CT导向下^125I粒子植入挽救治疗肾上腺转移瘤11例近期疗效评价

CT-guided radioactive ^(125)I seeds implantation as a salvage therapy for adrenal metastases:evaluation of short-term effect in 11 cases

目的评价CT导向下125I粒子植入挽救治疗肾上腺转移瘤的近期临床疗效及安全性。方法回顾分析11例接受125I粒子植入挽救治疗的肾上腺转移瘤患者的临床资料,可评价病灶11处,肿瘤长径为2.1~6.5 cm,平均(3.4±1.5)cm。术前应用治疗计划系统(TPS)计算布源,在CT导向下将125I粒子植入病灶内,随访观察客观缓解率、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)3/11,部分缓解(PR)6/11,疾病稳定(SD)2/11,缓解率(CR+PR)81.8%,总体生活质量变化无统计学意义。近期不良反应轻微,未见恶性高血压、大出血、感染等严重并发症。结论 CT导向下125I粒子植入挽救治疗肾上腺转移瘤安全有效、创伤小、并发症轻微,可作为一种降低肿瘤负荷的高效局部治疗方法。

Objective To evaluate the short-term effect and safety of CT-guided radioactive 125I seeds implantation, used as salvage therapy, for adrenal metastases. Methods The clinical data of 11 patients with adrenal metastases, who received radioactive 125I seeds implantation as a salvage therapy, were retrospectively analyzed. The number of lesions was 11 in total, and the longest diameter of the lesions ranged from 2.1 cm to 6.5 cm with a mean of （3.4 ± 1.5） cm. Treatment plan system （TPS） was used to design the optimal distribution and needed number of lzsI seeds according to matched peripheral dose （MPD）. Under CT guidance,125I seeds were implanted into the adrenal lesions. All patients were followed up for two months, and the overall response rate, quality of life and clinical complications were evaluated. Results The overall response rate, quality of life and clinical complications were assessed at two months after the operation. Of the 11 patients, complete response （CR） was obtained in 3, partial response （PR） in 6 and stable disease （SD） in 2. The remission rate （CR＋ PR） was 81.8%. The general living quality did not deteriorate when compared with the preoperative condition. The short-term adverse effects were very mild. No severe complications such as hypertensive crisis, massive bleeding, infection, etc. occurred. Conclusion As a salvage therapy for adrenal metastases, CT-guided radioactive 12sI seeds implantation is safe, effective and minimally-invasive with fewer and mild complications. Therefore, this technique can be used as an effective local therapy to reduce tumor load.