经导管肝动脉化疗栓塞联合^(125)Ⅰ粒子靶向内照射治疗肝脏恶性肿瘤的初步观察

Preliminary observation on brachytherapy by TACE combined with Iodine-125 seeds for treatment of hepatic carcinoma

目的探讨经导管肝动脉化疗栓塞(transcatheter hepatic arterial chemoembolization,TACE)联合植入125I粒子靶向内照射治疗肝脏恶性肿瘤的近中期疗效。方法本组24例中原发性肝癌18例、胆管细胞癌3例、大肠癌术后肝转移癌3例,共29个病灶。采取先进行1~3次TACE治疗,待病灶初步得到控制后在CT或彩色多普勒超声导向下植入125I粒子,粒子植入之前采用治疗计划系统(treatment planning system,TPS)模拟布源或遵循Halarism的125I经验公式(mCi=Da×5),求出术中所需125I粒子的总活度及算出治疗粒子的数量。将粒子重点植入到肿瘤实质内碘油缺损区域及肿瘤边缘。结果随访6~23个月,半年生存率为100%,未出现严重的并发症。治疗后6个月肝内病灶肿瘤影像学评价,24例患者中,完全缓解(CR)4例,部分缓解(PR)13例,有效反应率(CR+PR)71%,稳定(NC)4例,进展(PD)3例。结论 TACE联合植入125I粒子靶向内照射治疗肝脏恶性肿瘤是安全、微创、有效的方法。

Objective To investigate the short and mid term efficacy of brachytherapy by transcatheter hepatic arterial chemoembolization （TACE） combined with implantation of Iodine-125 seeds for treatment of hepatic carcino-ma. Methods There were 24 patients with 29 lesions, including 18 cases of primary hepatic carcinoma, 3 cases of cholangiocarcinoma and 3 cases of postoperative hepatic metastases with colorectal cancer. To treat these lesions with TACE for one to three times, then to implant Iodine-125 seeds under the guidance of CT or color Doppler ultrasound when lesions had been preliminarily controlled. Those Iodine-125 seeds were mainly implanted into the region that lack of lipiodol within tumor parenchyma and tumor margin according to the treatment planning system （TPS） or the Halarism′s experienced function （mCi=Da×5）. mCi was the total activity of Iodine-125 seeds. And the number of Io-dine-125 seeds needed equals to that of total activities divided by the activity of single particle. Results After follow-up for 6 to 23 months, patients showed no severer complications; the half-year survival rate was 100%. All the pa-tients underwent followed CT scan after six months. CR, PR, NC, PD were obtained in 4, 13, 4, 3 cases respectively. And the responsive rate of CR＋PR was 71%. Conclusion Brachytherapy by TACE combined with implantation of Iodine-125 seeds is a safe, minimally invasive and effective method for treatment of hepatic carcinoma.