CT导向下125I粒子植入联合髂内动脉化疗灌注治疗难治性复发性盆腔恶性肿瘤疗效评价

CT-guided ^(125)I particle implantation combined with iliac artery infusion chemotherapy for refractory and recurrent pelvic malignant tumors:evaluation of its curative effect

目的探讨CT导向下125I粒子植入联合髂内动脉化疗灌注治疗难治性复发性盆腔恶性肿瘤的临床疗效。方法选自2013年1月至2016年1月采用CT导向下125I粒子植入联合髂内动脉化疗灌注治疗难治性复发性盆腔恶性肿瘤35例患者为治疗组,与单纯采用125I粒子植入治疗的该类患者39例为对照组,对两组的近、远期疗效和临床症状改善进行比较。结果治疗组客观有效率60.0%(21/35),获益率85.7%(30/35);对照组客观有效率53.8%(21/39),获益率84.6%(33/39),两组客观有效率及获益率差异均无统计学意义(P=0.594,P=0.894);治疗组疾病无进展期平均12.2个月,对照组平均8.6个月,治疗组较对照组平均间隔时间延长了3.6个月,两组差异有统计学意义(P=0.002);治疗组复发率40.0%(12/30),对照组57.6%(19/33),两组比较差异有显著统计学意义(P=0.018)。治疗组治疗前后KPS平均值为72.4分和82.7分,对照组为68.9分和79.1分,各组治疗前后临床症状改善差异有统计学意义(P=0.043,P=0.039),两组治疗后临床症状改善差异无统计学意义(P=0.745)。结论对难治性复发性盆腔恶性肿瘤采用125I粒子植入是一种有效的治疗方案,但联合髂内动脉化疗灌注可以降低肿瘤复发,提高疾病无进展期。

Objective To evaluate the clinical value of CT-guided 125I particle implantation combined with iliac artery infusion chemotherapy in treating refractory and recurrent pelvic malignant tumors. Methods A total of 35 patients with refractory and recurrent pelvic malignant tumor, who were admitted to authors＇ hospital during the period from January 2013 to January 2016 to receive CT-guided 125I particle implantation combined with iliac artery infusion chemotherapy, were selected and used as the study group, while other 39 patients with refractory and recurrent pelvic malignant tumor received simple 125I particle implantation and were used as the control group. The short-term and long-term curative effect, as well as the improvement of clinical symptoms, were compared between the two groups. Results The objective effective rate and the benefit rate in the study group were 60.0% （21/35） and 85.7% （30/35） respectively, while those in the control group were 53.8% （21/39） and 84.6% （33/39） respectively, the differences between the two groups were not statistically significant （P=0.594 and P=0.894 respectively）. In the study group the mean disease progression- free period was 12.2 months, which was 3.6 months longer than that of 8.6 months in the control group, the difference between the two groups was statistically significant （P=0.002）. The recurrence rates in the study group and the control group were 40.0% （12/30） and 57.6% （19/33） respectively, the difference between the two groups was statistically significant （P=0.018）. The mean preoperative and postoperative KPS values in the study group were 72.4 points and 82.7 points respectively, which in the control group were 68.9 points and 79.1 points respectively; in each group statistically significant difference existed between the preoperative KPS value and the postoperative one （P=-0.043 and P=-0.039 respectively）, however, no statistically significant difference in postoperative KPS value existed between the study group and the control group （P=0.745）. Conclusion For the treatment of refractory and recurrent pelvic malignant tumors, CT-guided 125I particle implantation is an effective therapy, however, combination use of iliae artery infusion chemotherapy can reduce the incidence of tumor recurrence and prolong the disease progression-flee period.