【摘要】 目的探讨CT引导下经皮穿刺和纤维支气管镜(flexible fiberoptic bronchoscope,FFB)直视下种植放射性125I粒子植入近距离内照射治疗晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)的近期效果。方法术前临床和活检证实为NSCLC185例,粒子植入联合化疗组(n=121)进行放射性125I粒子植入,处方剂量(priscribed dose,PD)80Gy、长春瑞滨(诺维本)联合顺铂(NP)方案化疗,其中89例通过CT引导经皮穿刺种植,32例在FFB直视下种植粒子。单纯化疗组(n=64)行NP方案化疗。2组治疗后6个月根据CT和FFB检查,比较肿瘤体积,按国际标准判定疗效。结果粒子植入联合化疗组植入粒子后,瘤体接受的平均照射剂量为153.7Gy,匹配周边剂量(matched peripheral dose,MPD)89.6Gy,D9093.5Gy。6个月后粒子植入联合化疗组有效率(CR+PR)为95.0%(115/121),1年累计生存率0.90。单纯化疗组有效率为42.2%(27/64),1年累计生存率0.65,两组差异有显著性(log-rank检验,χ2=5.12,Prob=0.04<0.05)。结论放射性125I粒子植入联合化疗是一种有效的、微创的治疗晚期NSLC的方法,疗效明显高于单纯NP方案化疗的患者。更多还原

【Abstract】 Objective To evaluate the short-term efficacy of interstitial implantation of 125I seeds by using flexible fiberoptic bronchoscope (FFB) guided by CT for advanced non-small cell lung cancer (NSCLC). Methods A total of 185 patients with NSCLC, who were diagnosed clinically and pathologically, were enrolled into this study and divided into two groups. In 125I seeds group (n=121), the patients received interstitial implantation of 125I combined with NP regimen (NVB+DDP) chemotherapy with a prescribed dose (PD) of 80 Gy. Among the patients, the implantation was guided by CT in 89, and was performed directly under a FFB in 32. In control group (n=64), NP regimen (NVB+DDP) chemotherapy was used. Six months after the treatments, the tumor volume in the two groups was measured by using CT and FFB. The outcomes of the 2 groups were compared, and the efficacy of the treatments was evaluated according to the international standards. Results In the 125I seeds group, the mean radiation dose was 153.7 Gy, matched peripheral dose (MPD) was 89.6 Gy, and D90 was 93.5 Gy. Six months after the treatment, the effectiveness rate (CR+PR) was 95.0% (115/121), and 1-year survival rate was 0.90. In the control group, the effectiveness rate was 42.2% (27/64), and 1-year survival rate was 0.65. There existed significant difference between the two groups (log-rank test, χ2=5.12, Prob=0.04<0.05). Conclusions Interstitial implantation of 125I seeds combined with chemotherapy is an effective and minimally invasive method for advanced NSCLC. Its curative effect is significantly better than that of NP regimen chemotherapy.更多还原