CT引导下^(125)I粒子植入治疗不能手术切除的全身化疗失败后的结直肠癌肝转移的疗效及安全性

The efficacy and safety of CT-guided ~(125)I particle implantation in the treatment of liver metastases from colorectal cancer after failure of systemic chemotherapy without surgical resection

目的:评价CT引导下^(125)I粒子植入治疗不能手术切除的全身化疗失败后的结直肠癌肝转移(colorectal liver metastases,CRLM)的有效性和安全性。方法:回顾性分析2017年01月至2022年10月间我院核医学科收治的76例CRLM患者的临床资料,评价粒子植入肝转移灶疗效;采用两独立样本t检验及重复测量方差分析比较谷丙转氨酶(alanine aminotransferase,ALT)、谷草转氨酶(aspartate aminotransferase,AST)术前、术后差异;分析粒子植入术后总生存期(overall survival,OS),并分别比较左半结肠癌(left-side colon cancer,LSCC)、右半结肠癌(right-side colon cancer,RSCC)及直肠癌OS差异。结果:76例患者共133个肝转移灶,^(125)I粒子植入成功率为96.99%(129/133),术后6个月有效率80.62%,局部控制率89.92%。血清癌胚抗原(carcinoembryonic antigen,CEA)、糖类抗原19-9(carbohydrate antigen199,CA199)和甲胎蛋白(alpha fetoprotein,AFP)治疗前后比较差异均有统计学意义(t=2.803、5.015、2.221,P均<0.05)。76例患者粒子植入术后中位OS为26.25个月(范围为7.9~55个月);LSCC、RSCC及直肠癌粒子植入术后中位OS分别为32个月(范围为8.5~55个月)、21个月(范围为7.9~35个月)、26.5个月(范围为8.2~42.2个月),总OS比较:LSCC肝转移较RSCC和直肠癌显著延长(χ^(2)=10.42,P=0.005 5);进一步分析KRAS野生型亚组,LSCC肝转移亦较RSCC和直肠癌OS显著延长(χ^(2)=4.564,P=0.010 21)。结论:CT引导下^(125)I粒子植入对全身化疗失败后的不能手术的CRLM进行了安全有效的补救治疗,LSCC肝转移患者^(125)I粒子植入术后整体生存率明显高于RSCC及直肠癌肝转移患者,特别对于KRAS野生型的LSCC肝转移患者总生存率显著较RSCC及直肠癌肝转移患者增高。

Objective:To evaluate the effectiveness and safety of CT-guided ~(125)I particle implantation in the treatment of liver metastases from colorectal cancer after failure of systemic chemotherapy that cannot be surgically resected.Methods:We retrospectively analyzed the clinical data of 76 patients with liver metastases from colorectal cancer admitted our department of nuclear medicine of our hospital between January 2017 and October 2022 to evaluate the efficacy of particle implantation in hepatic metastases.We used two independent samples t-test and repeated-measures ANOVA to compare the differences between alanine aminotransferase and aspartate aminotransferase preoperatively and postoperatively.We analyzed the postoperative overall survival after particle implantation and compared the differences in OS in left-side colon cancer,right-side colon cancer,and rectal cancer respectively.Results:A total of 133 liver metastases were found in 76 patients,and the success rate of ~(125)I particle implantation was 96.99%(129/133).The 6-month postoperative effective rate was 80.62%,and the local control rate was 89.92%.The differences of CEA,CA199,and AFP were statistically significant before and after treatment(t=2.803,5.015,and 2.221,all P<0.05).The median OS after particle implantation was 26.25 months(range of 7.9~55) in 76 patients.The median OS after particle implantation for LSCC,RSCC,and rectal cancer was 32 months ( range 8.5 ~ 55),21 months( range 7.9 ~ 35),and 26.5 months( range 8.2 ~ 42.2),respectively,and the comparison of the total OS showed liver metastasis of LSCC was significantly prolonged than RSCC and rectal cancer( χ^(2)=10.42,P = 0.005 5).Through further analyzing the KRAS wild-type subgroup,the OS of LSCC liver metastasis was also significantly prolonged compared with RSCC and rectal cancer( χ^(2)= 4.564,P = 0.010 21).Conclusion:CT-guided ~(125)I particle implantation was a safe and effective remedial treatment for inoperable liver metastases from colorectal cancer after failure of systemic chemotherapy.The overall survival rate of LSCC patients with liver metastases after ~(125)I particle implantation was significantly higher than that of patients with liver metastases from RSCC and rectal cancer,especially the overall survival rate of LSCC patients with KRAS wild-type liver metastases was significantly higher than that of patients with liver metastases from RSCC and rectal cancer.