125I粒子腔内照射联合瘤体内粒子植入治疗局部进展期胰头癌

125I Intracavitary Irradiation Combined With 125I Seeds Implantation in the Treatment of Locally Advanced Pancreatic Head Cancer

目的探讨导管载入式125I粒子(SEMS-CL-125I)腔内照射联合瘤体内125I粒子植入治疗局部进展期胰头癌(locally advanced pancreatic head carcinoma,LA-PHC)的疗效。方法回顾性分析2015年1月2017年6月我科125I粒子照射治疗55例LA-PHC的临床资料,其中SEMS-CL-125I腔内照射法治疗31例(腔内组),SEMS-CL-125I腔内照射联合瘤体内125I粒子植入治疗24例(联合组)。比较2组患者术后主要生化指标、疼痛缓解、影像学、中位生存期及并发症发生等情况。结果与腔内组相比,联合组术后3个月疼痛缓解更佳(Z=-2. 170,P=0. 030),肿瘤影像学缓解更佳(Z=-2. 362,P=0. 018)。2组并发症发生率无显著差异(P> 0. 05),且均未出现术后出血、胰漏、粒子移位等严重并发症。与腔内组比较,联合组中位生存时间显著延长(9个月vs. 12个月,χ^2=13. 302,P=0. 000)。结论与单纯125I粒子腔内照射相比,125I粒子腔内照射联合实体瘤125I粒子植入对LA-PHC疗效更佳,可改善患者的一般身体状况,提高支架通畅率,同时表现出更佳的肿瘤进展控制,生存质量提高及生存期延长,且并不增加并发症。

Objective To explore the therapeutic efficacy of metal biliary stent (SEMS) catheter loaded 125 I particle (SEMS-CL- 125 I) intracavitary irradiation combined with 125 I seed implantation in the solid tumor in the treatment of locally advanced pancreatic head carcinoma (LA-PHC). Methods Clinical data of 55 patients with LA-PHC from January 2015 to June 2017 were retrospectively analyzed. Amongst, 31 cases were treated with SEMS-CL- 125 I intracavitary irradiation (intracavitary group) and 24 cases were treated with SEMS-CL- 125 I intracavitary irradiation combined with 125 I particle implantation in the solid tumor (combined group). The biochemical indexes changes, pain relief, imaging improvement, survival time and complications were compared between the two groups. Results Patients in the combined group had better pain improvement within 3 months ( Z =-2.170, P =0.030) and better imaging remission ( Z =-2.362, P =0.018). There was no significant difference in postoperative complications between the two groups ( P >0.05), and no serious complications such as postoperative bleeding, pancreatic fistula or particle transposition were observed in both groups. Compared with the intracavitary group, the median survival time of patients in the combined group was significantly longer (9 months vs. 12 months,χ^2=13.302, P =0.000). Conclusions Compared with intracavitary irradiation alone, 125 I intracavitary irradiation combined with seed implantation in the solid tumor is more effective for LA-PHC patients. It significantly improves patients’ general conditions and stent patency, while shows better control for the tumor progression and the improvement of survival time, but does not increase the occurrence of complications.