【摘要】 目的研究肝细胞肝癌（HCC）行¹²⁵I放射性粒子植入补救治疗后影响肿瘤局部控制(DCR的关键因素。方法共纳入HCC患者68例,接受CT引导下¹²⁵I放射性粒子组织间植入治疗,粒子活度选择0.6～0.8 mCi,匹配周围剂量（处方剂量,MPD）设置110～160 Gy,近期疗效评估采用mRECIST标准,对影响肿瘤DCR的诸多因素,如性别、年龄、肿瘤大小、粒子数量、粒子分布模式（分巴黎布源模式和蒙特卡洛布源模式两种）,以及粒子植入术后即刻D90剂量等6个因素采用非参数二分类logistic多因素分析。结果 68例HCC患者均成功完成¹²⁵I放射性粒子植入补救治疗。未发生三级以上不良事件。65例患者获得随访和评估。单因素分析显示,病灶大小（P=0.006）和D90剂量（P<0.001）对DCR有影响,肿瘤最大径>5 cm,D90<110 Gy预示DCR未控;多因素分析显示,D90剂量（P<0.001）是唯一影响DCR的关键参数。结论对于¹²⁵I放射性粒子植入补救治疗HCC而言,D90剂量是唯一影响肿瘤DCR的关键因素,足量的周边匹配剂量才能保证良好的临床疗效。更多还原

【Abstract】 Objective To investigate the key factors affecting disease control rate（DCR） of hepatocellular carcinoma（HCC） after remedial treatment of ¹²⁵I seed implantation. Methods A total of 68 patients with HCC were enrolled in this study. All patients received CT-guided ¹²⁵I seeds interstitial implantation. The activity of ¹²⁵I seed was 0.6-0.8 mCi, the matched peripheral dose（MPD） was 110-160 Gy.The mRECIST criterion was used to evaluate the short-term curative effect. The factors affecting tumor DCR,including gender, age, tumor size, number of ¹²⁵I seeds,¹²⁵I distribution pattern（Paris source model and Monte Carlo source model）, and immediate 90% target volume absorbed dose（D90） after ¹²⁵I seeds implantation, were statistically analyzed with non-parametric binary logistic multivariate analysis method.Results Successful remedial treatment of ¹²⁵I seed implantation was accomplished in all 68 HCC patients. No grade Ⅲ or above adverse reactions occurred. A total of 65 patients were able to be followed up and evaluated. Univariate analysis showed that the lesion size（P=0.006） and D90 dose（P<0.001） had an effect on DCR. The maximum diameter of tumor >5 cm and D90<110 Gy indicated that an uncontrolled DCR might be expected. Multivariate analysis revealed that D90 dose（P <0.001） was the only key parameter affecting DCR. Conclusion For the remedial treatment of HCC with ¹²⁵I seed implantation, D90 dose is the only key factor that affects DCR. Adequate MPD should be given in order to ensure a good clinical efficacy.（J Intervent Radiol, 2019, 28: 656-660）更多还原