【摘要】 目的探讨放射性103Pd粒子组织间近距离治疗恶性肿瘤的近期疗效和副反应。方法超声或CT引导下103Pd粒子植入。3例硬膜外麻醉,17例局部麻醉。中位肿瘤周边剂量为122.84Gy(97.31～182.78Gy)。103Pd粒子活度为1.4～1.8mCi。原发肿瘤边缘植入靶区外放1cm,转移瘤边界以影像学为准。根据治疗计划实施粒子针插植,利用Mick植入器后退式植入粒子。6例术后3～4周加用外放疗,剂量45～50Gy,每次2Gy。术后行CT扫描,进行质量评估。术后24～48h拍X线片,观察是否粒子发生移位。结果20例术后均未出现严重并发症。5例肿瘤完全缓解,12例部分缓解,2例稳定,1例前列腺癌术后PSA明显下降;局部控制率90%(18/20)。20例随访2～25个月,中位时间11个月,2例术后0.5、1年失访,12例死亡,6例生存。结论103Pd粒子组织间近距离治疗恶性肿瘤有较高的肿瘤局部控制率以及较高的安全性。更多还原

【Abstract】 Objective To investigate clinical outcomes and side effects of 103Pd seed brachytherapy for malignant tumors. Methods Twenty patients with residual or recurrent unresectable malignancies were treated with 103Pd seed implantation under the guidance of ultrasonigraphy or CT scans. Three patients were given a local anesthesia and 17 patients, general anesthesia. The match peripheral doses ranged from 97.3 Gy to 182.78 Gy (mean, 123 Gy). The activity of each seed ranged from 1.4 mCi to 1.8 mCi. The planning target volume (PTV) included a 1 cm isotropic expansion margin around the clinical target volume (CTV). The seeds were retrogradely placed with a Mick applicator. External beam radiation was required 3～4 weeks after seed implantation in 6 patients, with a total dose of 45～50 Gy and 2 Gy each fraction. All of the patients received CT scanning after implantation for quality evaluation and underwent routine chest X-ray examination at 24～48 hours for seed observation. Results A complete response was achieved in 5 patients and a partial response in 12 patients. Two patients were assessed as having stable disease. In 1 patient with prostatic cancer, the serum PSA level was decreased significantly. The local control rate was 90% (18/20). The 20 patients were followed for 2～25 months (median,11 months).Two patients were lost to follow-up at 6 and 12 months after operation, respectively. Twelve patients died and 6 patients survived.No severe complications were recorded postoperatively. Conclusions 103Pd brachytherapy for malignant tumors gives a high local control rate and satisfactory reliability.更多还原