食管鳞状细胞癌颈部转移淋巴结放疗后复发 125I粒子植入治疗的近期疗效分析

Analysis of the short-term efficacy of 125I seed implantation for recurrent cervical metastatic lymph nodes of esophageal squamous cell carcinoma after external beam radiation therapy

目的:探讨 125I粒子治疗食管鳞状细胞癌(简称鳞癌)颈部转移淋巴结放疗后复发的近期疗效影响因素。 方法:回顾性分析2013年1月至2019年3月间于河北省人民医院行 125I粒子植入的食管鳞癌颈部转移淋巴结放疗后复发的47例患者(男42例,女5例;年龄:47~77岁)资料。 125I粒子治疗前后进行CT检查,术后3个月根据实体瘤疗效评价标准(RECIST)进行近期疗效评价,分为有效组[完全缓解(CR)+部分缓解(PR)]和无效组[病情稳定(SD)+病情进展(PD)]。采用多因素logistics回归分析近期疗效的独立影响因素,根据ROC曲线确定最佳界值。 结果:47例患者中有效组26例(CR 3例,PR 23例),无效组21例(SD 7例,PD 14例)。肿瘤最大径、术后即刻90%大体肿瘤体积接受的剂量( D90)和复发间隔时间是近期疗效的独立影响因素[比值比( OR)及其95% CI:4.240(1.220~14.737)、0.999(0.999~1.000)和0.989(0.979~1.000), Wald值:5.163、5.043和3.956,均 P<0.05]。ROC曲线分析示肿瘤最大径、术后即刻 D90和复发间隔时间的曲线下面积分别为0.782、0.786和0.838,最佳界值分别为4.85 cm、115.78 Gy和297.5 d。 结论:125I粒子治疗食管鳞癌颈部转移淋巴结放疗后复发的近期疗效主要与肿瘤最大径、术后即刻 D90和复发间隔时间有关。肿瘤最大径<4.85 cm,术后即刻 D90>115.78 Gy,复发间隔时间>297.5 d的患者近期疗效较好。

Objective To analyze the influencing factors of short-term efficacy of 125I seed implantation for recurrent cervical metastatic lymph nodes of esophageal squamous cell carcinoma after external beam radiation therapy(RESCC).Methods From January 2013 to March 2019,47 patients(42 males,5 females;age:47-77 years)with RESCC who underwent CT guided 125I seed implantation in Hebei General Hospital were retrospectively analyzed.Patients were divided into effective group(complete remission(CR)+partial remission(PR))and ineffective group(stable disease(SD)+progressive disease(PD))according to response evaluation criteria in solid tumors(RECIST)at 3 months after implantation.Multivariate logistic regression was used to analyze the independent influencing factors of short-term efficacy.Cut-off values were determined by ROC curve.Results Of 47 patients,26 were effective(3 were CR and 23 were PR)and 21 were ineffective(7 were SD,14 were PD).Multivariate regression analysis showed that tumor diameter,immediate postoperative dose delivered to 90%gross tumor volume(D90),recurrence interval time were independent influencing factors of short-term efficacy(odds ratio(OR;95%CI):4.240(1.220-14.737),0.999(0.999-1.000),0.989(0.979-1.000),Wald values:5.163,5.043,3.956,all P<0.05).ROC curve showed that the AUC of tumor diameter,D90 and recurrence interval time were 0.782,0.786 and 0.838 respectively,with cut-off values of 4.85 cm,115.78 Gy and 297.5 d respectively.Conclusions The short-term efficacy of 125I seed implantation for RESCC is mainly related to the tumor diameter,immediate postoperative D90 and recurrence interval time.Patients with tumor diameter<4.85 cm,immediate postoperative D90>115.78 Gy and recurrence interval time>297.5 d have better efficacy.