^(125)I粒子植入治疗合并气道狭窄的难治性甲状腺癌的临床疗效

The clinical efficacy of ^(125)I seed implantation for the treatment of refractory thyroid cancer complicated by airway stenosis

目的探讨^(125)I粒子植入治疗合并气道狭窄的难治性甲状腺癌的疗效和安全性。方法收集2017年12月至2021年12月郑州大学第一附属医院行^(125)I粒子植入治疗合并气道狭窄的难治性甲状腺癌患者15例。通过CT引导下植入放射性^(125)I粒子,活度为0.3~0.8 mCi,处方剂量为80~120 Gy。随访观察肿瘤客观缓解情况、气道狭窄改善情况及不良反应等。结果术后即刻靶区D_(90)、V_(90)、V_(100)、V_(150)、V_(200)、CI、EI、HI分别为(105.30±11.22)Gy、(98.15±11.23)%、(93.01±1.15)%、(63.72±6.13)%、(42.15±6.26)%、0.63±0.07、(41.55±13.32)%、(27.72±7.13)%。术后2个月CR为1例,PR为10例,SD为4例。术后2个月、4个月、6个月客观缓解分别为11例、12例、15例。15例患者术前肿瘤大小及气道直径为(7.53±1.82)cm、(0.52±0.20)cm,术后2个月肿瘤大小及气道直径为(4.35±1.51)cm、(0.62±0.23)cm,术后6个月肿瘤大小及气道直径为(2.15±1.12)cm、(1.03±0.22)cm。2例患者粒子距离食管较近,植入2周后出现间断恶心、呕吐、咽下疼痛,症状较轻,给予解痉、抑酸、低剂量泼尼松口服后缓解。2例患者粒子距离皮肤较近,植入1个月后出现皮肤色素沉着,未出现破溃、感染,考虑1级放射性皮肤损伤。1例患者术后2个月因肿瘤完全缓解,粒子聚集,局部剂量过高,出现4级放射性损伤,皮肤色素沉着、溃烂、窦道形成,粒子部分脱落,经整形外科处理后愈合。所有患者均未出现因穿刺导致的窒息、死亡等即刻并发症。结论^(125)I粒子植入治疗合并气道狭窄的难治性甲状腺癌安全有效。

Objective To explore the efficacy and safety of ^(125)I seed implantation in treating refractory thyroid cancer(RTC)complicated by airway stenosis.Methods A total of 15 patients with RTC complicated by airway stenosis,who were admited to the First Affiliated Hospital of Zhengzhou University of China to receive CT-guided ^(125)I seed implantation between December 2017 and December 2021,were collected.CTguided ^(125)I seed implantation was performed in all patients.The activity of ^(125)I seed was 0.3-0.8 mCi,and the prescribed dose was 80-120 Gy.The patients were followed up,and the objective remission stenosis of tumor,the improvement of airway stenosis and the adverse reactions were calculated.Results Successful CT-guided ^(125)I seed implantation was accomplished in all 15 patients.Immediately after surgery the D_(90),V_(90),V_(100),V_(150),V_(200),CI,EI,and HI of the target volume were(105.30±11.22)Gy,(98.15±11.23)%,(93.01±1.15)%,(63.72±6.13)%,(42.15±6.26)%,(0.63±0.07),(41.55±13.32)%,and(27.72±7.13)%respectively.The postoperative 2-month,4-month and 6-month objective remission were 11/15,12/15 and 15/15 respectively.In the 15 patients,the preoperative mean tumor size and airway diameter were(7.53±1.82)cm and(0.52±0.20)cm respectively,the postoperative 2-month mean tumor size and airway diameter were(4.35±1.51)cm and(0.62±0.23)cm respectively,and the postoperative 6-month mean tumor size and airway diameter were(2.15±1.12)cm and(1.03±0.22)cm respectively.Two patients,in whom the implanted ^(125)I particles were close to the esophagus,developed intermittent nausea,vomiting,and swallowing pain 2 weeks after ^(125)I seed implantation,the clinical symptoms were mild,which were improved after oral administration of antispasmodic,acid-suppressive agents and lowdose prednisone medication.Two patients,in whom the implanted 1251 particles were close to the skin,developed skin pigmentation one month after ^(125)I seed implantation,and no ulceration or infection occurred,which was considered to be grade Ⅰ radiation skin damage.Two months after ^(125)I seed implantation,one patient developed grade Ⅳ radiation injury,including skin pigmentation,ulceration,sinus tract formation and partial ^(125)I seeds dropping off,because the tumor completely shrank and the 121 seeds became aggregation,resulting in excessive higher local radiation;the injuries were cured with plastic surgery.No puncture-related instant complications such as suffocation or death occurred in all patients.Conclusion For the treatment of RTC complicated by airway stenosis,CT-guided ^(125)I seed implantation is clinically safe and effective.