CT透视引导下经皮放射性^(125)I粒子永久植入治疗肺恶性肿瘤

CT fluoroscopy-guided percutaneous permanent implantation of ^(125)I seed for the treatment of pulmonary malignancies

目的探讨CT透视(CTF)引导下125I粒子永久植入治疗肺癌的临床应用价值。方法对24例肺恶性肿瘤患者施行CTF引导下经皮穿刺放射性粒子125I永久植入进行组织间放疗,包括原发性肺癌15例(15个病灶),转移性肺癌9例(13个病灶),共28个病灶,最大直径2.1～7.6cm(中位直径3.95cm),单个病灶的处方剂量80～100Gy。术后定期观察并发症情况,分析肿瘤局部控制率,使用Kaplan-Meier法统计生存率。结果所有患者均成功耐受手术,手术耗时30～75min(中位时间46min),无手术相关严重并发症发生;3例穿刺侧出现少量气胸,4例术后穿刺针道少量出血,无咯血;随访期间未发现放射性肺炎。中位随访时间31.5个月(8～46个月),病灶局部控制率78.57%(22/28);3年累积生存率为55.00%,中位生存时间为38个月(8～46个月),原发性肺癌和转移性肺癌患者生存率差异无统计学意义。结论 CTF为经皮穿刺放射性粒子植入提供实时引导和准确定位,可缩短手术时间,减少手术相关并发症。肺部恶性肿瘤125I粒子组织间放疗可达到理想的肿瘤局部控制率,延长患者生存时间。

Objective To observe the application value of CT fluoroscopy （CTF）-guided percutaneous permanent implantation of 125 I seeds for the treatment of pulmonary malignancies. Methods Twenty-four consecutive patients underwent CTF-guided percutaneous implantation of radioactive 125I seeds. There were 15 primary lung cancer patients （15 lesions） and 9 matastatic patients （13 lesions）. The maximal diameters of these 28 lesions ranged from 2.1 to 7.6 cm （median, 3.95 cm）. A prescription dose of 80--100 Gy was delivered to each lesion. Under CTF-guidance, the lesions were punc tured using 18G needles under local anesthesia, and then pre-planned 125 I seeds were implanted via the needles. The complications and local tumor control rate were documented. The survival was estimated by using the Kaplan -Meier method. Results All patients completed the procedure successfully with no technical failure. The procedure consumed 30--75 min （median 46 min）, none severe complications occurred. The complications included small asymptomatic pneumothorax in 3 patients and mild intrapulmonary hemorrhage along the needle tracks in 4 patients immediately after the procedure without hemoptysis. No radiation pneumonia was found during the follow-up period. The mean follow-up time was 31.5 months （range 8--46 months）. The lesion local control rate was 78.57% （22/28）. The total cumulative 3-year survival rate was 55.00%, and the median survival time was 38 months （range 8--46 months）. There was no statistical difference of survival rates between primary and secondary lung cancers. Conclusion CTF can provide real time guidance and accurate localization of needles and thereafter intratumor 125I seed distribution for the procedure of percutaneous 125 I seeds permanent implantation brachytherapy. It can shorten the length of the procedure and reduce the incidence of complications inherent to puncture. CTF-guided permanent implantation of 125 I seeds in treatment of malignant lung tumor results in a good local disease control with few complications, and therefore prolongs the survival of the patients.