【摘要】 背景与目的采用碘125(125I)粒子近距离治疗肿瘤的靶向优势,探讨微创植粒在Ⅲ、Ⅳ期肺癌综合治疗中的应用价值和临床疗效。方法对42例经常规治疗或其它疗法难以控制和部分初治的中晚期肺癌(其中中央型15例)患者,应用三维治疗计划系统(TPS)计算剂量和制定布粒计划,在CT引导下经皮穿刺、单针分次植入125I粒子进行近距离放疗。植粒后CT检查布粒情况和有无并发症。3～7天内同步或分期进行化疗与其它疗法治疗。每3～4周采用胸片、CT、MRI观察肿瘤缩小效果。结果粒子分布满意率为83.3%(35/42)。近期总有效率为85.7%,其中完全缓解率为26.2%(11/42),部分缓解率为59.5%(25/42),无变化率为14.3%(6/42),止痛有效率为83.3%(15/18)。并发轻度出血13例(31.0%),其中肺内渗血8例(19.0%),咯血5例(11.9%);少量气胸3例(7.1%);粒子移位1例(2.4%);全组未发生白细胞降低和放射性肺炎。结论微创植粒创伤小,并发症轻,安全有效,可有选择地应用。更多还原

【Abstract】 Background and objective Brachytherapy offers an innovative method of delivering conformal high-dose radiation to a defining target tumor. The aim of this study is to investigate the value and effect of using radioactivity 125I seed permanent implants combined with chemotherapy in the management of stage Ⅲ or Ⅳ lung cancer. Methods Forty-two lung cancer patients in stage Ⅲ and Ⅳ (15 center lung cancer) who couldn’t be relieved by routine methods were treated with 125I seed permanent micropuncture implant brachytherapy and chemotherapy. The dose and distribution of seeds was decided by treatment planning system, and CT was used during 125I seed permanent implant treatment. Distribution of seeds and complication was reviewed by CT scan after treatment. Chemotherapy was performed in 3 to 7 days after implanting. The effect was observed by X-ray, CT and MRI every 3 or 4 weeks. Results The satisfaction rate of seed distribution was 83.3% (35/42). The response rate of treatment was 85.7% (36/42), including complete response rate 26.2% (11/42), partial response rate 59.5% (25/42), no change rate 14.3% (6/42). Effective rate of pain relief was 83.3% (15/18). Thirteen patients (31.0%) had complication of mild hemothorax, 8 (19.0%) with bleeding in lung and 5 (11.9%) with hemoptysis. Three patients (7.1%) had mild pneumothorax and 1 patient (2.4%) had a malposition seed. Leucopenia and radiation pneumonia didn’t occurred. Conclusion 125I seed micropuncture implant has less trauma and complication, and is a safe and effective method. This method might be helpful in the treatment of lung cancer and can be selectively used in clinic.更多还原