CT引导下^(125)I粒子植入治疗晚期胰腺癌的临床疗效分析

CT-guided ^(125)I seed implantation for the treatment of advanced pancreatic carcinoma:a clinical therapeutic analysis

目的探讨CT引导下125I粒子组织间植入治疗晚期胰腺癌的疗效。方法回顾性分析2006年6月至2008年6月14例无法手术切除的晚期胰腺癌患者,于术前采用治疗计划系统(TPS)重建胰腺肿瘤的三维立体图像,通过TPS计算出所需粒子数目和总活度,在CT引导下将125I粒子植入胰腺肿瘤体内。采用的粒子活度为每粒0.5～0.8 mCi,粒子间距为0.6～1.0 cm,植入时避开血管、胰管以及肠管尤其是结肠等重要脏器,粒子植入后随访时间为2～18个月。结果 14例患者粒子植入术后3～7 d,疼痛开始缓解,术后2个月CT复查,完全缓解(CR)1例,部分缓解(PR)8例,疾病稳定(NC)3例,疾病进展(PD)2例,总有效率(CR+PR)64.3%。全组生存时间5～18个月,中位生存时间10个月。随访中无胰腺炎、胃肠道出血、放射性肠炎等严重并发症。结论 125I粒子组织间植入治疗晚期胰腺癌在疼痛缓解方面疗效明确,具有近期疗效好、创伤小、并发症少等优点。

Objective To explore the clinical efficacy of CT-guided 125I seed interstitial implantation for the treatment of advanced pancreatic carcinoma.Methods During the period from June 2006 to June 2008 in authors＇ hospital,CT-guided 125I seed interstitial implantation was carried out in 14 patients（9 males and 5 females with a mean age of 69.5 years） with unresectable advanced pancreatic carcinoma.The clinical data were retrospectively analyzed.Before the procedure treatment planning system was used to reconstruct 3-dimensional images of the tumor and to calculate the quantity and total activity of 125I seeds needed for the individual.Under CT guidance 125I seeds were implanted into the pancreatic tumor.The activity of 125I seed used in treatment was（0.5-0.8） mci,the interval distance between implanted seeds was（0.6-1.0） cm.When puncturing the tumor,the vessels,pancreatic duct,intestinal loop（especially colon） and adjacent important structures should be prevented from damage.A follow-up lasting for 2 ～ 18 months was conducted.The therapeutic results were analyzed.Results Three to seven days after implantation the pain was relieved.Follow-up CT performed two months after implantation showed that complete remission（CR） was obtained in 1 case,partial remission（PR） in 8 cases,no change（NC） in 3 cases and progressive deterioration（PD） in 2 cases.The overall effective rate（CR ＋ PR） was 64.3%.The survival time of patients ranged from 5 to 18 months,with a median survival time of 10 months.No serious complications,such as pancreatitis,intestinal hemorrhage,radiation colitis,etc.occurred.Conclusion For the treatment of advanced pancreatic carcinoma,interstitial implantation of 125I seeds has reliable effect in reliving pain and quite satisfactory short-term efficacy.The another advantage of this technique is minimally-invasive with few complications.