CT引导下125I放射性粒子植入联合化疗对结直肠癌骨转移患者的应用效果分析

Effect of CT guided 125I radioactive seed implantation combined with chemotherapy in colorectal cancer with bone metastasis

目的探讨CT引导下^(125)I放射性粒子植入联合化疗对结直肠癌骨转移患者的应用效果。方法回顾性分析2014年1月至2019年2月中国人民解放军空军军医大学第二附属医院收治的87例结直肠癌骨转移患者的临床资料与随访结果,根据治疗方式将患者分为观察组(CT引导下^(125)I放射性粒子植入术联合化疗,32例)与对照组(单纯化疗,55例),比较两组患者的近期肿瘤控制效果、局部疼痛的视觉模拟评分法(visual analogue score,VAS)评分、远期生存状况及并发症发生情况。结果两组患者治疗后1个月、3个月的VAS评分均显著低于本组治疗前(均P<0.05)。观察组患者治疗后1个月、3个月VAS评分均显著低于同期对照组(均P<0.05),治疗前疼痛为2级的患者占比、全部患者的治疗有效率均显著高于对照组(均P<0.05),客观缓解率、治疗后1年生存率均显著高于对照组(均P<0.05),中位生存时间显著长于对照组(P<0.05)。两组患者疾病控制率、治疗后3年生存率比较差异均无统计学意义(均P>0.05)。两组患者的不良反应以胃肠道反应与骨髓抑制较常见,观察组在放射性粒子植入期间未见持续高热、大出血、死亡等严重并发症,主要出现穿刺部位少量出血,予对症处理后好转。两组患者各不良反应发生率比较差异均无统计学意义(均P>0.05)。结论CT引导下^(125)I放射性粒子植入联合化疗能明显缓解结直肠癌骨转移患者的疼痛感,近远期疗效优于单纯化疗,安全性高。

Objective To investigate the effect of CT guided ^(125)I radioactive seed implantation combined with chemotherapy in colorectal cancer with bone metastasis.Method The clinical data and follow-up results of 87 colorectal cancer patients with bone metastasis treated in the Second Affiliated Hospital of Air Force Military Medical University of the People's Liberation Army from January 2014 to February 2019 were retrospectively analyzed.According to the treatment method,these patients were divided into observation group(CT guided ^(125)I radioactive seed implantation combined with chemotherapy,32 cases)and control group(pure chemotherapy,55 cases).The recent tumor control effect,visual analog score(VAS)of local pain,long term survival and complications were compared between the two groups.Result The VAS scores at 1 month and 3 months after treatment of the two groups were significantly lower than those before treatment(all P<0.05).For inter-group comparison,the VAS scores at 1 month and 3 months after treatment in observation group were significantly lower than those in control group at the same time(all P<0.05).The effective rates of patients with grade 2 pain before treatment and all patients in observation group were significantly higher than those in control group(all P<0.05),the objective response rate,1-year survival rate were significantly higher than those in control group(all P<0.05),and the median survival time was significantly longer than that in control group(P<0.05),there were no significant differences in disease control rate and 3-year survival rate between the two groups(all P>0.05).In terms of safety,the main adverse reactions of patients in the two groups were gastrointestinal reactions and bone marrow suppression.There were no serious complications such as continuous high fever,massive bleeding and death in the observation group during radioactive particle implantation,mainly a small amount of bleeding at the puncture site,which could be alleviated after symptomatic treatment.There were no significant differences in the incidences of adverse reactions between the two groups(all P>0.05).Conclusion CT guided ^(125)I radioactive seed implantation combined with chemotherapy can significantly alleviate the pain of colorectal cancer patients with bone metastasis,the short-term and long-term effect are better than that of simple chemotherapy,with high safety.