^(125)I粒子永久植入联合实时测温射频消融治疗肺癌效果分析

Clinical effect of permanent implantation of ^(125)I particles and radiofrequency ablation with real-time temperature measurement for treatment of patients with lung cancer

目的探讨^(125)I粒子永久植入联合实时测温射频消融治疗中晚期非小细胞肺癌(NSCLC)的临床效果。方法收集2012年10月至2015年1月在内蒙古呼和浩特市第一医院胸外科未接受外科手术治疗的中晚期NSCLC患者98例,根据患者意愿分为联合治疗组(n=45)和常规治疗组(n=53)。联合治疗组采用125I粒子永久植入联合实时测温射频消融治疗,并于术后3个月配合使用化疗方案(培美曲赛+卡铂);常规治疗组直接使用化疗方案(培美曲赛+卡铂)。术后1周和1、3、6、12个月复查增强CT明确临床疗效。采用欧洲癌症研究与治疗组织肺癌患者生命质量测定特异性模块(EORQLQ—LCl3中文版)、肺癌患者的总生存质量评价表和生存时间比较两组患者治疗前和治疗后的差异。结果联合治疗组患者治疗后均未出现严重并发症,术后复查增强CT,可见病灶部位于术后1个月开始强化逐渐减弱,3~6个月出现125I粒子位置缓慢聚集,病灶逐步固化坏死,形成空洞,去血管征象和凝固性坏死明显。随访7~24个月,联合治疗组生存率88.9%,常规治疗组生存率49.1%。治疗前,两组患者的EORQLQ—LCl3和总生存质量比较,差异均无统计学意义(P>0.05);治疗后,两组患者的EORQLQ—LCl3和总生存质量评分均较治疗前明显改善(P<0.05);且联合治疗组在EORQLQ—LCl3评分及总生存质量评分均明显优于常规治疗组(P<0.05)。联合治疗组患者的平均生存时间为(18.4±5.8)个月,显著优于常规治疗组的(10.9±4.2)个月(t=5.763,P<0.05)。结论125I粒子永久植入联合实时测温射频消融治疗肺癌是一种简单、安全、微创、有效的方法,同时125I粒子永久植入联合实时测温射频消融治疗与化疗有机结合,能很好地改善患者的生活质量并延长生存期。

Objective To investigate the clinical effect of permanent implantation of ^125I particles and radiofrequency ablation with real-time temperature measurement for the treatment of patients with non-small cell lung cancer （NSCLC）, Methods A total of 98patients with mid-late stage NSCLC without surgical treatment in Department of Chest Surgery, The First Hospital of Hohhot between October 2012 and January 2015 were enrolled, according to the patient will joint were divided intocombined treatment group （ n= 45） and convention treatment group （n = 5 3 ） . Patients in combinedreatment group underwent permanent implantation of ^125I particles and radiofrequency ablation with real- tme temperature measurement, and received chemotherapy （pemetrexed＋ carboplatin） 3 months after operation. Patients in conventional treatment group were just managed with chemotherapy （pemetrexed ＋ carboplatin）. The enhanced CT was performed to determine The clinical effects one week and 1,3,6 and 12 months after operation. The differences between two groups before and after treatment were analyzed by European Organization for Research and Treatment of Cancer Quality of Life Qu Cancer 13 Chinese Edition （EORQLQ -LC13 Chinese Edition）, Quality of Survival Assessment Tablefor Lung Cancer and survival time. Results No severe complications occurred after treatment incombined treatment group. Postoperative enhanced CT indicated that the focus gradually weakened 1month after operation, the locations of 1251 particles aggregated 3 to 6 months after operation,solidification and necrosis of focus then gradually took place, blank cavity formed, and obviousdevascularization and coagulative necrosis happened. Patients were followed up for 7 survival of combined treatment group was 88.9%, and tha t of eonventionLl treatmen t group was 49.1%. There was no significant difference in EORQLQ -LC13 and total quality of surbetween two groups（P〉0, 05）, After treatment, EORQLQ -LC13 and total quality of survival scores in two groups significantly improved （P〈0.05） ; and EORQLQ -LC13 and totll quality of survivin combined treatment group were much bet ter than those in eonventionLl Themeansurvivaltime incombined treatment groupwas（18, 4±5.8 ）months,which was significantly longer than that in eonventionLl reatment group [（10.9 ±4, 2） months] （ t =5.763, P 〈0.05 ） ,Conclusions tt is a simple, safe, minimally invasive and effective method to treat lung cancer withpermanent implantation of ^125I particles and radiofrequency ablation with real-time temperature measurement, which can improve the quality of life and prolong patient survivll in combination with conventional chemotherapy.