12 /19） respectively.One month after ^125I-seed implantation,the levels of serum CEA,CA19-9 and CA50 were significantly different to that determined before implantation in all cases（P〈0.05）.For the determination of CA19-9,the difference in CR,PR,SD and PD was statistically significant（H = 15.349,P〈0.05）.Conclusion CT-guided ^125I-seed implantation is a safe and effective interventional treatment for advanced pancreatic cancer with reliable short-term result and remarkable pain-relieving effect.Moreover,this therapy can significantly lower the levels of many serum tumor markers,which play some suggestive roles in evaluating the clinical curativeness.