放射性粒子植入在晚期恶性肿瘤治疗中的临床观察

Clinical observation of radioactive seed implantation in the treatment of advanced malignant tumors

目的探讨放射性碘125粒子(125I)植入治疗晚期恶性肿瘤的临床效果。方法收集2015年1月—2018年5月本院诊治的156例晚期恶性肿瘤患者,临床分期Ⅲ～Ⅳ期,均接受CT引导下植入^(125)I治疗。术前通过CT扫描了解肿瘤情况制定TPS治疗计划,术后随访3个月观察粒子植入分布和肿瘤缓解情况,评估临床效果及安全性。结果本组156例患者均在CT引导下成功完成^(125)I植入,共174个病灶,平均植入(17.9±4.2)粒,术后CT复查和TPS计划基本一致。术后3个月病灶直径为(3.8±0.7) cm,显著低于术前的(5.1±1.1) cm,差异具有统计学意义(P<0.05),其中CR 28例,PR 91例,PD 11例,SD 26例,Ⅲ期、Ⅳ期缓解有效率分别为79.44%和69.39%,两者相较无显著差异(P>0.05),临床缓解总有效率为76.28%(119/156)。术后出现少量痰中带血、肛门坠胀感、血尿等不良反应,经简单处理好转,外周血常规、肝肾检查无异常改变。结论放射性碘125粒子植入治疗晚期恶性肿瘤近期疗效显著,且安全性好,临床可推广应用。

Objective To explore the clinical effect of implantation of radioactive iodine 125 particle(125I) in the treatment of advanced malignant tumors. Methods A total of 156 patients with advanced malignant tumors were collected in our hospital from January 2015 to May 2018,the diseased stage was between Ⅲ ~ Ⅳ,they were treated with 125I implementation guided by CT. The TPS treatment plan was made by CT scan before operation.After 3 months of follow-up,the distribution of implanted particle and the remission of tumor were observed,and the clinical effect and safety were evaluated. Results The125I implantation was successfully completed under the guidance of CT in 156 cases,with a total of 174 lesions,the average number of particle implantation was( 17.9±4.2),and the postoperative CT reexamination was basically in accordance with the TPS plan.The average lesion diameter was( 3.8±0.7) cm after 3 months,which was significantly lower than( 5.1±1.1)cm before operation( P < 0. 05). Of which 28 cases of CR,91 cases of PR,11 cases of PD,26 cases of SD.Remission rate of stage Ⅲ and Ⅳ disease were 79. 44% and 69. 39% respectively,the difference was not statistically significant( P>0.05).The total clinical mitigation efficiency was 76.28%( 119/156).After operation,a small amount of adverse reactions such as blood in sputum,anal swelling and hematuria were occurred,but these symptoms improved after simple treatment. There was no abnormal change in blood cytological examination,liver and kidney function. Conclusions Radioactive 125 I implantation is effective and safe in the treatment of advanced malignant tumors. It can be widely applied in clinic.