CT引导经胸骨路径125I粒子植入治疗纵隔肿瘤的临床价值

The clinical value of CT-guided I seed implantation via trans-sternum approach in treating mediastinal tumors

目的探讨经胸骨路径在CT引导125I粒子植入治疗位于前、中纵隔肿瘤的临床应用。方法收集2017年9月至2019年9月接受CT引导经胸骨路径125I粒子植入治疗的20例前、中纵隔肿瘤患者临床资料。记录术后即刻剂量学参数,观察术后粒子分布满意率、并发症发生率及局部疗效,随访术后半年、1年的生存率。结果术后即刻剂量验证剂量学参数如下:90%肿瘤靶区接受剂量(D90)(134.30±14.53) Gy;肿瘤靶区接受90%、100%、150%和200%处方剂量的体积百分比(V90、V100、V150和V200)分别为(97.15±2.09)%、(93.04±1.75)%、(66.86±7.53)%、(42.95±9.11)%;适形指数(conformity index,CI)、靶区外体积指数(EI)、均匀性指数(homogeneity index,HI)分别为0.65±0.06、(40.79±13.72)%、(27.90±7.53)%。粒子分布满意率90%。术后即刻1例患者出现气胸、1例患者出现咯血。平均随访(12.0±4.8)个月(4~24个月),术后2个月、半年、1年局部控制率分别为65.0%、64.7和53.8%。半年、1年生存率89.5%和81.3%。随访期间有4例患者死亡、3例患者出现局部进展,无放射相关并发症发生。结论经胸骨路径是CT引导125I粒子植入治疗前、中纵隔肿瘤的安全路径,术后粒子分布满意率高。

Objective To explore the clinical application of CT-guided125I seed implantation via trans-sternum approach in treating tumors located at anterior and middle mediastinum. Methods The clinical data of 20 patients with tumors located at anterior or middle mediastinum, who were admitted to the First Affiliated Hospital of Zhengzhou University of China during the period from September 2017 to September2019 to receive CT-guided125I seed implantation via trans-sternum approach, were retrospectively analyzed.The immediate postoperative dosimetry parameters were recorded. The postoperative satisfaction rate of125I seed distribution, the incidence of complications and local effect were evaluated. The patients were followed up, the 6-month and one-year survival rates were calculated. Results The immediate postoperative dose validation of dosimetric parameters showed that 90% tumor target dose(D90) was(134.30±14.53) Gy, the percentages of tumor target volume receiving 90% prescription dose(PD), 100% PD, 150% PD and 200%PD(V90, V100, V150 and V200) were(97.15±2.09)%,(93.04±1.75)%,(66.86±7.53)% and(42.95±9.11)%,respectively. The conformity index(CI), external index(EI) and homogeneity index(HI) were(0.65±0.06),(40.79±13.72)% and(27.90±7.53)%, respectively. The satisfaction rate of125I seed distribution was 90%.Immediately after treatment, one patient developed pneumothorax and one patient developed hemoptysis. The patients were followed up for a mean time of(12.0±4.8) months(ranging of 4-24 months). The postoperative 2-month,6-month and 12-month local control rates of were 65.0%, 64.7%, and 53.8%, respectively. The 6-month and12-month survival rates were 89.5% and 81.3%, respectively. During the follow-up period, 4 patients died, 3 patients developed deterioration of local lesions. No radiation-related complications occurred. Conclusion In treating tumors located at anterior and middle mediastinum with CT-guided125I seed implantation, the use of via trans-sternum approach is clinically safe, and the satisfaction rate of125I seed distribution is high.