CT引导下放射性^(125)I粒子植入治疗复发性宫颈癌的疗效及生存分析

Survival analysis on CT-guided radioactive ^(125)I seed implantation in the treatment of recurrent cervical cancer

目的探讨CT引导下放射性^(125)I粒子植入治疗复发性宫颈癌的安全性和有效性。方法回顾性分析自2018年1月至2020年12月在江苏省肿瘤医院行放射性^(125)I粒子植入近距离放射治疗的31例复发性宫颈癌,患者的病史、剂量-体积直方图参数、并发症、局部控制(LC)、总生存(OS)和影响因素。结果31例复发性宫颈癌患者共有43个病灶进行放射性^(125)I粒子植入。截至2021年3月17日,中位随访时间为10个月。中位LC及OS时间分别为9个月(1~27个月)和10个月(2~36个月)。1年和2年的局部控制率分别为73.3%和43.2%,1年和2年的总生存率分别为81.8%和51.3%。8例因肿瘤进展死亡,2例因非肿瘤原因死亡。与粒子植入手术相关的并发症包括气胸、坐骨神经损伤、呕吐、尿频、腹泻、皮肤黏膜毒性,均为1~2级,未发生严重不良反应和并发症。多因素分析显示保形指数(CI)(HR=5.713,95%CI:1.324~24.646,P=0.019)及短期疗效(HR=47.009,95%CI:6.674~331.085,P<0.001)是影响LC的独立影响因素,高目标区域外部指数(EI)(HR=5.334,95%CI:1.099~25.877,P=0.038)是OS的独立影响因素。结论CT引导下放射性^(125)I粒子植入作为复发性宫颈癌局部治疗的一种手段,具有安全、有效、微创等特点,值得临床推广应用。

Objective To investigate the safety and efficacy of CT-guided radioactive ^(125)I seed implantation in the treatment of recurrent cervical cancer.Methods A retrospective analysis was performed on 31 patients with recurrent cervical cancer who received radioactive ^(125)I seed implantation brachytherapy in Jiangsu Cancer Hospital from January 2018 to December 2020.The history,dose-volume histogram parameters,complications,local control(LC),overall survival(OS)and influencing factors were analyzed.Results A total of 43 lesions in 31 patients received radioactive ^(125)I seed implantation.By March 2021,the median follow-up time was 10 months.The median duration of LC and OS was 9 months(1-27 months)and 10 months(2-36 months)respectively.The LC and OS rates at 1 and 2 years were 73.3%,43.2%and 81.8%,51.3%.Eight patients died from tumor progression,and two patients died of non-neoplastic causes.Complications related to particle implantation included pneumothorax,sciatic nerve injury,vomiting,frequent micturition,diarrhea,skin and mucosal toxicity,all of which were of grade 1-2.And no serious side effects or complications occurred.Multivariate analysis showed that the conformal index(CI)(HR=5.713;95%CI=1.324-24.646,P=0.019)and short-term efficacy(HR=47.009;95%CI=6.674-331.085,P=0.000)were the independent factors affecting LC.And the external index of high target region(EI)(HR=5.334;95%CI=1.099-25.877,P=0.038)was closely associated with poor OS.Conclusions Radioactive ^(125)I seed implantation guided by CT is a safe,effective and minimally invasive method for local treatment of recurrent cervical cancer,which is worthy of clinical application.