【摘要】 目的评估CT引导下125I粒子组织间植入治疗难治性肝癌的安全性和疗效。方法 40例经临床或病理确诊局部未控难治性肝癌患者,其中原发性肝癌27例(门静脉癌栓2例),转移性肝癌13例,在CT导向下行125I粒子组织间植入术。术前采用治疗计划系统(TPS)计算布源,125I粒子活度为0.6~0.8 m Ci,外周匹配剂量(MPD)100~140 Gy。粒子植入手术均在局麻下进行,采用经皮肝穿刺,利用单针或多针技术,平行于肿瘤/癌栓长轴方向,间隔0.5~1 cm逐一植入。采用m RECIST评估近期疗效。KaplanMeier法分析中位肿瘤进展时间(m TTP)和中位总生存时间(m OS)。结果手术操作成功率100%。肿瘤直径1.5~12.0 cm(平均4.0 cm),共植入125I粒子1 748枚(平均每例植入44枚)。近期有效率37.5%(CR 8例,PR 7例),SD 37.5%(15例),疾病控制率(DCR)75%。m TTP 7.0个月(95%CI:4.524~9.476个月),m OS10个月(95%CI:6.901~13.099个月),手术相关不良反应包括,包膜下少量出血2例(5%),粒子肝内游走2例(5%),肝区疼痛不适1例(2.5%),均无需特殊处理;1例(2.5%)术后3 h出现寒战高热,给予对症解热处理。结论 CT引导下125I粒子永久性组织间植入补救治疗难治性肝癌不仅安全,且有效,值得临床进一步推广。更多还原

【Abstract】 Objective To evaluate the safety and clinical efficacy of CT-guided125 I seeds interstitial implantation in treating the refractory liver cancers that show poor response to commonly used therapies.Methods A total of 40 patients with refractory clinically or pathologically-proved liver cancer were enrolled in this study,the diseases included primary liver cancer(n = 27,with coexisting portal vein cancerous thrombus in 2) and metastatic liver cancer(n = 13).CT-guided125 I seeds interstitial implantation was performed in all patients.Preoperative plan of seeds implantation protocol was formulated by using the treatment plan system(TPS); the125 I seed activity was 0.6-0.8 m Ci and the peripheral matching dose(MPD) was 100-140 Gy.The procedure of125 I seeds interstitial implantation was performed under local anesthesia in all patients.By using percutaneous trans-hepatic puncturing and single-or multiple-needle technique,the125 I seeds were implanted along a line parallel to the long axis of the tumor and/or tumorous thrombus with an interval of 0.5-1.0 cm.The short-term efficacy was evaluated by modified response evaluation criteria in solid tumors(m RECIST),and the median time to tumor progression(m TTP) and the median overall survival time(m OS) were calculated by Kaplan and Meier method.Results The technical success rate was 100%.The diameter of the tumor was 1.5-12.0 cm(mean 4.0 cm),and a total of 1 748125 I seeds were implanted in 40 patients(mean 44 seeds per patient).The short-term effective rate was 37.5%(n = 15),including complete remission in 8 cases and partial remission in 7 cases,the stable disease was seen in 15 cases(37.5%),and the disease control rate was 75%.The m TTP was 7.0 months(95%CI:4.524-9.476 months),while m OS was 10 months(95%CI:6.901-13.099 months).The procedure-related adverse reactions included small amount of subcapsular hemorrhage(n = 2,5%),intrahepatic migration of125 I seeds(n = 2,5%),pain at liver area(n = 1,2.5%); and no special treatment was needed in these patients.One patient developed high fever with chills 3 hours after the procedure,which was relieved after symptomatic and antipyretic treatment.Conclusion For the treatment of refractory liver cancers,CT-guided125 I seeds permanent interstitial implantation,used as a remedial therapy,is safe and effective.This technique is worth popularizing in clinical practice.更多还原