放射性^(125)I粒子植入治疗放化疗后进展晚期恶性肿瘤患者的临床分析

Clinical analysis of radioactive particle125I implantation in the treatment of progressive advanced malignant tumors after radiochemotherapy

目的探讨放射性125I粒子植入治疗放化疗后进展晚期恶性肿瘤临床分析。方法选取2014年1月至2017年12月间响水县人民医院收治的59例放化疗后进展晚期恶性肿瘤患者,通过三维肿瘤治疗计划系统(3D-TPS)进行恶性肿瘤三维立体重建,计算所需125I总活度及数目,CT引导下植入125I,2个月后评价近期客观疗效,比较治疗前后生活质量(ADL)评分、Karnofsky功能状态(KPS)评分以及美国疼痛协会癌痛(APS-POQ)分级,并记录治疗期间不良反应情况,随访2年,记录1年和2年生存率。结果 59例放化疗后进展晚期恶性肿瘤患者,治疗两个月后总缓解率为62.7%,1年生存率为62.7%,2年生存率为42.4%。患者癌痛分级治疗前后比较,差异有统计学意义(P<0.05)。患者治疗后ADL评分和KPS评分均高于治疗前,差异有统计学意义(P<0.05)。术后各类肿瘤患者均出现一定不良反应,对症治疗后均明显缓解。结论放射性125I粒子植入治疗放化疗后进展晚期恶性肿瘤,近期疗效良好,能显著降低癌痛,提高生活质量及功能状态,且治疗安全有效。

Objective To study the clinical analysis of radioactive particle ^（125）I implantation in the treatment of progressive advanced malignant tumors after radiochemotherapy.Methods Fifty-nine patients with progressive advanced malignant tumors after radiochemotherapy treated at Xiangshui County People＇s Hospital from January 2014 to December 2017 were included in this study as the observational objects.Three-dimensional reconstruction of malignant tumors was performed using the 3D-radiation treatment planning system（3D-TPS） system.The total activity and number of ^（125）Ⅰ were calculated.^（125）Ⅰ was implanted with the guidance of CT.Recent objective efficacy was evaluated after 2 months.The quality of life score（ADL）,Karnofsky functional status score（KPS） and American Pain Association cancer pain Grading（APS-POQ）before and after the treatment were compared.Adverse reactions during treatment were recorded.During a follow-up of 2 years,the survival rates were record at 1 year and 2 years after the treatment.Results At 2 months after the treatment,the overall remission rate was 62.7%,1-year survival rate was 62.7% and the 2-year survival rate was 42.4%.The difference in APS-POQ cancer pain with specific grade before and after the treatment was significant（P〈0.05）.After the treatment,ADL score and KPS score were significantly higher than those before treatment（P〈0.05）.All types of cancer patients had some adverse reactions after surgery,which significantly were relieved after symptomatic treatment.Conclusion Radioactive particle^（125）Ⅰ implantation in the treatment of progressive advanced malignant tumors after radiochemotherapy shows good short-term efficacy.It can significantly reduce cancer pain and improve the quality of life and functional status,being safe and effective.