【作者】 王俊杰； 袁惠书； 刘江平； 姜伟娟； 李金娜； 姜玉良； 田素青；

【Author】 Wang Jun-jie Yuan Hui-shu Liu Jiang-ping Jiang Wei-juan Li Jin-na Jiang Yu-liang Tian Su-qing (Cancer Center of Peking University 3rd Hospital,Beijing,China 100083)

【机构】 北京大学第三医院肿瘤治疗中心；

【摘要】 目的:探讨超声或 CT 引导下放射性¹²⁵Ⅰ粒子组织间植入治疗复发直肠癌的技术可行性、近期疗效和副反应．方法:15例直肠癌术后盆腔复发患者,4例女性,11例男性．手术采用硬膜外麻醉,2例患者行经阴道超声引导放射性¹²⁵Ⅰ粒子植入术,13例患者行 CT 引导放射性¹²⁵Ⅰ粒子植入术．肿瘤匹配周边剂量为90～110Gy,每颗粒子活度为0．50mCi～0．70mCi,植入33～70颗．术后24～48小时拍胸、盆腔 X 光片和盆腔 CT 扫描了解粒子是否发生移位．术后6例患者加三维适形放疗,4～6野/次,200～300cGy/ 次,5次/周,总剂量为4500～5000cGy,间隔为4周．2例患者粒子治疗后加健择、5-氟尿嘧啶和四氢叶酸化疗1个周期,随访3～15个月,根据 CT 扫描结果判断肿瘤大小．结果:术后平均7天疼痛缓解,其中完全缓解12例,2例部分缓解,1例无变化,有效率93．33%．9例患者肿瘤完全缓解,2例部分缓解,4 例局部进展,有效率86．67%．2例术后6个月和12个月时死于肺转移．1例粒子移位盆腔,无治疗相关并发症发生．结论:经超声或 CT 引导放射性¹²⁵Ⅰ植入治疗复发直肠癌具有安全、微创、并发症发生率低和疗效肯定等优势,粒子治疗后应配合外放疗和全身化疗,有望进一步提高疗效．更多还原

【Abstract】 OBJECTIVE:To investigate the technological feasibility,efficacy and morbidity of ¹²⁵I seed implantation in recurrence of rectum cancer guided by ultrasonography or CT.METHOD:15 patients with recurrence of rectum cancer were treated with ¹²⁵I seed implantation guided by ultrasonography or CT.The MPD of ¹²⁵I seed implantation were 90～110Gy,The activity of ¹²⁵I per seed ranged from 0.50 to 0.70mCi,the total number of sources implanted ranged from 33～70.the doses of external beam radiation therapy（EBRT） were 4500～5000Gy,200～300cGy/f,5f/w.The intervals between ¹²⁵Iseed implantation and EBRT were 4w.the seed implantation period ranged approximately 2～3 hours,all of 15 cases in this series had routine chest,pelvic X ray or pelvic CT scan within 24～48 hours after seed implantation. Follow-up ranged from 3 to 24 months.RESULTS:All patients could well tolerated seed implantation.Pain completely relieve in 12 cases,partial relieved in 2 cases and no response was in one case,the response rate was 93.33%,the median relieve time was 7-10d.9 cases were complete response,2 cases were partial response,4 cases were progressive disease,the local control rate was 86.67%.2 cases were died with dissemination to lung.One seed migrated and did not cause any clinical relative morbidity.CONCLUSION:¹²⁵Iimplantation in recurrence of rectum cancer guided by ultrasonography or CT was safety,minimally invasion,low morbidity and high efficacy,it was worth of development and promotion.更多还原