CT导向下放射性125Ⅰ粒子植入联合重组人血管内皮抑制素治疗椎体转移瘤的疗效观察

CT-guided radioactive 125I seed implantation combined with recombinant human endostatin in the treatment of vertebral metastases

目的:探讨CT引导下放射性125I粒子植入联合重组人血管内皮抑制素(恩度)治疗椎体转移瘤的技术方法及疗效分析。方法:对30例发生椎体转移的患者行肿瘤内放射性125I粒子植入治疗,植入颗粒数为15~85,125I粒子活度为29.6MBq(0.8mCi),肿瘤周边的匹配剂量为105~165Gy。术后同步给予重组人血管内皮抑制素7.5mg/m^2,d1~14静滴。术后行计量验证并观察患者疼痛及神经功能改善情况。结果:所有患者共随访6~36个月(平均15.6个月)。90%肿瘤靶体积接受的剂量(D90)中位值为118.12GY,125I粒子植入前伴有疼痛的26例患者,经治疗后疼痛完全缓解20例,疼痛部分缓解5例,有效止痛率为96%;其中有20例出现神经功能障碍的患者,15例患者经治疗后神经功能得到改善或恢复正常。粒子植入治疗4个月后复查CT,CT显示28个病灶完全或部分缓解,2个病灶显示稳定。有2例患者在粒子植入治疗8个月后出现再次复发,给予复发患者补种粒子治疗。椎体转移控制率为93%,1年生存率为60%。手术治疗期间未出现严重神经功能损伤。结论:CT引导下放射性125I粒子植入联合重组人血管内皮抑制素治疗椎体转移瘤的方法是安全有效的,可有效缓解疼痛,改善患者神经系统功能。

Objective To investigate the technique and efficacy of CT-guided radioactive 125I seed implantation combined with recombinant human endostatin(Endo)in the treatment of vertebral metastases.Methods 30 patients with vertebral metastasis were treated with 125I seed implantation.The number of implanted particles was 15~85,the activity of 125I seed was 29.6 MBq(0.8 mCi),and the matched dose around the tumor was 105~165 Gy.Recombinant human endostatin 7.5 mg/m^2 and d1~14 intravenous drip were given simultaneously after operation.Quantitative verification was performed and pain and neurological improvement were observed.Results All patients were followed up for 6 to 36 months(average 15.6 months).The median dose(D90)of 90%target volume was 118.12GY.There were 26 patients with pain before implantation of 125I seeds.Among them,20 patients had complete pain relief after treatment,5 patients had partial pain relief,and the effective rate of pain relief was 96%.There were 20 patients with neurological dysfunction and 15 patients with neurological function improved or returned to normal after treatment.Four months after implantation,28 lesions showed complete or partial remission and 2 lesions were stable.Relapse occurred in 2 patients 8 months after implantation,and particle replacement therapy was performed.The tumor control rate was 93%and the one-year survival rate was 60%.No severe neurological impairment occurred during the operation.Conclusion CT-guided percutaneous seed implantation combined with recombinant human endostatin is safe and effective in the treatment of vertebral metastases,which can effectively relieve pain and improve neurological function of patients.