放射性核素^(125)Ⅰ粒子治疗恶性淋巴结转移瘤临床观察

Clinical observation of radioactive ^(125)Ⅰgranule treatment on malignant lymph node shift lump

目的探讨利用B超或CT引导下放射性核素^(125)Ⅰ粒子组织间植入内照射治疗不能耐受放化疗或放化疗失效而复发的淋巴结转移方法、可行性及疗效。方法 2008年1月～2010年2月本院收治的恶性淋巴转移复发患者42例,其中男27例,女15例,局部麻醉,间距1 cm,以术前TPS计划的粒子数及进针方向做参考,注意避开重要血管及神经,在B超或CT定位下用粒子针进行植入,粒子针插植边缘达到肿瘤影像学边缘,粒子间距0.5～1 cm,术后即行超声复查,了解粒子分布状况,必要时进行补植入,避免剂量冷区。粒子活度为(1.85×10~7)～(2.96×10~7)Bq,中位植入粒子数35粒(2～68粒)。结果根据疗效评估标准,1～6个后进行CT扫描,随访10～36个月,其中完全缓解38.1%(16/42),部分缓解52.3%(22/42),无变化2例、(PD)2例9.5%(4/42),总有效率90.5%(38/42)。6个月、1年、2年总生存率分别为100%、81.2%、40.7%。结论通过用TPS计算肿瘤大小,计算肿瘤所需的受照剂量,在B超和CT引导下植入放射性核素^(125)Ⅰ粒子进行肿瘤体内照射,开拓了新的治疗方法,且疗效显著,不良反应少,功能不受损伤,并发症少,止痛效果快。

Objective To investigate that the use of B-or CT-guided interstitial implantation of radioactive particles （125）I within the radiation treatment can not accept chemotherapy or radiotherapy and chemotherapy lymph node recurrence with ineffective method.The feasibility and efficacy will be summarized as well.Methods From January 2008 to February 2010,42 patients were treated with malignant lymph node metastasis and recurrence,including 27 males and 15 females as follows：local anesthesia,spacing 1 cm,the TPS program preoperative needle direction of particle number and a reference,avoiding of the attention of important blood vessels and nerves,ultrasound or CT in the B orientation implanted under the needle with the particles,the particles reaching the edge of the tumor implantation needle edge imaging,particle spacing of 0.5 - 1 cm,after reviewing the ultrasound,understanding particle distribution,necessary,make implantation, avoiding the dose of the cold zone.Particle activity is 1.85×107 Bq～2.96×107 Bq,the median number of particles implanted in 35（2 - 68） tablets.Results Efficacy assessment criteria based on the results of 1-CT scan after 6 months,follow-up 10-36 months,including CR 38.1%（16/ 42）,PR 52.3%（22/42）,NC2 cases ＋ PD2 patients 9.5%（4/42）,the total effective rate CR ＋ PR 90.5%（38/42）.6 months,1 year and 2 year overall survival rates were 100%,81.2%,40. 7%.Conclusion The tumor size calculated by using TPS to calculate exposure doses required for tumor,and CT in the B-guided implantation of （125）I particle irradiation of tumor in vivo provide new treatment methods,which has advantages such as improved cure rate,fewer side effects,no functional damage,fewer complications and faster analgesic effect.