开放式磁共振实时透视引导125I放射性粒子治疗脑肿瘤的临床应用

125I radioactive particle implantation guided by open MR real-time imaging for the treatment of brain tumors: preliminary study on its clinical application

目的探讨开放式磁共振(MR)引导125I放射性粒子植入治疗脑胶质瘤及转移瘤的可行性及有效性。方法回顾性分析34例临床确诊的脑胶质瘤及转移瘤患者资料,包括初治脑胶质瘤6例,复发性恶性脑胶质瘤14例,脑转移瘤14例(乳腺癌脑转移6例,肺癌脑转移6例,结肠癌脑转移2例)。全部患者均采取了开放式MR引导下125I放射性粒子植入治疗。术前行治疗计划系统(TPS)确定125I放射性粒子的数量及空间分布,术中应用1.0 T开放式MR透视实时引导技术引导,术后24 h CT扫描并行剂量验证。定期随访观察术后疗效及并发症。结果根据WHO疗效评价标准,全组病例1、3和6个月有效率分别为47.1%、70.5%和80.1%;全组病例1年生存率为64.7%。并发症包括术中针道少量出血1例,癫痫发作1例,术后3个月出现认知功能障碍1例,术后8个月认知功能恢复正常。无治疗相关死亡病例。结论开放式磁共振引导125I放射性粒子植入治疗脑胶质瘤及转移瘤安全、可行、有效;MR透视实时引导技术操作简便、导引精确,可有效降低并发症发生率。

Objective To explore the feasibility and effectiveness of125 I radioactive particle implantation guided by open magnetic resonance(MR) real-time imaging in treating brain gliomas and metastases.Methods The clinical data of 34 patients with clinically proved brain tumors were retropectively analyzed,including initial brain glioma(n=6),recurrent malignant glioma(n =14)and brain metastasis(n=14). Of the14 brain metastases, brain metastasis from breast cancer was seen in 6 cases, brain metastasis from lung cancer in 6 cases and brain metastasis from colon cancer in 2 cases. Under the guidance of open MR real-time imaging,125 I radioactive particle implantation was performed in all patients. Before brachytherapy procedure,treatment plan system(TPS) was used to determine the required number of125 I radioactive particles and their reasonable spatial distribution. During the procedure, real-time imaging of a 1.0 T open MR scanner was used to guide the technical manipulation. CT scan was performed within 24 hours after the treatment and postoperative dosimetry verification was conducted. All the patients were regularly followed up to observe the curative effect and complications. Results According to the response evaluation criteria of WHO, the one-,3-and 6-month effective rates of all patients were 47.1%, 70.5% and 80.1% respectively, and the one-year survival rate was 64.7%. The complications included small amount bleeding in needle puncture track(n=1)and epileptic attack(n =1). One patient developed cognitive dysfunction 3 months after treatment, which returned to normal in eight months. No procedure-related death occurred. Conclusion For the treatment of brain gliomas and brain metastases,125 I radioactive particle implantation guided by open MR real-time imaging is clinically safe, feasible and effective. The technique of MR fluoroscopy real-time imaging guidance is easy to operate with precise orientation. This technique can effectively reduce the incidence of complications.