手术加^(125)I粒子永久性植入治疗肺癌单发脑转移瘤的临床疗效及放射性脑损伤程度的研究

Efficacy of Permanent Interstitial Implantation of ^( 125)I Seeds for Solitary Brain Metastasis from Non-small Cell Lung Carcinoma

背景与目的:研究证实全脑放射治疗可引起放射性脑损伤,因此,探索一条能取代全脑照射而不影响疗效的新的治疗方法十分必要。本研究的目的就是评价手术加125I粒子永久性组织间植入治疗非小细胞肺癌单发脑转移瘤的疗效及放射性脑损伤程度。方法:将67例非小细胞肺癌单发脑转移瘤随机分为:手术加125I粒子植入组(植入组)32例(47.8%);全脑加小野照射组(常规组)35例(52.2%)。所有患者均经病理证实为非小细胞肺癌,其中鳞癌42例,腺癌25例。CT或MRI证实67例患者颅内有转移灶且为单发。植入组行局部脑转移瘤切除术,术后根据肿瘤大小、部位、125I粒子排列距离和每粒粒子剂量大小确定插入粒子数量。粒子植入部位:在肿瘤切除部位及周围组织或手术区域肿瘤可能残存或复发部位。常规组先行全脑照射,2～3Gy/次,5次/周,照射至剂量为30～39Gy/3～4周后缩小野加量,总剂量达45～55Gy/5～6周。结果:植入组局控率、复发率、中位复发时间分别为96.9%、15.6%和9个月;常规组分别为82.9%、17.1%和7个月,两组比较均无统计学意义(P>0.05)。植入组的中位生存时间、1年生存率、1年死亡率分别为12个月、40.6%以及28.1%;常规组为9个月、31.4%以及37.1%,两组比较均有显著性差异(P<0.05)。植入组急性放射性反应明显轻于常规组。

Background & Objective:Some studies have already showed that whole brain irradiation (WBI) could cause radiation brain damage. It is necessary to explore a novel treatment modality to replace whole brain irradiation without influencing the therapeutic efficacy. The purpose of this study was to assess the therapeutic efficacy and radiation brain damage of permanent interstitial implantation of 125I seeds following tumor resection for solitary brain metastasis from non small cell lung carcinoma (NSCLC). Methods:Sixty seven patients with solitary brain metastasis from non small cell lung carcinoma were randomly assigned into two groups:Thirty two cases(47 8%) were treated with resection and permanent interstitial implantation of 125I seeds(I),and 35(52 2%) received whole brain irradiation and local small field radiation (C). All patients were biopsy verified non small cell lung carcinoma, including 42 squamous cell carcinomas and 25 adenocarcinomas. They all were solitary brain metastasis from non small cell lung carcinoma diagnosed by CT or MRI. After resection of solitary brain metastasis,different numbers of 125I seeds were implanted according to some parameters in groupⅠ. In group C, 35 patients received whole brain irradiation to a total dose of 30～39 Gy/3～4 weeks, 2～3 Gy/ fraction, 5 fractions/week followed by a boost of 15～25 Gy/2～3 weeks through local small fields. Results:The local control rate, the recurrent rate,and the median recurrent time were 96 9%, 15 6%,and 9 months in group Ⅰ, and 82 9%, 17 1%,and 7 months in group C, respectively. The differences were no significant (P >0 05). The median survival time, the 1 year survival rate, and the 1 year mortalities were 12 months, 40 6%,and 28 1% in group Ⅰ, and 9 months, 31 4%,and 37 1% in group C, respectively. The differences were significant(P< 0 05). Acute irradiation response and radiation brain damage were markedly milder in group Ⅰ than in group C. Conclusions: The results from this study show that resection and permanent interstitial implantation of 125I seeds for solitary brain metastasis from non small cell lung carcinoma can not only improve the survival rates and decrease the mortalities, but also reduce radiation brain damage to improve the life quality. It is a good and effective modality, especially for younger patients. However,further study for long term effect is needed.