放射性^125I粒子植入治疗椎体及椎旁肿瘤

目的：评价放射性^125I粒子组织间永久性植入治疗椎体及椎旁肿瘤的疗效和安全性。方法：对16例椎体及椎旁肿瘤患者（3例原发肿瘤,13例转移瘤）共28个病灶,行CT引导下或者术中^125I粒子永久性植入治疗。粒子活度0．5—0．8mCi,每个病灶植入粒子数目7—100颗。肿瘤最小周边剂量（mPD）110—160Gy。术后行质量验证。结果：中位随访时间26．5个月（5—61个月）。疼痛缓解率93．7％。神经功能恢复或者保留率93．75％。1年局部控制率64％,2年局部控制率50％,3年局部控制率32％,5年局部控制率4％。中位局部控制时间32个月。1年生存率73％,2年生存率59％,5年生存率41％。中位生存期36个月。1例患者因肿瘤进展出现截瘫,其余患者未出现明显的不良反应。结论：放射性^125I粒子植入术单独或联合手术治疗椎体及椎旁肿瘤安伞、不良反席小．耐受性好。临床疗效尚需进一步临床研究证实。     

超声引导^125I粒子植入治疗前列腺癌方法的建立与近期疗效

目的探讨超声引导放射性^125I粒子治疗前列腺癌方法建立和近期疗效。方法26例前列腺癌全身或硬膜外麻醉下行经直肠超声引导粒子植入治疗。经直肠超声获取前列腺图像,将图像直接传输到计算机治疗计划系统,术中适时计算机计划,肿瘤周边匹配剂量（matched peripheral doses,MPD）145～160Gy。根据治疗计划插植粒子针,利用Mick植入器植入粒子,粒子植入总数为19—90颗,粒子活度0．35～0．4mCi。术后1个月行盆腔CT扫描,质量验证。结果26例患者成功实施会阴超声和模板引导放射性^125I粒子组织间近距离治疗前列腺癌手术。手术历时1—1．5h。术后验MPD为（137．73±36．5014）Gy。26例前列腺癌患者^125I粒子治疗后生物化学控制率92．3％,2例患者术后6个月出现骨转移。^125I粒子植入治疗,34．6％无尿道副反应,Ⅰ、Ⅱ、Ⅲ、Ⅳ和Ⅴ级尿道副反应分别为38．5％、11．5％、11．5％、0和0。Ⅰ级直肠副反应发生率为3．9％。1例患者1颗粒子移位,没有引起临床相关并发症,无粒子移位到肺。结论经会阴超声引导放射性粒子治疗前列腺癌具有微创、精确度高和副反应发生率低等优势。     

骨肿瘤

应用RNA干扰技术抑制骨肉瘤细胞中基质金属蛋白酶-1基因表达的研究;原发性恶性骨肿瘤治疗原则及若干问题（述评）;经皮椎体成形术在脊柱转移瘤治疗中的应用;瘤椎全切与重建治疗胸腰椎肿瘤伴神经功能障碍;经皮椎体成形术联合^125I粒子植入治疗脊椎转移瘤;     

CT引导下经皮穿刺植入^125I粒子治疗老年中心型肺癌近期疗效分析

目的：探讨CT引导下经皮穿刺组织问植入^125I粒子治疗老年中心型肺癌的近期疗效。方法：30例老年中心型肺癌（鳞状细胞癌），随机分成A、B两组，A组为^125I粒子治疗组（15例），采用经皮穿刺组织间^125I粒子植入术，^125I粒子放射性活度为0．8mCi／颗，据TPS计划系统确定粒子放射性总活度和布源。B组为对照组（15例），采用经支气管动脉化疗药物灌注术，灌注的化疗药物为环磷酰胺、多柔比星及顺铂。结果：A组总有效率86．67％，B组总有效率53．33％，二者比较差异有统计学意义，P〈0．05。A组病例治疗后新发生椎体（T12）转移1例；B组病例治疗后新发生纵隔淋巴结转移1例，脑转移1例。结论：经皮穿刺组织间植入^125I放射微粒子治疗老年中心型肺癌（鳞状细胞癌）近期疗效显著，优于单纯经支气管动脉化疗药物灌注术。     

^125I粒子植入治疗外照射后肺癌残存病灶的可行性分析（附18例）

目的：探讨和评估放射性^125I粒子植入治疗肺癌外照射（适形放疗,伽玛刀）后局部残存病灶的疗效。方法：依据TPS计划系统预先计算出18例肺癌患者外照射后局部残存病灶处所需植入的粒子数目,活度和处方剂量;在手术植入过程中再次通过TPS计划系统做粒子植入剂量验证报告,同时分析危及器官心包、食道、脊髓等组织的受量,以达到与治疗计划相符的处方剂量;粒子植入后2个月再行TPS剂量验证,评估实际肿瘤包块粒子治疗的剂量。结果：18例患者瘤体最小周边剂量（mPD）为80—120Gy,靶区90％体积的吸收剂量（D90）为103．6—137．6Gy;肿瘤距离心包,脊髓组织最近的在1—2cm处,吸收剂量迅速衰减到20％到5％左右,为24和6Gy;18例患者2个月内瘤体达到CR＋PR者17例（94％）,瘤体缩小明显,无明显变化（NC）1例（6％）。并发症：气胸6例,喀血0例,18例患者未发现放射性损伤。结论：放射性^125I粒子植入治疗可有效控制外照射后肺癌局部残存病灶,是一种安全,有效的方法。     

放射性^125I粒子植入联合内分泌治疗早期前列腺癌

目的：探讨经会阴超声引导放射性^125I粒子植入联合去势治疗早期前列腺癌疗效和不良反应。方法：39例早期前列腺癌实施经会阴超声引导和适时计划指导放射性^125I粒子植入治疗,7例粒子术前行去势术,21例粒子植入后同时行去势术,11例粒子治疗后联合药物去势治疗。粒子治疗的匹配周边剂量（matched peripheral doses,MPD）为145—160Gy,尿道剂量低于400Gy。^125I粒子活度0．35—0．50mCi,中位植入69颗（19—97颗）。结果：失败标准为前列腺特异抗原（prostate specific antigen,PSA）治疗后升高〉4ng／ml,≤〈4ng／ml为生物化学无进展生存（biochemical disease—free survival,BDFS）。全部患者顺利完成粒子植入术。36例粒子治疗后达到BDFS,3例分别在粒子治疗后6、8和36个月PSA升高,2例行内分泌治疗,1例行外放疗联合内分泌治疗。2年和3年BDFS分别为94．8％（37／39）和92．3％（36／39）。粒子植入治疗后Ⅰ级和Ⅱ级直肠不良反应发生率分别为5．1％（2／39）和7．7％（3／39）,没有Ⅲ级和Ⅳ级直肠反应。粒子植入治疗后Ⅰ级、Ⅱ级和Ⅲ级尿道不良反应发生率分别为53．8％（20／39）、17．9％（7／39）和2．6％（1／39）,对症处理好转。2例粒子移位,没有相关并发症。结论：经会阴超声引导放射性^125I粒子植入治疗前列腺癌具有安全、微创、并发症发生率低等优点。     

CT引导放射性125I粒子组织间植入治疗复发直肠癌的疗效观察

目的探讨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、疗效和副反应.方法23例直肠癌术后复发患者行CT引导下^125I粒子植入术,其中3例行2次粒子植入.20例手术采用硬膜外麻醉,3例局部麻醉.20例腹卧位,3例仰卧位.术前通过治疗计划系统行三维治疗计划,确定粒子数目、空间分布和粒子针数目.既往放疗者肿瘤匹配周边剂量为90～120Gy,未行放疗者为140～160Gy.治疗PTV为CTV外加1 cm.粒子活度18.5～25.9 MBq（0.5～0.7 mCi）.植入粒子33～137颗,术后即刻行CT扫描进行质量验证.术后1周3例患者加三维适形放疗,2～3 Gy/次,总剂量45～50Gy.每3个月复查1次CT.结果随访3～28个月.术后平均7 d疼痛缓解,其中完全缓解12/15,部分缓解2/15,无变化1/15,总有效率为93%.肿瘤局部控制率为87%.中位生存时间14个月,1、2年生存率分别为93%和50%.4例全身合并全身转移,2例8个月和12个月时死于肺转移.无治疗相关严重并发症发生.结论CT引导放射性^125I粒子植入治疗复发直肠癌具有安全、微创、并发症率低和疗效肯定等优势,疗后配合外放疗和全身化疗有望进一步提高疗效.     

脊柱软骨肉瘤术后复发CT引导下放射性^125I粒子植入的初步观察

目的评价脊柱软骨肉瘤术后复发cT引导下放射性^125I粒子植入的初步结果。方法采用cT引导放射性125I粒子植入的方法对5例脊柱软骨肉瘤术后复发患者进行治疗,术前应用三维治疗计划系统制定粒子分布计划,术中间距0．5～1．0cm植入粒子,距离危险器官的安全距离大于1．0cm,术后进行质量验证。结果本组平均随访时间15．2个月（2—41个月）,局部有效率60．0％。平均局部控制时间11．4个月,1年局部控制率60．0％。平均生存期15．2个月,1年生存率为66．7％。术前和术后NRS评分分别为6．00±2．65分和1．00±1．00分,二者差异有显著性（P值〈O．05）,镇痛有效率100．0％。结论CT引导下放射性^125I粒子植入治疗脊柱软骨肉瘤术后复发病例效果确切．疼痛缓解满意,临床应用价值较高。     

^125I粒子植入治疗骨转移瘤的临床应用

目的：探讨^125I粒子治疗肿瘤骨转移的临床疗效。方法：对40例不同肿瘤来源的骨转移患者的52个病灶行^125I粒子永久植入治疗，观察骨痛缓解情况。路及术后骨转移病灶的影像学变化。结果：^125I粒子永久植入治疗骨转移灶的止痛有效率为92．5％，其中显效23例、有效14例、无效3例，总缓解率为92．5％；治疗后疼痛分级较治疗前有明显降低（P〈0．05）。术后2个月的影像学检查结果显示，部分缓解病灶为12个、稳定32个、进展8个。所有患者均未出现严重的不良反应。结论：组织间永久植入^125I粒子治疗肿瘤转移灶疗效确定，不良反应的发生率较低且严重度较轻，是一种值得推广的治疗方法。     

手术联合^125I粒子及缓释化疗粒子靶向治疗胶质瘤的临床研究

目的探讨术中应用^125I粒子及化疗粒子联合植入法治疗胶质瘤的可行性和疗效。方法南阳医专附院自2003年12月至2007年12月,应用术中放、化疗粒子联合植入法治疗胶质瘤41例。治疗中交替植入卡莫司汀（BCNU）缓释化疗粒子和放射性^125I粒子。放射性粒子的肿瘤匹配周边剂量（MPD）为90～100Gy。结果41例患者均顺利完成治疗,术后3—6个月CT复查肿瘤变化,显示瘤体不同程度缩小,其中6例完全缓解,24例部分缓解,8例稳定,局部控制率为73％。随访6—28个月,最长1例随访时间为术后4年,现仍存活。1例术后6个月死于胶质瘤复发。结论手术联合放射性^125I粒子和BCNU缓释化疗粒子联合应用局部植入技术安全、副作用小、费用低及并发症发生率低,是综合治疗胶质瘤的有效手段之一。     

Permanent implantation of iodine-125 seeds as a salvage therapy for recurrent head and neck carcinoma after radiotherapy

Seventeen patients with head and neck recurrent carcinoma underwent (125)I seed implantation under CT or ultrasound guidance. The actuarial D90 of the (125)I seeds implanted was 90-160 Gy (median, 126 Gy). Median follow-up was 10 months (range, 3-48 months). The median local control time was 16 months; the 1- and 2-year local control rates were 66.5% and 49.9%, respectively. The 1- and 2-year survival rates were 51.3% and 38.5%, respectively (median, 16 months). None of the patients experienced grade 4 toxicity. (125)I seed implantation was a feasible and effective salvage treatment for patients with recurrent head and neck cancers.     

复发转移胸壁肿瘤CT引导125I粒子治疗疗效初探

目的 初步探讨CT引导¹²⁵I粒子植入治疗复发或转移胸壁肿瘤的可行性和疗效。
方法 回顾分析2004-2012年间23例复发或转移胸壁恶性肿瘤患者接受CT引导¹²⁵I粒子植入治疗资料。术前计算机治疗计划系统行三维治疗计划,确定粒子数目、空间分布,术后即刻CT扫描剂量验证。90%靶体积接受的剂量为100~160 Gy (中位数130 Gy),¹²⁵I粒子活度为(1.85~2.89)×10⁷ Bq (中位数2.63×10⁷ Bq)。植入粒子8~269颗(中位数53颗)。局部控制率和生存率计算采用Kaplan-Meier法。
结果 随访率100%,随访时间满3、5年者分别为11、8例。23例患者中4例完全缓解、12例部分缓解。1、3、5年局部控制率分别为82%、62%、62%,肿瘤特异生存率分别为61%、45%、45%,总生存率分别为58%、58%、39%。疗后1例患者出现轻中度臂丛神经损伤,6例出现1、2级皮肤损伤。
结论 初步结果显示CT引导¹²⁵I粒子植入治疗复发或转移胸壁肿瘤安全有效。     

Image-guided percutaneous (125)I seed implantation as a salvage treatment for recurrent soft tissue sarcomas after surgery and radiotherapy

The purpose of this study was to evaluate the safety and efficacy of percutaneous iodine-125 ((125)I) seed implantation using computed tomography (CT) or ultrasound guidance in the treatment of recurrent soft tissue malignancies after surgery and radiotherapy. From February 2002 to September 2009, 18 patients with recurrent soft tissue sarcomas were treated under ultrasound or CT guidance. The actuarial median number of (125)I seeds implanted was 35 (range, 6-129), and the actuarial D90 of the implanted (125)I seeds ranged from 107.9 to 204.4 Gy (median, 147.1 Gy). The activity of the seeds ranged from 0.4 to 0.8?mCi (median, 0.7?mCi). Follow-up times ranged from 4 to 78 months (median, 20 months). The median local control was 41 months (95% CI, 15.9-66.1 months). The 1-, 2-, 3-, 4-, and 5-year local controls were 78.8%, 78.8%, 78.8%, 26.3%, and 0%, respectively. The median survival was 32 months (95% CI, 16-48 months). The actuarial 1-, 2-, 3-, 4-, and 5-year survivals were 76.6%, 61.3%, 39.4%, 39.4%, and 39.4%, respectively. Seven (7) patients (38.9%) experienced recurrence after seed implantation. Six (6) patients (33.3%) died of distant metastases and 1 died of stroke. Two (2) patients developed ulceration, 1 case caused by recurrence and another by a reaction of the skin to radiation. Percutaneous (125)I seed implantation for recurrent soft tissue malignancies under CT or ultrasound guidance is safe and is associated with high efficacy and low morbidity.     

CT导向下125I粒子植入治疗晚期肿瘤转移淋巴结的近期疗效

背景与目的:淋巴结转移是影响恶性肿瘤分期、治疗和预后的重要因素,恶性肿瘤经过综合治疗后残留淋巴结或新出现的转移淋巴结,往往治疗比较困难.本研究旨在评价CT导向下125I粒子植入治疗晚期肿瘤转移淋巴结的临床价值.方法:回顾性分析2003年11月至2007年4月中山大学肿瘤防治中心收治的47例经病理确诊为恶性肿瘤并接受经CT导向下125I粒子植入治疗的患者临床资料.转移淋巴结共计57枚,直径1.0～5.5 cm;其中直径＜2 cm 20枚(35.1%),≥2 cm、＜3 cm 21枚(36.8%).≥3 cm、＜4 cm 10枚(17.5%),≥4 cm 6枚(10.5%).采用计算机立体定位计划系统(treatment plan system,TPS)计算布源,在CT导向下将(2.2～3.3)×107 Mq活度的125I粒子相隔1.0×1.5 cm平面播植.手术结束后1～3个月复查CT或PET-CT.结果:治疗前17例有疼痛症状的患者中13例于术后5～14 d内疼痛缓解.有效率76.5%.47例患者中淋巴结完全缓解38例(80.9%),部分缓解4例(8.5%),无变化3例(6.4%),进展2例(4.3%),总有效率89.4%.主要的并发症为少量出血7例(14.9%).结论:CT导向下125I粒子植入治疗恶性肿瘤转移淋巴结近期效果好,安全性高,创伤小,并发症发生率低.     

CT导向下125I粒子植入治疗晚期头颈肿瘤的近期疗效

目的：评价CT导向下125I放射性粒子植入治疗晚期头颈肿瘤的临床价值。方法：回顾分析2007年10月-2008年8月接受CT导向下125I放射性粒子植入治疗的10例晚期头颈癌患者的临床资料。采用计算机立体计划系统计算布源,在CT导向下125I粒子平面插植。手术结束后1—3个月复查CT。结果：10例患者中8例术后5—14天疼痛缓解,有效率80％,2例无效。10例患者局部肿瘤完全缓解8例（80％）,部分缓解1例,无效1例。无明显并发症发生。结论：协I粒子植入治疗晚期头颈肿瘤近期疗效好,安全性高,创伤小,并发症发生率低。     

125Ⅰ粒子治疗头颈部肿瘤颈淋巴结放疗后复发的结果分析

目的 探讨125I粒子植入治疗头颈部肿瘤单纯放疗后淋巴结复发及颈清扫+放疗后淋巴结复发患者疗效.方法 2002年9月至2009年7月收治的36例患者入组,其中单纯颈部放疗后淋巴结复发17例,颈清扫+放疗后淋巴结复发19例.局部麻醉超声或CT引导下植入3～78个粒子.粒子针间距1 cm,后退式植入粒子间距为1 cm,距影像学边界外0.5 cm.术后剂量验证实际D90为90～160 Gy,中位数130Gy.结果 随访率为100%,随访满1、2年者分别为11、3例.总反应率为81%,1、2年局部控制率分别为69%、35%,生存率分别为50%、22%;颈清扫+放疗后复发组的1、2年局部控制率分别为72%、54%,单纯颈部放疗后复发组分别为67%、50%(χ2=0.00,P=0.965);生存率分别为48%、13%和51%、39%(χ2=0.17,P=0.676).结论 125I粒子植入治疗头颈部肿瘤单纯放疗后淋巴结复发及颈清扫+放疗后淋巴结复发患者是一种安全、有效的微创挽救治疗手段.

Abstract：

Objective To summarize the efficacy and the feasibility of 125I seed implantation for recurrence cervical lymph node of head and neck tumor after radiotherapy or radiotherapy plus neck dissection. Methods Thirty-six patients with the recurrence cervical lymphnode of head and neck tumor after radiotherapy (17 patients) or radiotherapy plus neck dissection (19 patients) were treated with 125I seed implantation guided by ultrasound or CT under local anesthesia. The median number of seeds was 27( range from 3 to 78 ). Postoperative quality evaluation were routinely obtained for all patients. The actuarial D90 ranged from 90-160 Gy (median, 130 Gy). Results The follow-up rate was 100%. The number of the patients who were followed up over 1-and 2-year were 11 and 3. The overall response rate was 81%. The 1-and 2-year over local control rates, over survival rates were 69% and 35%, 50% and 22%, respectively.The 1-and 2-year local control rates in patients with recurrence node after radiotherapy plus neck dissection were 72% and 54%, while those were 67% and 50% in patients with recurrence node after radiotherapy,respectively (χ2=00,P=0.965). The 1-and 2-year survival rates in two groups were 48%, 13% , and 51%, 39%, respectively (χ2=0.17, P=0.676). Conclusions 125I seed implantation is a safe,minimal invasive with low morbidity and high efficacy salvage treatment method for cervical lymph node recurrence of head and neck tumor after radiotherapy with or without neck dissection.     

Percutaneous ultrasonography-guided permanent iodine-125 implantation as salvage therapy for recurrent head and neck carcimonas

Twenty-nine (29) patients with recurrent head and neck carcinomas underwent (125)I seed permanent implantation under ultrasonography guidance and the feasibility and efficacy of (125)I seed implantation were assessed. The postplan evaluation showed that the actuarial D90 of (125)I seeds ranged from 90 to 160 Gy (median, 130 Gy). The activity of each (125)I seed ranged from 0.35 to 0.8?mCi (median, 0.6?mCi). The total number of sources implanted ranged from 3 to 61 (median, 22). The follow-up ranged from 3 to 40 months (median, 8 months). The 1-, 2-, and 3-year local control rates were 53.1%, 34.8%, and 17.4%, respectively, with a median local control of 16 months (95% confidence interval, 5.8-26.1). The 1-, 2-, and 3- year survival rates were 54.1%, 27.5%, and 27.5%, respectively (median, 13 months; 95% confidence interval, 6.0-19.9). Of the 25 patients, 5 (17.2%) died of local recurrence and 7 (24.1%) died of metastases; 2 patients showed recurrences at 3 and 8 months after seed implantation and subsequently died of pneumonia. One (1) patient died of heart disease. One (1) developed ulceration with tumor progression. Blood vessel damage and neuropathy were not observed. Percutaneous ultrasound-guided (125)I seed implantation is a feasible, safe salvage for patients with recurrent carcinomas of the head and neck.     

CT-guided radioactive seed implantation for recurrent rectal carcinoma after multiple therapy

The recurrent carcinoma has been difficult to manage after surgery and radiotherapy, extensive resection of locally recurrent rectal cancer is associated with significant morbidity and mortality. Re-irradiation, even in combination with chemotherapy has shown very short survival. We assess the feasibility and efficacy of CT-guided interstitial permanent brachytherapy with ¹²⁵I or ¹⁰³Pd seeds for recurrent rectal cancer after multiple treatments. Fifteen patients with locally recurrent rectal carcinoma received ¹²⁵I or ¹⁰³Pd seed implants under CT guidance. The minimal peripheral dose of seed implants was 110–165 Gy (median 150 Gy). Two weeks after seed implantation, a 50 Gy of stereotactic radiotherapy was given to one patient; four patients received 2–4 cycles of chemotherapy. A median follow-up was 8 months (range 4–50 months). The duration of pain-free survival was 0–50 months (median 7 months). Local control was maintained for 3–50 months (median 7 months). The 1- and 2-year local controls were 16.2 and 8.1%, respectively. Eleven patients died: two (18.2%) of local recurrence, seven (63.6%) of local recurrence and metastases, and two (18.2%) of metastases. Four patients (26.7%) survived the median survival was 9 months. The 1- and 2-year actuarial overall survival rates were 42.9% and 10.7%, respectively. One patient (7.6%) experienced a grade 4 toxic event; there was no associated neuropathy. CT-guided radioactive seed implantation is feasible and safe as a salvage or palliative pain relief treatment for patients with recurrent rectal cancers after surgery and radiotherapy.     

CT引导下125I 粒子植入联合化疗治疗复发性卵巢癌

目的:探讨CT引导下125I 粒子植入联合化疗治疗复发性卵巢癌患者的临床疗效及安全性。方法:回顾性分析采用125I粒子植入联合化疗治疗的21例复发性卵巢癌患者资料。共29处可评价病灶,其中25处适合125I 粒子植入治疗。应用治疗计划系统制定125I 粒子植入计划,在CT引导下植入粒子。粒子植入术后3 d 内行紫杉醇脂质体静脉化疗,次日经肿瘤供血动脉灌注卡铂,每3 周重复1 次,随访观察治疗效果及并发症。结果:2 个疗程化疗结束后125I 粒子植入治疗的25处病灶中完全缓解（CR）为16%（4/25）、部分缓解（PR）为56%（14/25）、疾病稳定（SD）为12%（3/25）、疾病进展（PD）为16%（4/25）,总有效率（CR+PR）为72%（18/25）,疼痛缓解率为82.4%（14/17）,KPS 评分较治疗前升高（P=0.019）。 中位无进展生存时间（PFS）为6.8 个月,中位生存时间（OS）为14.2 个月,1 年生存率为42.9%（9/21）,主要为血液学及消化道不良反应,所有患者未发生严重的放射性损伤并发症。结论:125I粒子植入治疗联合化疗能够提高复发性卵巢癌患者的临床缓解率,改善临床症状,并且耐受性良好。