CT引导下放射性粒子125I植入治疗原发性肝癌的近期疗效和安全性

Short-term efficacy and safety of CT-guided radioactive 125I seeds implantation for the treatment of primary liver cancer

目的 观察CT引导下放射性粒子125I植入治疗原发性肝癌的近期疗效和安全性.方法 收集2010年4月至2011年3月在中山大学附属第一医院及解放军第四五八医院收治的原发性肝癌病例63例,接受研究病灶75个（其中16个病灶长径小于5 cm,其余病灶长径大于5 cm）,均行CT引导下放射性粒子125I植入治疗.术后2个月分别行CT检查评价粒子植入治疗效果.分别记录术前、术后3d、1个月、2个月肝功能变化及术后6个月内并发症发生情况.结果 所有75个病灶术后2个月CT检查评价治疗效果完全缓解（CR）4个,部分缓解（PR）10个,稳定（SD）39个,进展（PD）22个,总有效率为18.7％.然而对于长径小于5 cm的16个病灶,治疗效果评价完全缓解（CR）4个,部分缓解（PR）8个,稳定（SD）3个,进展（PD）1个,总有效率为75％.术后1、2个月复查肝功能丙氨酸氨基转移酶（ALT）及天门冬氨酸氨基转移酶（AST）与术前比较差异具有统计学意义（P＜0.05）,均较术前升高；术后3 d ALT、AST与术前比较及术后各时间点间比较差异无统计学意义.术前、术后各时间血清总胆红素及白蛋白水平变化差异无统计学意义.术后6个月内共出现粒子移位24例,针道种植转移2例,气胸2例,1例出现恶心、呕吐、纳差.结论 对于失去外科手术机会的原发性肝癌患者,放射性粒子125I植入治疗对于长径小于5 cm肿瘤病灶,有效率较高.放射性粒子植入会引起一些不良反应和并发症,但未发现有致命性并发症发生.

Objective To investigate the short-term efficacy and safety of 125I seeds implantation in the treatment of primary liver cancer.Methods A total of 75 lesions （16 with the longest diameter of 5 cm or less,the longest diameter of remaining lesions greater than 5 cm） were derived from 63 patients with primary liver cancer who underwent CT-guided 125I seeds implantation in The First Affiliated Hospital,Sun Yat-sen University and The 458th Military Hospital between April 2010 and March 2011.The efficacy was determined at 2 months postoperatively.The changes in liver function before the opteration and within 3 days,and 1,2 months postoperatively.Complications within 6 months postoperatively were examined.Results Among all lesions,4 obtained complete remission （CR）,10 partial remission （PR）,39 stable disease （SD） and 22 progression of disease （PD）,corresponding to the total effectiveness rate of 18.7%.However,these figures were 4,8,3 and 1 for the lesions with the longest diameter of 5 cm or less,resulting in the total effectiveness rate of 75%.The levels of alanine transferrase （ALT） and aspartate transferrase （AST） at 1 and 2 months postoperatively,but not day 3 （P〉0.05）,were statistically higher than those before the surgery （both P〈0.05）.And there was not statistically significant between the various time points after surgery.There was no marked difference in the levels of serum bilirubin and albumin between preoperative and postoperative time points （both P〉0.05）.After a follow-up period of 6 months,24 cases developed seeds migration and 2 needle tract implantation,2 cases developed pneumothorax and 1 digestive tract reaction,including nausea,vomiting and loss of apetite.Conclusions Radioactive 125I seeds implantation is effective for the treatment of unresectable primary liver cancer with the longest diameter of 5 cm or less.However,this treatment may induce adverse events and complication,but fatal complications are rare.