^(125)I放射性粒子植入联合原位微波灭活术对骨盆转移性肿瘤的近远期疗效分析

Short-term and long-term efficacy of ^(125)I radioactive seed implantation combined with situ microwave inactivation on pelvic metastatic tumor

目的探讨^(125)I放射性粒子植入(radioactive seed implantation,RSI)联合原位微波灭活术对骨盆转移性肿瘤的近远期疗效。方法本研究是一项单中心回顾性临床研究,根据治疗方式将2017年1月至2021年12月解放军联勤保障部队第九四〇医院骨科收治的90例骨盆转移性肿瘤患者分为观察组(^(125)I RSI联合原位微波灭活术,38例)与对照组(原位微波灭活术,52例),比较两组患者的围手术期资料、手术前后视觉模拟评分法(visual analogue scale,VAS)评分、卡氏功能状态(Karnofsky performance status,KPS)评分以及远期生存状况。结果全部患者均成功完成既定术式,未发生神经损伤、深部感染、死亡等严重并发症。观察组患者手术时间显著长于对照组(P<0.05)。两组患者术中出血量、术后切口延迟愈合发生率比较差异均无统计学意义(均P>0.05)。两组患者术后1周、2个月、6个月的VAS评分均显著低于本组术前(均P<0.05),KPS评分均显著高于本组术前(均P<0.05)。观察组患者术后2个月、6个月的VAS评分均显著低于同期对照组(均P<0.05),KPS评分均显著高于同期对照组(均P<0.05),而两组患者术后1周的VAS评分与KPS评分比较差异均无统计学意义(均P>0.05)。全部患者共随访7~43个月,中位随访时间为18.3个月,两组患者局部复发率、术后1年和2年生存率、中位总生存时间比较差异均无统计学意义(均P>0.05)。结论^(125)I RSI联合原位微波灭活术对骨盆转移性肿瘤患者的近期疗效优于单用原位微波灭活术,能迅速缓解患者的疼痛感,提高功能状况,安全性高,但远期疗效及生存状况未见明显改善。

Objective To investigate the short-term and long-term efficacy of ^(125)I radioactive seed implantation(RSI)combined with situ microwave inactivation on pelvic metastatic tumor.Method This study is a single center retrospective clinical study.According to the treatment methods,90 patients with pelvic metastatic tumors admitted to the Department of Orthopaedics,the 940th Hospital of Joint Logistics Support Force of CPLA from January 2017 to December 2021 were divided into observation group(125I RSI combined with situ microwave inactivation,38 cases)and control group(microwave situ inactivation,52 cases).The perioperative data,visual analogue scale(VAS),Karnofsky performance status(KPS)score and long-term survival status of the two groups were compared before and after operation.Result All patients successfully completed the established operation without serious complications such as deep infection,nerve injury and death.The operation time of observation group was significantly longer than that of control group(P<0.05),but there were no significant differences in the amount of intraoperative bleeding and the incidence of delayed wound healing between the two groups(all P>0.05).Compared with the preoperative level within the group,the VAS scores of patients in the two groups significantly decreased at 1 week,2 months,and 6 months after operation(all P<0.05),while the KPS scores significantly increased(all P<0.05).Compared with control group during the same period,the VAS scores of patients in observation group were significantly decreased and KPS scores were significantly increased at 2 months and 6 months after operation(all P<0.05),but there were no significant differences in VAS scores and KPS scores of patients between the two groups at 1 week after operation(all P>0.05).All patients were followed up for 7-43 months,and the median follow-up time was 18.3 months.There were no significant differences in local recurrence rate,1-year survival rate,2-year survival rate and median overall survival between the two groups(all P>0.05).Conclusion The short-term efficacy of ^(125)I RSI combined with situ microwave inactivation for patients with pelvic metastatic tumors is superior to that of situ microwave inactivation alone.It can quickly relieve pain,improve functional status,and have high safety.However,there is no significant improvement in long-term efficacy and survival status.