CT引导放射性^(125)I粒子植入治疗23例浅表淋巴结转移瘤

CT-guided ^(125)I seed brachytherapy for superficial lymph node metastases: a report of 23 cases

目的探讨放射性^(125)I粒子植入治疗浅表淋巴结转移瘤的技术方法、近期疗效及临床意义。方法对2014年12月至2016年6月放射性^(125)I粒子植入治疗的23例浅表淋巴结转移瘤的患者进行回顾性分析。所有患者术前应用治疗计划系统(TPS)制定植入计划,根据术前计划在CT引导下行浅表淋巴结转移瘤^(125)I粒子植入术,术后行质量验证。分别于术后1、3、6、9、12个月复查CT,进行临床疗效及并发症评估。结果对23例患者、28个靶区病灶进行了治疗,术后1、3、6、9、12个月的局部控制率分别为84.6%、82.4%、81.2%、83.3%和85.7%。中位随访时间为9个月(1~16个月),生存15例,死亡8例。靶区病灶的中位局部控制时间为12个月(95%CI:7.4,16.5),而中位无进展生存时间为3个月(95%CI:0.3,5.7),P=0.194。术后出现急性皮肤放疗反应Ⅰ/Ⅱ级6例,无其他并发症和不良反应。结论^(125)I粒子植入治疗浅表淋巴结转移瘤,方法可行,近期疗效可靠,安全性较高,是局部治疗有效方法之一。

Objective To evaluate the efficacy and complications of CT-guided permanent^（125）I seed brachytherapy in patients with the superficial lymph node metastases. Methods Clinical data of 23 patients with 28 superficial lymph node metastases who underwent CT-guided^（125）I seed brachytherapy during Dec. 2014 and Jun. 2016 were retrospectively reviewed. Brachytherapy was preplanned for all patients using a 3-dimensional radiation therapy planning system. With CT guidance,^（125）I seed was placed into the metastases. Dosimetry verification was performed immediately after operation. Efficacy and complications were evaluated 1,3,6,9 and 12 months postoperatively. Results The median local control rate of 1,3,6,9 and 12 months was 84. 6%,82. 4%,81. 2%,83. 3% and 85. 7%,respectively. The median follow-up was 9 months（ 1-16 months）,during which 8 patients died and 15 survived. The local control time was 12months（ 95% CI： 7. 4,16. 5）,the median progression-free-survival（ PFS） was 3 months（ 95% CI： 0. 3,5. 7）,P =0. 194. No major complications occurred during or after brachytherapy except for Ⅰ / Ⅱ acute skin radioreaction in 6 cases. Conclusion CT-guided^（125）I seed brachytherapy is a safe and effective treatment for superficial lymph node metastases with fewcomplications.