放射性碘125粒子植入联合高频热疗治疗晚期肺癌的近期疗效观察

Study of iodine 125 particles implantation combined with high-frequency hyperthermia in the treatment of the advanced lung cancer

目的观察CT引导下植入碘125粒子联合高频热疗治疗晚期肺癌的近期临床疗效。方法 2011年11月至2013年3月,将60例被证实为无法手术的晚期肺癌患者分为治疗组和对照组各30例,治疗组采用高频热疗加放射性粒子植入,对照组采用单纯粒子植入。热疗采用吉林迈达公司生产的NRL-004型内生场肿瘤热疗机,热疗于粒子植入后3～5d进行,隔日1次,每次60min,连续3次。用三维实体定向放射治疗计划系统(TPS)制定其粒子治疗计划,在CT定位引导下,经皮穿刺,按照治疗计划系统(TPS)将放射活度为0.8mCi的放射性碘125粒子永久性植入肿瘤内持续照射,处方剂量为90Gy。术后2个月进行CT扫描,参照WHO实体肿瘤疗效RECIST标准,测量肿瘤大小并进行疗效评估,此外进行疼痛缓解疗效评估和常见不良反应评估。结果治疗组总有效率为96.7%,对照组总有效率为80.0%,差异有统计学意义(P<0.05),胸壁局部疼痛缓解率治疗组为75.0%(6/8),对照组为50.0%(5/10)。两组患者不良反应均不大,常见的不良反应仍为少量气胸、粒子植入后移位脱落等,两组发生比例无明显差异,粒子治疗结合热疗相对于单纯粒子植入可能会发生皮肤灼伤,但比例低,与单纯热疗类似,经过治疗后可以恢复。结论放射性碘125粒子植入治疗中晚期肺癌能取得较好的近期临床疗效,但结合高频热疗可以获得更好的近期临床疗效,对胸壁局部疼痛缓解率治疗组亦明显好于对照组,两组患者不良反应均较轻微,无治疗相关性死亡病例。

Objective To observe the efficacy of CT guided implantation of iodine 125 particles combined with high-frequency hyperthermia in the treatment of the advanced lung cancer .Methods From 2011 November to 2013 March ,60 patients with ad-vanced lung cancer were randomly divided into treatment group ：high frequency hyperthermia combined with iodine 125 particle im-plantation（30 cases） ,the control group ：the iodine 125 particle implantation group（30 cases） .Thermotherapy was performed 3 -5 days after the implantation using NRL-004 type hyperthermia instrument made by Jilin Maida company in China ,every other day once time ,a total of six times ,60 minutes each time .The iodine 125 particle implantation was performed according to the treatment planning system（TPS） formulation by CT guided and the dosage was 90 Gy .The evaluation of treatment effect was conformed by CT scans after two months of treatment .The side effects was assessed too .Results The total effective rate was 96 .7% in the treatment group ,the control group was 80 .0% ,there was a statistically significant difference （P〈 0 .05） .The local pain in chest wall remission rate was 75 .0% （6/8） and 50 .0% （5/10） in the treatment group and the control group（P〉0 .05） .The side effects of the treatment was slight including pneumothorax and particle migration and so on .Conclusion Iodine 125 particles implantation is an effective treatment in the treatment of advanced lung cancer and can obtained better effects combined with high-frequency hy-perthermia .The side effects of the treatment is slight for two groups and no death related treatment .