^(125)I粒子植入联合支气管动脉灌注化疗治疗肺癌的临床观察

Clinical application of ^(125)I seed implantation combined with bronchial arterial infusion chemotherapy for lung cancer

目的探讨125I粒子植入联合支气管动脉介入化疗治疗肺癌的临床价值。方法 2004-10～2011-06共58例肺癌患者,先行125I粒子植入术,之后行支气管动脉灌注化疗术。术前采用特定计算机治疗计划系统(treatment planning system,TPS)模拟布源,计划术中所需125I粒子的总活度及粒子的数量。在CT引导下将125I粒子植入瘤体区。术后2,4,6,12个月CT扫描,参照WHO实体肿瘤疗效评价标准,测量肿瘤组织两个垂直直径之乘积进行疗效评价。结果125I粒子植入联合支气管动脉灌注化疗治疗后2,4,6,12个月随访,有效率分别为62.07%,71.93%,83.64%,78.18%。全组58例中1例4个月因出现全身转移而病死,2例6个月因心包转移医治无效病死,其余55例患者均全部完成治疗;所有患者未出现放射损伤症状,未发现粒子迁移,化疗不良反应轻(部分患者出现轻度恶心呕吐,1例患者脱发)。结论125I粒子植入联合支气管动脉灌注化疗治疗肺癌能有效控制肿瘤治疗"冷点"及针道种植转移;具有较好的临床应用价值。

Objective To investigate the clinical value of 125I seed implantation combined with bronchial arterial infusion chemotherapy for lung cancer.Methods From October 2004 to June 2011,58 patients with lung cancer were implanted with 125I seeds and then received bronchial arterial infusion chemotherapy.Before operation,the treatment planning system（TPS）was used to simulate the positioning of seeds so as to figure out the total activity and quantity of 125I seeds.Then the 125I seeds were implanted into the tumor area under CT.CT scan was performed after operation for 2,4,6,and 12 months respectively,then the clinical efficacy was evaluated according to WHO Response Evaluation Criteria in Solid Tumors.Results The effective rates were 62.07%,71.93%,83.64% and 78.18% after operation for 2,4,6 and 12 months,respectively.Among 58 patients,one died of cancer metastasis after 4 months,and 2 patients died of pericardium migration after 6 months.The other 55 patients all completed the treatment.No radiation damage or seed migration occurred,and the adverse reactions to chemotherapy were slight,only few of patients were found with mild nausea and vomiting,and one patient got hair loss.Conclusion The 125I seed implantation combined with bronchial arterial infusion chemotherapy for lung cancer can effectively control the ＂cold spots＂ of tumor treatment and needle tract implantation metastasis,and it has a good clinical application value.