高强度聚焦超声与^(125)Ⅰ放射性粒子植入治疗中晚期胰腺癌疗效观察

Clinical Efficacy of High Intensity Focused Ultrasound and ^(125)Ⅰ Seed Permanent Brachytherapy in the Treatment of Advanced Pancreatic Carcinoma

目的:观察高强度聚焦超声(HIFU)与125I放射性粒子植入治疗中晚期胰腺癌的临床疗效和安全性。方法:124例中晚期胰腺癌患者随机分为A组(29例)、B组(33例)、C组(32例)和D组(30例)。A组给予单纯化疗,B组采用HIFU治疗联合化疗,C组采用125I放射性粒子植入治疗联合化疗,D组采用125I放射性粒子植入治疗+HIFU治疗+化疗。比较各组患者临床受益情况、疗效、生存时间和不良反应。结果:A组、B组、C组和D组的临床受益率分别为27.59%,84.85%,78.13%和83.33%,联合治疗(B组、C组和D组)明显优于单纯化疗的A组(P<0.05),B组、C组和D组间差异无统计学意义(P>0.05);各组总有效率分别为17.24%,72.73%,43.75%和93.33%,联合治疗(B组、C组和D组)明显优于单纯化疗的A组(P<0.05),且D组明显优于B组,B组明显优于C组(P<0.05);A、B、C、D组的肿瘤体积缩小率分别为14.7%,54.3%,31.8%和65.5%,组间差异具统计学意义(P<0.05)。各组中位生存期比较,联合治疗(B组、C组和D组)生存率明显优于单纯化疗的A组(P<0.05),且D组明显优于B组,B组明显优于C组(P<0.05);各组不良反应无显著差别(P>0.05)。结论:HIFU、125I放射性粒子植入和化疗均为治疗中晚期胰腺癌可选择的有效手段,联合治疗较单纯治疗更佳;HIFU和125I放射性粒子植入联合治疗并辅助化疗的疗效明显,是一种安全、有效的治疗方法。

Objective： To analyze the clinical efficacy and safety of high intensity focused ultrasound（ HIFU） and ^（125）Ⅰ seed permanent brachytherapy in the treatment of advanced pancreatic carcinoma. Methods： Totally 124 patients with advance pancreatic carcinoma were divided into group A（ 29 cases）,group B（ 33 cases）,group C（ 32 cases） and group D（ 30 cases） according to the random number table. Group A received chemotherapy alone,group B received HIFU combined with chemotherapy,group C received ^（125）Ⅰ seed permanent brachytherapy combined with chemotherapy and group D received HIFU and ^（125）Ⅰ seed permanent brachytherapy combined with chemotherapy. The clinical benefit response,efficacy,survival time and adverse reactions among the groups were compared. Results： The clinical benefit rate of group A,B,C and D was 27. 59%,84. 85%,78. 13% and 83. 33%,respectively,which was significantly better in the combined treatment groups（ group B,C and D） than that in the chemotherapy group（ group A,P 〈0. 05）,and among group B,C and D,there was no significant difference（ P 〈0. 05）. The total effective rate was 17. 24%,72. 73%,43. 75%and 93. 33%,respectively,which was significantly better in the combined treatment groups（ group B,C and D） than that in the chemotherapy group（ group A,P 〈0. 05）,and among the combined treatment groups,the order was group D group B group C（ P 〈0. 05）. The ratioes of the tumor shrinkage of group A,B,C and D were 14. 7%,54. 3%,31. 8% and 65. 5%,respectively. There was significant differnce among the groups（ P 〈0. 05）. The median survival time in each group was 6. 4,14. 6,10. 8 and 17. 8months,which was significantly better in the combined treatment groups（ group B,C and D） than that in the chemotherapy group（ group A,P 〈0. 05）,and among the combined treatment groups,the order was group D group B group C（ P 〈0. 05）. The adverse reactions in each group showed no significant difference（ P 〈0. 05）. Conclusion： Conclusion： HIFU, ^（125）Ⅰ seed permanent brachytherapy and chemotherapy are effective methods in the treatment of advanced pancreatic carcinoma,and the combination therapy is better than chemotherapy alone. HIFU and ^（125）Ⅰ seed permanent brachytherapy combined with chemotherapy is an effective and safe treatment regimen.