复发转移胸壁肿瘤CT引导125I粒子治疗疗效初探

Therapeutic effect of 125I seed implantation under computed tomography guidance in treatment of recurrent or metastatic chest wall tumor：a preliminary study

目的初步探讨CT引导125I粒子植入治疗复发或转移胸壁肿瘤的可行性和疗效。方法回顾分析2004--2012年间23例复发或转移胸壁恶性肿瘤患者接受CT引导125I粒子植入治疗资料。术前计算机治疗计划系统行三维治疗计划，确定粒子数目、空间分布，术后即刻CT扫描剂量验证。90％靶体积接受的剂量为100～160Gy（中位数130Gy），125I粒子活度为（1．85～2．89）×108Bq（中位数2．63×107Bq）。植入粒子8～269颗（中位数53颗）。局部控制率和生存率计算采用Kaplan-Meier法。结果随访率100％，随访时间满3、5年者分别为11、8例。23例患者中4例完全缓解、12例部分缓解。1、3、5年局部控制率分别为82％、62％、62％，肿瘤特异生存率分别为61％、45％、45％，总生存率分别为58％、58％、39％。疗后1例患者出现轻中度臂丛神经损伤，6例出现1、2级皮肤损伤。结论初步结果显示CT引导125I粒子植入治疗复发或转移胸壁肿瘤安全有效。

Objective To preliminarily evaluate the feasibility and therapeutic effect of 125I seed implantation under computed tomography （CT） guidance in the treatment of recurrent or metastatic chest wall tumor. Methods A retrospective analysis was performed on the clinical data of 23 patients with recurrent or metastatic malignant chest wall tumor who underwent 1~I seed implantation under CT guidance from July 2004 to October 2012. A computerized treatment planning system was used for three-dimensional treatment planning before operation to determine the number and spatial distribution of 125I seeds. CT scan dosimetry was performed immediately after operation. The dose received by 90% of the target volume was 100--160 Gy （ median： 130 Gy）. The activity of 125I seeds was （ 1.85 --2. 89） ×107 Bq （ median： 2.63 - 107 Bq）. The total number of seeds implanted was 8--269 （median ：53 ）. The local control rate and survival rate were calculated by the Kaplan-Meier method. Results The follow-up rate was 100%. Two patients were followed up for at least 3 years, and 2 for at least 5 years. Of the 23 patients, 4 had a complete remission, and 12 had a partial remission. The 1-, 3-, and 5-year local control rates were 82%, 62%, and 62%, respectively;the 1-, 3-, and 5-year tumor-specific survival rates were 61%, 45%, and 45%, respectively;the 1-, 3-, and 5-year overall survival rates were 58% , 58% , and 39% , respectively. After treatment, mild or moderate braehial plexus injury was seen in one patient, and grade 1 or 2 skin injury was seen in 6 patients. Conclusions 125I seed implantation under CT guidance is safe and effective in the treatment of recurrent or metastatic chest wall tumor, according to the preliminary study.