放射碘-125微粒组织间种植辅助治疗直肠癌的前瞻性研究

目的 :探讨术中放射碘 12 5 ( 12 5I)微粒种植近距离放射辅助治疗直肠癌的疗效。方法 :对 1997年～ 1998年间112例施行前切除加全直肠系膜切除手术 (TME)的直肠癌进行前瞻性对照治疗研究。病人分TME +静脉化疗 (四氢叶酸钙 +5Fu) +顺铂 (DDP)腹腔灌注 +术中12 5I种植组 ( 4 9例 )和TME +静脉化疗 +DDP腹腔灌注 +术后放疗组 ( 63例 ) ,随访比较两组间控便功能、治疗并发症、5年局部复发率、转移率和生存率等。结果 :两组间术后肛门控便功能相当 ;吻合口瘘发生率、吻合口狭窄率和远处转移率差异无显著性意义 ;实验组DukeC、D期局部复发率低于对照组 (P <0 0 5 ) ,5年生存率高于对照组 ( P <0 0 5 ) ,实验组放射反应减少 ( P <0 0 1) ;种植微粒数超过 5 0枚时可能增加吻合口瘘的发生 (P <0 0 5 ) ,影响控便功能 (P <0 0 5 ) ,而 5年生存率并不因此增加。结论 :组织内12 5I微粒种植近距离放射辅助治疗直肠癌总体疗效优于外照射 ,可降低DukeC、D期的局部复发率和提高其 5年生存率 ,并能减少放射反应。但应恰当使用放射剂量 ,避免吻合口瘘的发生。

^(125)Ⅰ放射性粒子术中组织间植入治疗Ⅲ_a期非小细胞肺癌的近期临床研究

目的:探讨术中12 5Ⅰ放射性粒子组织间植入治疗Ⅲa 期非小细胞肺癌的近期疗效和可行性。方法:将4 4例Ⅲa 期非小细胞肺癌患者随机分为手术加12 5Ⅰ放射性粒子永久植入组2 0例和术后常规外放疗组2 4例,比较两组的局部复发率、转移率、1年生存率和并发症发生率,采用χ2 检验。结果:植入组的局部复发率、1年生存率和骨髓抑制、放射性肺炎发生率为5 %、10 0 %、0 %、0 % ;与常规组的2 9 .2 %、79 .2 %、8 3%、5 8. 3%相比,P <0 . 0 5 ;转移率分别为10 %、2 5 % ,两组相比P >0 .0 5。结论:术中12 5Ⅰ放射性粒子组织间植入治疗Ⅲa 期非小细胞肺癌的近期疗效明显,安全性高,有一定的实用价值;远期疗效尚需进一步探讨。

Treatment of Unresectable Carcinoma of Pancreas with ^(125)I Implantation and ^(125)I Plus Gemcitabine

Objective: To study the role of 125 I and 125 I plus gemcitabine (GEM) in treatment of unresectable carcinoma of pancreas. Methods: From April 2000 to April 2003, 38 untreated patients with locally advanced pancreatic cancer (LAPC) were collected and randomized into two groups: Arm A 125 I (18 patients) and Arm B 125 I+GEM (20 patients). Eligibility criteria were: cytologically and pathologically proven pancreatic carcinoma, Karnofsky performance status (kps) 60 80, age 18 75 years, adequate hematological, renal and liver function, and controllable pain. Arm A patients were treated with 125 I implants. Arm B patients started chemotherapy within 10 14 d post operatively following the implant procedure. Chemotherapy doses were as follows: GEM 1 000 mg/m 2 weekly × 3 followed by 1 week of rest for 3 cycles. In addition, all patients underwent laparotomy and surgical staging. The surgical procedures performed were biopsy, gastric bypass and biliary bypass. The total activity and number of seeds used were as recommended by Anderson. The mean activity, minimal peripheral dose (MPD), and volume of implants were 20 mCi, 14 000 cGy, and 53 cm 3, respectively. Results: Overall response rate (CR+PR) in Arm A was 37.6% and in Arm B it was 44.5% ( P >0.05). PR median duration in Arm A was 6.7 months and in Arm B it was 4.8 months ( P <0.05). Clinical benefit response was experienced by 11.7 % of Arm A compared with 42.1% of Arm B ( P <0.05). The incidences of hematological toxicity (such as neutropenia) between Arm A and Arm B were 5.8% and 21.1%, respectively ( P >0.05). The survival rates of 12 and 24 month were 32.5%, 16.3% for Arm A and 61%, 38.7% for Arm B ( P =0.04). The rate of complication of Arm A was lower than that of Arm B without statistical significance. Conclusion: To some extent, 125 I or 125 I plus GEM is able to lead to a moderate objective response for LAPC with obstructive jaundice on the base of biliary bypass or/and gastric bypass, but 125 I plus GEM is more effective than 125 I in improvement of the quality of life and survival rate in patients with LAPC.

Iodine-125 interstitial brachytherapy for experimental liver cancer

Objective：To study the effect of iodine-125 interstitial brachytherapy on liver cancer. Methods： Animal model of human liver cancer was established by injecting SMMC-7721 cells cultivated in vitro subcutaneously into the flank of BALB/c nude mice. Nude mice with tumor of 5 mm in diameter were randomly divided into 2 groups （n = 10）. One iodine-125 seed of apparent activity 0.8 mCi was implanted into the center of tumor in treatment group, whereas an inactive seed was implanted in control group. The other 20 nude mice with tumor reaching 10 mm in diameter were also treated as above. The size of tumor was determined weekly after implantation, and pathological examination and blood routine were taken on the 28th day. Results： Tumor growth was obviously inhibited in treatment group of tumor of 5 mm in diameter, and there was statistically significant difference in tumor volume between treatment and control groups （P〈0.01）. Around iodine-125 seed, apparent necrosis of tumor was shown in treatment group, accompanied by karyopyknosis and reduced plasma in residual tumor cells microscopically. Tumor growth was not inhibited in either treatment or control group of tumor of 10 mm in diameter. There was no obvious adverse effect except for decreased white blood cells in treatment groups. Conclusion： There is certain effect of iodine-125 interstitial braehytherapy on liver cancer, which is associated with the size of tumor.

Treatment of Unresectable Advanced Gastric Cancer Using lodine-125 Brachytherapy

OBJECTIVE The purpose of the study was to examine the efficacy of treating patients with advanced gastric cancer using iodine-125 （^125Ⅰ） brachytherapy. METHODS Ten patients with unresectable advanced gastric cancer were selected based on their pattern of CT scans. We utilized a brachytherapy planning system to determine the distribution of the ^125Ⅰ seeds, their activity and quantity. The matched peripheral dose （MPD） was 110-135 Gy.^125Ⅰ seeds were implanted in a single plane or biplane by an intraoperative small incision or percutaneous puncture. The postoperative hemogram, CT, KPS, pain-relieving period and survival period were recorded. RESULTS One patient developed a complete response （CR）, 4 patients a partial response （PR）, 3 patients showed no change （NC） and 2 patients developed progressive disease （PD）. The overall response rate （CR＋PR） was 50% （5/10）. The pain-relieving rate was 89% （8/9）. The patients＇ appetite and KPS were improved. The longest survival period was 10 months and median life span was 4 months. There were 8 patients whose seeds fell off resulting in an expulsion rate of 3.8% （26/692）. The patients showed 0-1 degree acute radio-therapeutic side-effects without other symptoms such as abdominal pain, vomitus cruentes or intestinal obstruction etc.CONCLUSION Applying ^125Ⅰ implantation to treat advanced gastric cancer with a reasonable seed distribution can significantly improve clinical symptoms and their quality of life. The radioactive damage is mild. This method can be used as an important supplementary treatment for unresectable advanced gastric cancer.

Intraoperative permanent implantation of radioactive I-125 seed for local advanced non small lung cancer

Objective： To study the clinical efficacy and methods of permanent implantation of radioactive I-125 seed in surgery for local advanced non small lung cancer （LANSCLC）. Methods： From Apr. 2004 to Apr. 2006, the I-125 seeds were implanted into 30 patients with LANSCLC in surgery. The numbers of seeds were 10-40. The chemotherapy was performed in 10 to 14 days after operation. Results： There was no operative death, and the distribution of seeds and complications were reviewed by CT and X-ray after treatment. The distribution of seeds was satisfactory in all patients. The complete response rate （CR） was 56.6% and the part response （PR） was 26.6%. The overall response rate was 83.3% after 4-24 months of surgery. There was no one occurred radiation pneumonia. Prospective efficacy await further follow-up. Conclusion： Permanent implantation of 1-125 seed in surgery for LANSCLC, is a safe and effective method with mild complications.