插植放疗与粒子植入治疗盆腔淋巴结的疗效对比分析

Comparative analysis of therapeutic effects between interstitial brachytherapy and particle implantation in the treatment of pelvic lymph nodes

目的对比高剂量率插植放疗与粒子植入放疗用于外放疗后射野内盆腔转移淋巴结治疗的安全性和有效性。方法回顾性分析2017年1月至2020年4月沧州中西医结合医院外放疗后射野内残存或新发转移盆腔淋巴结患者的临床资料。符合纳入标准的42例患者,其中男12例,女30例,平均年龄(61.6±9.64)岁,年龄范围为39~82岁。根据治疗方法不同分为高剂量率插植放疗组(18例)和粒子植入放疗组(24例)。治疗后随访3年,对比分析两组患者局部控制率(LCR)、并发症发生率及总生存(OS)。年龄、手术时间资料符合正态分布,采用t检验进行比较;其余资料采用χ^(2)检验或Fisher精确检验。采用Kaplan-Meier方法计算OS率和LCR。结果两组患者基线资料差异无统计学意义(P>0.05)。高剂量率插植放疗组手术时间长于粒子植入放疗组[(66.39±11.07)∶(45.75±9.19)min,P<0.001]。随访期间,高剂量率插植放疗组和粒子植入放疗组的LCR差异无统计学意义(1年LCR为88.9%∶87.5%,P=0.927;2年为72.2%∶62.5%,P=0.874)。两组中位OS期差异无统计学意义(31.6∶29.8个月,P=0.798);两组近期并发症发生率差异无统计学意义[(4/18例)∶(5/24例,20.8%),P=1.000],未观察到远期并发症。结论高剂量率插植放疗治疗盆腔转移淋巴结的有效性和安全性,与粒子植入放疗相当。

Objective To compare the safety and efficacy of high-dose-rate interstitial brachytherapy and particle implantation radiotherapy in the treatment of lymph nodes with pelvic metastases in the field after external radiotherapy.Methods Clinical data of 42 patients with residual or newly metastatic pelvic lymph nodes after radiotherapy at Cangzhou Integrated Traditional Chinese and Western Medicine Hospital who met the inclusion criteria from January 2017 to April 2020 were retrospectively analyzed.Among them,12 patients were male and 30 females,aged 39-82 years,(61.6±9.64)years on average.According to the treatment method,all patients were divided into the high-dose-rate interstitial brachytherapy group(n=18)and particle implantation radiotherapy group(n=24).During 3-year follow-up,the local control rate(LCR),incidence of complications and overall survival(OS)were compared between two groups.Age and operation time conforming to normal distribution were analyzed by t-test.The remaining indexes were analyzed by the Chi-square test or Fisher's exact test.The OS and LCR were calculated by Kaplan-Meier method.Results There was no significant difference in baseline data between two groups(all P>0.05).The operation time in the high-dose-rate interstitial brachytherapy group was longer than that in the particle implantation radiotherapy group[(66.39±11.07):(45.75±9.19)min,P<0.001].During subsequent follow-up,there was no significant difference in the LCR between two groups(1-year LCR 88.9%vs.87.5%,P=0.927;2-year LCR 72.2%vs.62.5%,P=0.874).There was no significant difference in the median OS between two groups(31.6 vs.29.8 months,P=0.798).There was no significant difference in the incidence of early complications between two groups[(4/18)vs.5/24(20.8%),P=1.000].No late complications observed.Conclusion High-dose-rate interstitial brachytherapy yields equivalent efficacy and safety to particle implantation radiotherapy in the treatment of lymph nodes with pelvic metastases.