CT引导^125I粒子植入术治疗胃癌术后区域淋巴结转移

CT-guided ^125Ⅰ seed implantation for locoregional lymph node metastases in patients with recurrent gastric cancer

目的评价cT引导^125Ⅰ粒子植入术治疗胃癌术后区域淋巴结转移的安全性与近期疗效。方法对23例胃癌术后局限性区域淋巴结转移并接受cT引导^125Ⅰ粒子植入治疗患者的临床病理特征与生存资料进行回顾性分析。所有患者术前经放射性粒子植入计划系统模拟布源，计算放射性粒子总活度与粒子数量。CT引导下经皮穿刺植入^125Ⅰ粒子。术后2个月参照实体瘤疗效评价标准（RECIST）评价近期疗效，采用寿命表法计算植入术后患者1、2和3年生存率；以单变量Cox模型检验相关因素对生存的影响；采用log—rank法比较组间（肿瘤最大径〉3em组和〈3em组）生存差异并绘制生存曲线。20例患者粒子植入术后接受了以氟尿嘧啶类药物为基础的全身化疗。结果23例患者均未出现严重并发症。CR14例（60．9％，14／23），PR5例（21．7％，5／23），PD4例（17．4％，4／23）。患者粒子植入术后1、2和3年生存率分别为（87_＋7）％、（47±11）％与（13±9）％，中位生存时间为（22．1±5．1）个月。单变量Cox分析，肿瘤最大径是影响生存时间的因素（X^2=9．752，P=0．002），〉3em组和〈3cm组的中位生存时间分别为（17．0±5．0）和（30．O±5．1）个月，2组总生存时间差异具有统计学意义（X^2=5．828，P=0．016）。结论CT引导^125Ⅰ粒子植入术治疗胃癌术后局限性区域淋巴结转移创伤小且并发症少，并能取得较高的局部控制率。

Objective To evaluate the safet-y and short term effect of ^125Ⅰ seed implantation for lo- eoregional lymph node metastases in patients with recurrent gastric cancer. Methods The data of 23 gastric cancer patients with loeoregional lymph node metastases treated by CT-guided ^125Ⅰ seed implantation were retrospectively studied. Patient characteristics and survival data were collected and analyzed. The procedure for seed implantation was performed under CT guidance according to preoperative treatment planning. Evalu- ation of short-term effect was carried out two months after the ^125Ⅰseed implantation using response evalua- tion criteria in solid tumors （RECIST）. The 1-, 2- and 3-year survival rates were plotted using the life table method. The potential predictors of survival were tested using univariate Cox models. Log-rank method was used to test the difference of survival in subgroups with tumor size 〉3 em and 〈3 cm. Twenty patients under- went fluoropyrimidinc-based chemotherapy after ^125Ⅰ seed implantation. Results None of the 23 patients had serious complications. Two months after ^125Ⅰ seed implantation, the CR, PR and PD rates were 60.9% （14/ 23 ）, 21.7% （ 5/23 ） and 17.4% （ 4/23 ） , respectively. The median survival time was （ 22.1 ±5.1 ） months, and the 1-, 2-, 3-year survival rates were （87±7）%, （47×11）% and （ 13±9）%, respectively. The tumor size （longest diameter） was the most significant factor for prognosis （X^2 = 9.752, P= 0. 002）. Patients with tumor 〈3 cm in diameter had longer survival time than those with tumor 〉3 em（（30.0±5.1） vs （ 17.0±5.0） months; X2 = 5.828, P= 0.016）. Conclusion CT-guided brachytherapy using ^125Ⅰ seed implantation is a safe and effective method for palliative treatment of locoregional lymph node metastases for recurrent gastric cancer.