CT导向下^(125)I粒子植入补救治疗盆腔恶性肿瘤近期疗效评价

CT-guided radioactive seeds ^(125)I implantation used as salvage therapy for malignant pelvic tumors:evaluation of short-term effects

目的评价CT导向下125I粒子植入补救治疗盆腔恶性肿瘤的近期临床疗效及安全性。方法 32例盆腔恶性肿瘤,可评价病灶35处,肿瘤长径为3～12 cm,平均(6.8±2.3)cm。所有病例均为接受过手术、化疗或放疗等综合治疗后盆腔复发或转移的恶性肿瘤患者,术前应用治疗计划系统(TPS)计算布源,在CT导向下将125I粒子植入盆腔病灶内,随访观察临床受益率、疼痛缓解率、生活质量评分及并发症状况。结果术后随访2个月,随访结束评价病灶完全缓解(CR)4/35,部分缓解(PR)20/35,病灶稳定(SD)6/35,病灶进展(PD)5/35,临床受益率(CR+PR+SD)85.7%(30/35),疼痛缓解率89.3%(25/28),总体生活质量较治疗前有明显改善(P<0.001)。近期不良反应轻微,未见大出血、盆腔脓肿、肠瘘、肠穿孔等严重并发症。结论 CT导向下125I粒子植入补救治疗盆腔恶性肿瘤安全有效、操作简便、创伤小、近期临床受益率高,可作为一种改善患者生活质量、降低肿瘤负荷的高效局部治疗手段。

Objective To evaluate the short-term clinical effects and safety of CT-guided radioactive seeds ^125Ⅰ implantation used as salvage therapy for malignant pelvic tumors. Methods A total of 32 patients （4 males and 28 females, aged 22 - 74 years） with recurrent or metastatic malignant pelvic tumors were enrolled in this study. The detected lesions were 35 in total. The longest diameter of the lesions ranged from 3 to 12 cm with a mean of （6.8 ± 2.3） cm. All the patients had received combination therapy such as surgery, chemotherapy, radiotherapy, etc. before. Treatment plan system （TPS） was used to design the optimal distribution and needed number of ^125Ⅰ seeds according to matched peripheral dose （MPD）. Under CT guidance, ^125Ⅰseeds were implanted into the pelvic lesions. All patients were followed up for two months, and the clinical effective rate, pain relief, quality of life and clinical complications were evaluated. Results The clinical effective rate, pain relief, quality of life and clinical complications were assessed at two months after the treatment. Of the 35 patients, complete response （CR） was obtained in 4, partial response （PR） in 20, stable disease （SD） in 6 and progressive disease （PD） in 5. The clinical effective rate （CR ＋ PR ＋ SD） was 85.7% （30/35）. The pain relief rate was 89.3% （25/28）. The general living quality was significantly improvedwhen compared with the preoperative condition （P 〈 0.01 ）. The short- term adverse effects were very mild. No severe complications such as massive bleeding, pelvic abscess, intestinal fistula, intestinal perforation, etc. occurred. Conclusion As a salvage therapy for recurrent or metastatic malignant pelvic tumors, CT-guided radioactive seeds 125I implantation is safe, simple and minimally- invasive with higher short- term clinical effective rate. Therefore, this technique can be used as an effective local therapy to improve patient＇s living quality as well as to reduce the tumor load.