CT引导下^125I放射性粒子植入治疗Ⅲ期非小细胞肺癌疗效分析

Clinical efficacy of CT-guided 125I radioactive seeds implantation for stage Ⅲ of non-small cell lung cancer

目的 探讨CT引导下125I放射性粒子植入治疗Ⅲ期非小细胞肺癌（non-small cell lung cancer, NSCLC）的临床疗效及影响预后因素。方法 回顾性分析247例2002年6月至2009年6月,在天津医科大学第二医院接受125I放射性粒子植入治疗的Ⅲa/Ⅲb期NSCLC患者的临床疗效。对相关临床指标进行单因素、多因素预后分析。结果 患者治疗后,1、3、5年生存率分别为82.8％、23.8％和11.5％;中位生存时间为24.8个月。其中,Ⅲa期5年生存率为14.7％,中位生存时间为29.7个月;Ⅲb期5年生存率为11.2％,中位生存时间为 24.0个月。1、3、5年局部控制率分别为92.2％、63.8％和25.7％。单因素分析结果显示,年龄、病程、治疗前血红蛋白值（≥120 g/L）、临床分期、瘤体最大直径、处方剂量、手术后平均剂量、手术后D100及治疗模式为患者预后影响因素;多因素分析结果显示,治疗前血红蛋白值（≥120 g/L）、手术后D100及瘤体最大直径为预后独立影响因素。结论 ^125I放射性粒子植入治疗Ⅲ期非小细胞肺癌显示了较好的疗效。治疗前血红蛋白值、手术后D100及瘤体最大直径为NSCLC患者预后的主要影响因素。

Objective To evaluate the clinical effects of CT-guided 125I radioactive seed implantation in treatment of stage Ⅲ non-small cell lung cancer （NSCLC） and the influential factors of prognosis. Methods 247 patients of stage Ⅲa/Ⅲb NSCLC underwent CT-guided 125I radioactive seed implantation.The clinical effects and the factors affecting prognosis were analyzed by univariate and multivariate analyses. Results The 1-, 3-, and 5- year overall survival rates were 82.8%, 23.8%, and 11.5%, respectively. The median survival time was 24.8 months, and the local control rate was 92.2%, 63.8%, and 25.7%, respectively. The 5- year overall survival rate was 14.7%,and the median survival time was 29.7 months of the stage Ⅲa patients. And the 5- year overall survival rate was 11.2%,and the median survival time was 24.0 months at the stage Ⅲb. Univariate analysis showed that age, course of disease, hemoglobin before treatment, clinical stage, maximum diameter of tumor, prescribed dose （PD）, post-operational mean dose, post-operational dose covering 100% volume （D100）, remedial model were the main prognostic factors; however, multivariate analysis revealed that hemoglobin ≥120 g/L before treatment, post-operational dose covering 100% volume （D100） and maximum diameter of tumor were the independent risk factors for predicting the survival. Aerothorax was observed in 37 patients with an incidence rate of 14.9%, and hemothorax was observed in 22 patients with an incidence rate of 9%. Conclusions 125I radioactive seed implantation therapy is effective in the treatment of stage Ⅲ NSCLC. Hemoglobin level before treatment, post-operational dose covering 100% volume （D100）, and maximum diameter of tumor are the main prognostic factors for the NSCLC patients treated with radiotherapy for NSCLC.