CT引导下放射性粒子植入治疗难治性肝癌的临床分析

Clinical efficacy analysis of CT-guided radioactive seed implantation for treatment of refractory hepatic malignancies

目的探讨放射性~(125)Ⅰ粒子植入治疗难治性肝癌的临床疗效和安全性。方法收集经病理诊断明确为肝癌且经CT引导下放射性~(125)Ⅰ粒子植入治疗患者的临床影像学资料进行分析,对患者进行为期12个月的随访,评价~(125)Ⅰ粒子植入治疗难治性肝癌的疗效及安全性。结果 17例患者21个病灶共植入粒子769枚,平均每个病灶植入36.6枚,术后进行放疗计划系统(Radiotherapy Treatment Planning System,TPS)系统剂量验证,D_(90)平均值为92.3 Gy(88~110 Gy),V_(100)平均值为91%(81%~126%);粒子植入术后6个月总有效率最高为82.4%,术后9个月病灶完全缓解例数最多(10例),后均呈逐渐下降趋势;其中9例同时行MRI检查,术后6个月病灶T2加权成像(T2-weighted imaging,T2W1)及弥散加权成像(diffusion weighted imaging,DWI)信号降低最明显;14例肝细胞肝癌患者,术前甲胎蛋白(alpha fetal protein,AFP)升高者11例,术后9个月9例AFP降低。出现肝包膜下少量出血1例,粒子移位到肺部1例,术后出现发热1例。结论经临床综合多种治疗后效果不佳的难治性肝癌患者采用CT引导下组织间放射性~(125)Ⅰ粒子植入治疗近期效果显著,安全性高。

Objective:To investigate the clinical efficacy and safety of radioactive 125Ⅰseed implantation in the treatment of refractory hepatic malignancies.Methods The data of patients who were pathologically diagnosed as hepatic malignancies and treated with CT-guided radioactive 125Ⅰparticle implantation were collected.The patients were followed up for 12 months to evaluate the efficacy and safety of 125Ⅰparticle implantation in the treatment of refractory hepatic malignancies.Results A total of 769 particles were implanted in 21 lesions in 17 patients with an average of 36.6 implants in each lesion.After Radiotherapy Treatment Planning System(TPS)dose verification,the average D90 was 92.3 Gy(range 88~110 Gy),and the average V100 was 91%(range 81%~126%).The total effective rate was 82.4%at 6 months after particle implantation.The number of patients with complete remission was the most(10 cases)at 9 months after the operation,and they all showed a gradual decline.Nine patients underwent MRI at the same time to observe the changes of T2-weighted imaging(T2W1)and diffusion weighted imaging(DWI)signals.The lesions of T2W1 and DWI were most obvious at 6 months.Among the 14 hepatocellular carcinoma patients,11 patients showed increased alpha fetal protein(AFP)before surgery,and 9 patients showed decreased AFP at 9 months after surgery.One patient had a small amount of hemorrhage under the liver capsule,one had particle translocation to the lungs,and one had fever after operation.Conclusions Patients with refractory hepatic malignancies with poor clinical outcome after multiple treatments have significant short-term effects and high safety with CT-guided interstitial radioactive 125Ⅰparticle implantation.