^125Ⅰ粒子植入联合动脉化学栓塞治疗原发性肝癌合并门静脉癌栓

Transcatheter arterial chemoembolization combined ^125iodine seed implantation for primary hepatic carcinoma with portal vein tumor thrombus thrombosis

目的探讨^125Ⅰ粒子结合动脉化学栓塞治疗原发性肝癌伴门静脉癌栓的临床价值。方法回顾性分析不能行手术治疗的原发性肝癌伴Ⅱ型或Ⅲ型门静脉癌栓的23例患者的临床资料，男20例、女3例；年龄34-70岁，平均（56±8）岁；肝内原发肿瘤1-15个（中位数为4个）。23例门静脉癌栓的平均直径为（20．5±1．5）mm，平均长度为（37．4±2．6）mm。所有患者均行动脉化学栓塞治疗肝内原发病灶，同时经皮穿刺门静脉癌栓内^125Ⅰ粒子植入治疗门静脉癌栓。通过治疗计划系统计算出处方剂量、所需粒子数、粒子的空间分布、粒子放射性活度、匹配周边剂量等参数，然后在CT监视下，依次在肿瘤的不同层面及位置植入^125Ⅰ粒子。结果每例患者动脉化学栓塞治疗次数1．0-6．0次，平均（3．1±0．4）次；门静脉穿刺粒子植入次数1．0-2．0次，平均（1．4±0．5）次；植入粒子数4-17枚，平均（7±1）枚。患者生存期3-24个月，中位生存期18个月。患者3、6和12个月生存率分别为91．3％（21／23）和69．6％（16／23）和60．9％（14／23）。所有患者均未见与治疗相关的严重并发症发生。结论^125Ⅰ粒子植入联合动脉化学栓塞治疗，可以显著延长伴有门静脉癌栓的原发性肝癌患者的中位生存期。

Objective To assess the therapeutic value of transcatheter arterial chemoembolization combined ^125iodine seed implantation for primary hepatic carcinoma with portal vein tumor thrombus. Methods The data of 23 patients ranging from 34 to 70 years old [ average age （ 56 ± 8 ） years ] with primary hepatic carcinoma with portal vein tumor thrombosis of type Ⅱ and type Ⅲ were retrospectively collected. The tumor number of liver parenchyma ranged from 1 to 15 （ median number 4）. The average diameter of tumor thrombus was （20. 5 ± 1.5 ） mm and average length was （ 37.4 ± 2. 6） mm. All of the tumors of liver parenchyma in 23 patients were treated by transcatheter arterial chemoembolization （TACE） and tumor thrombus were treated with ^125 iodine seed implantation. Before the ^125iodine seed implantation, the formula dosage, the number, the spatial distribution, the intensity of radioactivity and the matched peripheral dosage of seed were calculated by treatment planning system （TPS）. Then the ^125iodine seeds were implanted in different levels and locations of port vein thrombosis under CT guided. Results The follow-up period ranged from I to 26 months. The times of transcatheter arterial chemoembolization were 1 to six times （median time 3.1 ±0.4） and the ^125iodine seed implantation in the port vein thrombosis were 1 to 2 times （ median time 1.4 ±0. 5）. The numbers of implanted lzs iodine seeds were 4 to 17 （ median number 7.0± 1.0）. The median survival time was 18.0 months （3-24 months）. The 3,6 and 12 months survival rates were 91.3% （21/23）, 69. 6% （ 16/23）, and 60. 9% （14/23）. There was no severe side-effect related to therapy. Conclusions Transcatheter arterial chemoembolization combined 125iodine seed implantation for portal vein tumor thrombosis could significantly prolong the median survival time of patientwith primary hepatic carcinoma with portal vein tumor thrombosis.