^(125)Ⅰ粒子组织间植入联合射频热疗治疗局部复发性直肠癌的临床观察

Interstitial permanent implantation of ^(125)Ⅰ seeds combined with radiofrequency hyperthermia for patients with locally recurrent rectal carcinoma

目的 :探讨CT引导下经皮125I粒子组织间植入联合射频热疗治疗局部复发性直肠癌的临床疗效和安全性。方法 :分析2011年2月—2013年12月在CT引导下接受经皮125I粒子组织间植入治疗的直肠癌术后局部复发患者48例,其中24例接受125I粒子组织间植入联合射频热疗(联合组),24例接受单纯125I粒子组织间植入治疗(单纯组)。观察两组患者的肿瘤缩小情况、血清癌胚抗原水平的变化、疼痛缓解率和不良反应发生情况。结果 :治疗后2个月,联合组肿瘤有效(完全缓解+部分缓解)率(91.67%,22/24)高于单纯组(66.67%,16/24)(P<0.05)。两组患者治疗后血清癌胚抗原水平均显著下降,组间差异无统计学意义(P>0.05)。联合组术后疼痛缓解率(72.73%,8/11)高于单纯组(33.33%,5/15)(P<0.05)。治疗后1个月,联合组急性放射损伤不良反应发生率(29.17%,7/24)显著低于单纯组(70.83%,17/24)(P<0.05)。结论 :CT引导下经皮125I粒子组织间植入联合射频热疗治疗局部复发性直肠癌的近期疗效较好,并发症较少,是局部复发性直肠癌有效的综合治疗手段之一。

Objective： To explore the clinical efficacy and safety of interstitial permanent implantation of 125I seeds combined with radiofrequency hyperthermia in treatment of locally recurrent rectal carcinoma. Methods： From February 2011 to December 2013, 125I seeds implantation was performed under CT guidance for 48 patients with locally recurrent rectal carcinoma. Twenty four patients of them also underwent radiofrequency hyperthermia as a combined treatment （combined treatment group）, and other 24 patients underwent single 125I seed brachytherapy （single treatment group）. The local control of tumor, pre- and post-treatment serum carcinoembryonic antigen （CEA） levels, response rate （RR） of pain relief and the adverse reactions were evaluated. Results： Two months after treatment, the response （complete reponse＋partial response） rate of the tumor was 91.67% （22/24） in the combined treatment group, which was higher than that in the single treatment group [66.67%, 16/24; P 〈 0.05）. Serum CEA level was significantly reduced after treatment in both groups, and no significant difference was found between the two groups （P 〉 0.05）. Response rates of pain relief were 72.73% （8/11） and 33.33% （5/15） in the combined and single treatment groups, respectively; and the difference was statistically significant （P 〈 0.05）. One month after treatment, the rate of complications was lower in the combined treatment group （29.17%, 7/24）, as compared with that of the single treatment group （70.83%, 17/24; P 〈 0.05）. Conclusion： Interstitial permanent implantation of 125I seeds combined with radiofrequency hyperthermia for locally recurrent rectal carcinoma has a good short-term response and less complications, which may be an effective comprehensive therapy for locally recurrent rectal carcinoma.