经皮瘤内注射平阳霉素碘油化疗乳剂治疗复发性骶尾部脊索瘤

Percutaneous intratumoral injection with pingyangmycin lipiodol emulsion for treatment of recurrent sacrococcygeal chordomas

目的评估经皮穿刺瘤内注射平阳霉素碘油乳剂对手术切除后复发性骶尾部脊索瘤的疗效。方法回顾性分析2006年10月～2008年12月收治的复发性骶尾部脊索瘤患者7例,所有患者均在透视引导下行经皮穿刺瘤内注入平阳霉素碘化油乳剂治疗。患者在末次治疗后每隔3个月随访1次,进行临床评价。记录患者首次入院、末次出院及随访期间视觉模拟疼痛评分,判断肿瘤坏死及疼痛缓解程度。结果 7例患者共计行经皮瘤内注入平阳霉素碘油乳剂22次(每位患者3～4次),注射平阳霉素碘化油乳剂平均用量:平阳霉素48.0mg(每次10～20mg),超液化碘油40ml(每次6～20ml)。5例患者在治疗后48h出现低热和呕吐。所有患者末次术后1月视觉模拟疼痛评分明显降低;平均随访21.7月(10～26月),6例患者完全缓解(PR);1例患者部分缓解(SD),7例患者均未出现并发症。结论经皮穿刺瘤内注入平阳霉素碘化油乳剂能有效控制复发骶骨脊索瘤生长,减轻患者疼痛,可作为复发性骶尾骨脊索瘤治疗的有效方法。

Objective：To evaluate the effectiveness and safety of fluoroscopy-guided percutaneous intratumor injection of pingyangmycin lipiodol emulsion（PLE） in the management of recurrent sacrococcygeal chordomas.Methods Seven patients with recurrent sacrococcygeal chordomas presenting with severe local pain with visual analogue score（VAS） ？？ received treatment sessions of fluoroscopy-guided percutaneous intratumor injection of PLE.The patients were followed up every 3 months afterthe last session to assess theirclinical responses and observe the changes in the tumorsize measured by computed tomography.The changes in the VAS,tumor necrosis and pain relief as well as the adverse events were recorded.Results A total of 22 sessions of fluoroscopy-guided percutaneous intratumoral PLE injection was performed in these cases（3 or 4 sessions in each case）.The total average pingyangmycin dose delivered was 48.0 mg and the average lipiodol dose was 40.0 ml in each case.Five patients showed low feverand vomiting 48 afterthe injection.During the follow-up（median time of 21.7 months,range 10-26 months）,all the patients showed obviously reduced tumor size and VAS,and partial remission was achieved in 6 patients and stable disease（SD） in 1 patient.None of the patients had complications during the follow-up.Conclsuion Fluoroscopy-guided percutaneous intratumoral injection of PLE can be effective and safe and may serve as a alternative fortreatment of recurrent sacrococcygeal chordomas