放射性125I粒子植入治疗非小细胞肺癌近期疗效的多因素分析

The short term therapeutic effects of radioactive 125I seeds implantation for treatment of non.small-cell lung cancer

目的探讨影响放射性125I粒子植入治疗非小细胞肺癌（NSCLC）近期疗效的因素。方法141例原发性NSCLC患者实施CT引导下放射性125I粒子植入治疗，其中26例单纯粒子植入，115例粒子植入联合化疗。所有患者术后6个月行胸部CT检查，根据肿瘤大小变化进行疗效评估，并分析影响近期疗效的相关因素。结果（1）粒子植入后完全缓解37例，部分缓解93例，有效率92．2％。（2）单因素分析显示：肿瘤分型（F=5．162，P=0．023）、覆盖100％肿瘤瘤体剂量（D100）（F=100．713，P=0．000）、治疗模式（F=16．205，P=0．000）对局部疗效有影响。单因素logistic回归分析显示：D100、治疗模式、肿瘤分型均为影响局部疗效的独立因素。（3）单因素分析显示：肿瘤分型（X2=7．313，P=0．007）、D100（X2=71．6，P=0．000）、治疗模式（X2=20．5，P=0．000）均为影响晚期NSCLC粒子植入治疗效果的重要因素。所有患者治疗期间均未发生相关严重并发症，且与近期疗效无明显相关（P〉0．05）。结论CT引导下放射性125I粒子植入治疗NSCLC是一种安全、有效的治疗方法D100为影响近期疗效最主要因素。

Objective To explore influential factors of local therapeutic effect in CT guided braehytherapy of 125I seeds for non-small-cell lung carcinoma （NSCLC）. Methods Totally 141 primary NSCLC patients diagnosed by bronchoscope or puncture biopsy were treated with CT guided 125I seeds implantation treatment from 2003 January to 2005 January. Among them, 26 patients were treated with seeds implantation only and remaining 115 combined with chemical therapy. Preplaus were performed by using treatment planning system before the implantation. We took the implantation with the prescription dose of 80- 110 Gy, 1 seed per 1 cm3, under the guide of computed tomography. Six months after implantation treatment, CT graphs were taken to evaluate the therapeutic effect. Results All the patients were survival until 6 months after implantation, and 37 were complete remission, 93 were partial remissions. The effective rate was 92. 2%. Among all the observed factors, pathologic type （ F = 5. 162, P = 0. 023 ）, dose of cover 100% tumor （ D100 ） （ F = 100. 713, P = 0. 000 ） and treatment methods （ F = 16. 205, P = 0. 000 ） were the independent influent factors （ P 〈 0. 05 ）. Among these, D100 was the most important factor （ P = 0. 000 ）. Single factor analysis indicated that pathologic type （X2 =7. 313, P =0. 007）, Dr00 （X2 =71.6, P =0. 000） and treatment methods 0（2 = 20. 5, P = 0. 000） were significant influent factors. Of all 141 cases, 24 had complications during or after implantation treatment ,while no severe complications were reported. There was no significant correlation between complication and local therapeutic effect （ P 〉 0.05 ）. Conclusion CT guided implantation of 125I seeds for lung cancer has good clinical effects and few complications. D100 is the most important factor to influence the local therapeutic effect. Implantation treatment combined with chemotherapy is an ideal measure for NSCLC treatment.