CT引导下碘-125粒子植入治疗非小细胞肺癌并椎体转移癌的安全性与有效性

Safety and efficacy of CT guided iodine-125 particle implantation in the treatment of non small cell lung cancer patients with vertebral metastatic carcinoma

目的探讨CT引导下碘-125粒子植入治疗非小细胞肺癌(NSCLC)并椎体转移癌的安全性与有效性。方法选取经皮椎体成形术(PVP)联合CT引导下碘-125粒子植入治疗的40例患者为观察组,PVP联合吉西他滨、顺铂治疗的40例患者为对照组。比较2组治疗有效性、安全性、PVP手术效果及骨代谢指标[Ⅰ型胶原吡啶交联终肽(ICTP)、骨特异性碱性磷酸酶(BALP)]、外周血肿瘤循环细胞(CTCs)的变化。结果观察组完全缓解率、部分缓解率、客观缓解率、临床获益率依次为40. 00%、55. 00%、95. 00%、100. 00%,显著高于对照组的2. 50%、30. 00%、32. 50%、75. 00%(P <0. 05)。观察组疼痛完全缓解率、无效率以及临床缓解率均显著优于对照组(P <0. 05)。治疗前,2组病变椎体前缘、椎体中线及椎体后缘高度对比无显著差异(P> 0. 05);治疗后,2组病变椎体前缘、椎体中线及椎体后缘高度均显著改善(P <0. 05),但2组组间比较差异均无统计学意义(P> 0. 05)。治疗前,2组骨代谢指标ICTP、BALP水平比较无显著差异(P> 0. 05);治疗后,2组ICTP、BALP水平均显著下降,且观察组显著低于对照组(P <0. 05)。治疗后,2组CTCs阳性表达率均显著下降,且观察组阳性表达率显著低于对照组(P <0. 05)。对照组不良反应发生率高达70. 00%(28/40),显著高于观察组的20. 00%(P <0. 05)。结论 CT引导下碘-125粒子植入治疗NSCLC并椎体转移癌安全有效。

Objective To explore the safety and efficacy of CT guided iodine-125 particle implantation in the treatment of non small cell lung cancer (NSCLC) patients with vertebral metastatic carcinoma. Methods A total of 40 patients treated by percutaneous vertebroplasty (PVP) and CT guided iodine-125 particle implantation were selected as observation group, and 40 patients treated by gemcitabine combined with cisplatin were selected as control group. The efficacy, safety, surgical effect of PVP, and changes of bone metabolic indexes [type I collagen pyridine crosslinked terminal peptide (ICTP), bone specific alkaline phosphatase (BALP)] and peripheral blood tumor circulating cells (CTCs) were compared between the two groups. Results The complete remission rate, partial remission rate, objective remission rate and clinical benefit rate of the observation group were 40.00%, 55.00%, 95.00% and 100.00% respectively, which were significantly higher than 2.50%, 30.00%, 32.50% and 75.00% of the control group ( P <0.05). The complete pain relief rate, inefficiency rate and clinical remission rate of the observation group were significantly better than those of the control group ( P <0.05). Before treatment, there were no significant differences in the height of the anterior edge, midline and posterior edge between the two groups ( P >0.05). After treatment, the height of the anterior edge, midline and posterior edge of the lesions in both groups improved significantly ( P <0.05), but there were no significant differences between the two groups ( P >0.05).Before treatment, there were no significant differences in the levels of ICTP and BALP between the two groups ( P >0.05). After treatment, the levels of ICTP and BALP in both groups decreased significantly, and the observation group was significantly lower than the control group ( P <0.05). After treatment, the positive expression rate of CTCs in both groups decreased significantly, and the positive expression rate in the observation group was significantly lower than that in the control group ( P < 0.05). The incidence rate of adverse reactions in the control group was 70.00%(28/40), which was significantly higher than 20.00% in the observation group ( P <0.05). ConclusionThe CT guided iodine-125 particle implantation is effective and safe in the treatment of NSCLC patients with vertebral metastatic carcinoma.