超声引导放射性粒子治疗复发性肝癌的疗效及安全性评价

Ultrasound-guided radioactive seed implantation for treatment of recurrent hepatocellular carcinoma

目的评价超声引导下放射性粒子植入治疗复发性肝癌的疗效。方法选取2014年1月至2018年12月于解放军总医院第一医学中心接受超声引导下粒子植入治疗的肝癌患者31例,共计33个病灶。对31例复发性肝癌患者进行影像重建,导入放射治疗计划系统(TPS)进行术前规划,术中实时超声引导下按照规划布放粒子,术后增强影像扫描重建并利用TPS系统进行放射剂量学评估及疗效评价。评价指标包括术后2、3、6、12个月的影像学改变,术后并发症、肿瘤局部控制率、无进展生存时间(PFS)、总生存期(OS)。以Kaplan-Meier法绘制生存曲线。结果所有手术均顺利完成,中位随访时间25个月,术后2个月随访病例完全缓解率、部分缓解率、疾病稳定率和局部控制率分别为3%(1/33),15.2%(5/33),75.8%(25/33),93.9(31/33),2例出现局部进展(6.1%,2/33);术后12个月局部控制率为90.9%(30/33);术后1、3、5年的总生存率为91%、81%、50%,平均无进展生存时间为27.6个月,中位无进展生存时间为23.2个月。术后疼痛5例,发热2例,腹泻1例。结论超声引导下放射性粒子治疗复发性肝癌临床疗效确切,是一种安全有效的治疗方法。

Objective To evaluate the efficacy of ultrasound-guided radioactive seed implantation in the treatment of recurrent hepatocellular carcinoma.Methods Image reconstruction was performed in 31 patients with recurrent hepatocellular carcinoma.Preoperative planning was carried out by using the treatment planning system(TPS).Particles were placed according to the plan under the guidance of real-time ultrasound during operation.Postoperative enhanced imaging reconstruction was performed,and radiodosimetric evaluation and curative effect evaluation were carried out using the TPS.The indicators evaluated included imaging changes at 3,6 and 12 months after operation,postoperative complications,local tumor control rate,progression-free survival(PFS),and overall survival(OS).SPSS 19.0 software was used for statistical analyses,and Kaplan Meier method was used to plot the survival curve.Results All operations were successfully completed.The median follow-up time was 25 months.The complete remission rate,partial remission rate,disease stability rate,and local control rate were 3%(1/33),15.2%(5/33),75.8%(25/33),and 93.9(31/33),respectively,and two(6.1%,2/33)cases had local progress.The local control rate was 90.9%(30/33)at 12 months after operation.The overall survival rates were 91%,81%,and 50%,respectively,at 1,3,and 5 years after operation.The average progression-free survival time was 27.6 months and the median progression-free survival time was 23.2 months.Postoperative pain occurred in five cases,fever in two cases,and diarrhea in one case.Conclusion Ultrasound-guided radioactive particle therapy for recurrent hepatocellular carcinoma is effective and safe.