CT引导下125I粒子植入术对晚期肺癌及肺转移癌的治疗作用

Therapeutic Effect of CT-guided 125I Seed Implantation on Advanced Lung Cancer and Pulmonary Metastatic Carcinoma

背景与目的原发性肺癌及肺转移癌均为常见肺部恶性肿瘤,是主要的癌症相关死亡原因。晚期肺癌及肺转移癌以全身治疗为主,局部治疗对全身治疗后肺部残存的顽固性病灶或复发病灶为一种有效治疗手段。125I放射性粒子植入作为一种高效的适形放疗,对肺部局限性癌灶具有一定的控制作用。本研究旨在探讨计算机断层扫描(computed tomography,CT)引导下经皮穿刺肺组织间125 I放射性粒子植入治疗晚期肺癌和肺转移癌的临床效果及安全性。方法连续性收集2014年1月1日-2018年11月30日浙江大学医学院附属第一医院胸外科行125 I放射性粒子植入术治疗的105例晚期肺癌和肺转移癌患者的临床病理资料,术后随访至2019年3月。观察粒子植入术的临床疗效及并发症发生情况。结果本研究共纳入105例患者,晚期肺癌患者78例,肺转移癌患者27例。粒子治疗患者术后中位生存时间为395天,术后1年生存率约为78.1%,术后2年生存率约为56.1%。粒子植入治疗晚期肺癌的效果与肺转移癌的效果相当。粒子联合射频消融、微波消融、化疗并没有提高粒子治疗效果。但是粒子联合外放射治疗较单纯粒子治疗具有显著生存劣势。结论CT引导下125 I放射性粒子植入术并发症可控,可以作为晚期肺癌和肺转移癌的一种安全有效的治疗方法。

Background and Objective Primary lung cancer and metastatic lung cancer are common ma-lignant tumors of the lung and are the main cause of cancer-related death.Advanced lung cancer and lung metastatic cancer are mainly treated by systemic therapy,and local treatment is also an effective treatment for the refractory or recurrent lesions in the lungs after systemic treatment.125 I radioactive particle implantation,as an efficient conformal radiotherapy,has a certain control effect on localized lung cancer.The purpose of this study was to investigate the clini-cal efficacy and safety of computed tomography(CT)guided percutaneous puncture of lung tissue with 125 I radioactive particle implantation in the treatment of advanced lung cancer and lung metastatic cancer.Methods Continuouslycol-lectedthe clinical and pathological data of 105 patients with advanced lung cancer and metastatic lung cancer treated by 125 I radioactive seed implantation in the Department of Thoracic Surgery,First Affiliated Hospital of Zhejiang Univer-sity School of Medicine from January 1,2014 to November 30,2018.The patients were followed until March,2019.The clinical efficacy and complications of seedimplantation were analyzed.Results A total of 105 patients were included in the study,78 patients with advanced lung cancer and 27 patients with lung metastases.The median survival time after seed therapy was 395 days.The 1-year survival rate was about 78.1%,and the 2-year survival rate was about 56.1%.Seed implantation for advanced lung cancer is equivalent to lung metastasis.Seed combined with radiofrequency ablation,microwave ablation,and chemotherapy did not improve seed treatment.However,particle combined with external ra-diation therapy has a significant survival disadvantage compared with simple seed therapy.Conclusion The CT-guided 125 I radioactive seed implantation has controllable complications and can be used as a safe and effective treatment for advanced lung cancer and lung metastases.