复发恶性胶质瘤患者二次术后^125Ⅰ粒子植入与普通放射治疗疗效对比分析

Therapeutic effect comparison of interstitial implantation of ^125Ⅰ seeds and general radiotherapy after surgery of recurrent malignant gliomas

目的 探讨恶性胶质瘤复发患者手术后，放射性^125Ⅰ粒子置入与普通放射治疗的疗效及并发症的比较情况。方法 选取自2006年9月至2010年1月青岛市立医院东院区神经外科收治的复发恶性胶质瘤患者58例，其中粒子置入组26例，对照组32例。所有患者实施脑肿瘤大部切除术。粒子置入组患者根据肿瘤大小、部位等具体情况分布植入^125Ⅰ粒子；对照组接受颅脑放疗剂量为（50～60Gy）。2组患者均随访，比较1年、3年生存率和中位生存时间、并发症和生活质量情况。结果 粒子置入组与对照组1年生存率分别为46．2％和34．4％，差异无统计学意义（P〉0．05）；3年生存率为19．2％和12．5％，差异具有统计学意义（P〈0．05）。粒子置入组与对照组平均生存时间分别为（15．6±2．51个月和（9．4±1．3）个月，差异具有统计学意义（P〈0．051；所有患者均未发生4级及以上不良反应，粒子置入组2～3级不良反应中眩晕、头痛的发生率也远低于对照组，差异有统计学意义（P=0．030，P=0．035）。结论 恶性胶质瘤复发术后结合放射性^125Ⅰ粒子植入可有效提高患者生存率并延长生存时间，减少传统放疗带来的放射性脑损伤，且安全性好，副作用小。

Objective To observe the efficacy and complications of iodine-125 radioactive seeds implantation after surgery of recurrent malignant gliomas. Methods Fifty-eight patients with recurrent gliomas, admitted to our hospital from September 2006 to January 2010, were randomly divided into observation group （n=26） and control group （n=32）. All patients accepted tumor subtotal resection. Patients in the observation group were implanted with iodine-125 seeds which were planned by therapy planning system （TPS） depending on the tumor size and position. Patients in the control group were irradiated at 50-60 Gy after the operations. Patients from both groups were followed up for 3 years, and the l-year and 3-year survival rates, median survival time, complications and quality of life were observed. Results The survival rate of 1-year of observation group and control group was 46.2% and 34.4%, without significant difference （P〉0.05）, while that of 3-years time was 19.2% and 12.5%, with significant difference （P〈0.05）. The average survival time of the two groups was （15.6±2.5） months to （9.4±1.3） months, with statistically significant difference （P〈0.05）. No severe complications （grade four or higher than grade four） were noted; lower rates of dizziness and headache were found in observation group as compared with those in control group （P=0.030, P=0.035）. Conclusions The iodine-125 radioactive seeds implantation after surgery of recurrent malignant gliomas not only can improve the survival rate and prolong survival time, but also reduce radiation brain damage to improve the life quality. So it is a safe and effective treatment, and worth of applicattion in clinic.