CT引导下植入125I放射粒子治疗脊柱溶骨性转移瘤

Application study of vertebral column metastasis tumor with embedment of 125I by CT guide

目的 探讨CT引导下植入125I放射粒子治疗脊柱溶骨性转移瘤的方法、疗效、安全性.方法 回顾分析山东省平阴县人民医院放射科和青岛大学附属医院介入医学中心自2004年9月至2012年3月收治的31例脊柱溶骨性转移瘤患者,行CT引导下经皮穿刺植入125I放射粒子治疗.应用放射性粒子近距离治疗计划系统（BI-TPSTM）计划125I放射粒子的活度和用量,处方剂量PD为110 ～ 140 Gy,粒子活度为26.0 ～ 29.6 Mbq/颗,术后行CT扫描并进行质量验证,定期CT随访,分析疗效.31例脊柱溶骨性转移瘤患者,分别于术后2、4、6、12个月复查CT,观察肿瘤变化,统计肿瘤局部控制有效率（RR）,评价疼痛缓解情况.结果 19例合并椎旁软组织肿块患者2、4、6、12个月肿瘤RR依次是：19/19、19/19、18/19、17/19例;31例患者治疗后2、4、6、12个月疼痛降低1～3级的缓解率依次是96.8％ （30/31）、96.8％ （30/31）、90.3％ （28/31）、71.0％ （22/31）;3例（9.68％）在植入部位被破坏的骨质内出现了明显的骨化.12例治疗后1个月出现皮肤色素沉着,未见脊髓坏死和皮肤溃疡.结论 CT引导下植入125I放射粒子治疗脊柱溶骨性转移瘤,疗效可靠、安全性高.

Objective To discuss the method,safety and effect of embedding 125I to Brachytherapy vertebral column metastasis tumor by CT guided.Methods 31 cases of vertebral column metastasis tumor were treated with percutaneous embedding 125I by CT guided.They were observed the preoperative size and contour of lesions and were planed the activity and dosage of 125I,the PD （prescribed dose） was 110-140 Gy,and the particle activity was 26.0-29.6 Mbq.CT scanning and therapeutic effect analysis were immediately carried out after operations.We also made CT scanning regularly to analyze the effect.Results 31 cases of vertebral column metastasis tumor were respectively re-examed of CT in 2,4,6 and 12 months after operation.We surveyed the local rate,evaluate the easement of pain and observed the tumor.The local response rate of 19 cases with paravertebral mass was 19/19,19/19,18/19,17/19 cases in turn.The probability of odynolysis 31cases after 2,4,6 months therapy was 96.8％ （30/31）,96.8％ （30/31）,90.3％ （28/31）,71.0％ （22/31）in turn.9.68％ of 31 cases that was happened significant ossification in the devastated vertebral body.12 cases appeared skin pigmentation without myelodiastasis or cutaneous ulcer.Conclusion The method to treat the vertebral column metastasis tumor of embedding 125I by CT guided was simple,reliable and safety.