125I粒子植入联合化、放疗治疗局部复发性晚期肺癌

目的探讨125I粒子植入联合化、放疗治疗局部复发性晚期肺癌效果。方法32例在CT引导下经皮行125I粒子植入术。术前经治疗计划系统（TPS）制定治疗计划。肿瘤匹配周边剂量（MPD）为110～140Gy，治疗靶体积（PTV）包括临床靶体积（CTV）外周1cm，每个粒子活度为0．7mCi。术后即刻行CT扫描进行质量验证。粒子植入术后3～7d内同步或分期进行化疗或化、放疗，化疗方案选用EP（依托泊苷和顺铂）、NP（长春瑞滨和顺铂）或TP（紫杉醇和顺铂）。结果植入后2～4个月CR46．9％（15／32），PR37．5％（12／32），NC15．6％（5／32），总局部控制率（CR＋PR）84．4％。1年和2年生存率分别为78．6％（22／28）、66．7％（10／15），4例生存超过3年。并发症：气胸11例（34．4％），其中3例大量气胸急诊置管引流治愈；出血9例（28．1％），其中肺内渗血5例、咯血4例；粒子脱靶3例（9．4％），其中2例落入胸腔膈肌，1例偏离靶区，未发生粒子迁移与放射性肺损伤。结论”’I粒子植入联合化、放疗治疗局部复发性肺癌疗效满意。

Implantation of 125I Seeds Combined with Radiotherapy and/or Chemotherapy for Local Recurrent Lung Cancer at a Late Stage

Objective To explore the efficacy of implantation of 1251 seeds combined with radiotherapy and/or chemotherapy for local recurrent lung cancer at a late stage. Methods A total of thirty-two patients were received implantation of 125I seeds therapy with a MPD of 110 to 140 Gy in our hospital. CT scan was used for guidance. Before the operation, a therapeutic plan was made by TPS. The therapeutic target volume （PTV） included the clinical target volume （CTV） plus the surrounding tissues 1 cm adjacent to the edge of CTV. The activity of each seeds was set at 0.7 mCi. The distribution of the seeds was checked by CT scan immediateIy after the impIantation. Then, chemotherapy or radiotherapy was carried out in 3 to 7 days. EP, NP, or TP was used for the patients receiving chemotherapy. Results In 2 to 4 months after the treatments, the CR, PR, and NC were 46.9% （15/32） , 37.5% （ 12/ 32） , and 15.6% （5/32） , respectively. The rate of complete local control was 84.4% （ CR ＋ PR）. The 1- and 2-year survival rate in this series were 78.6% （22/28） and 66.7% （ 10/15 ）. Four of these patients survived over 3 years. Eleven of the patients （34.4%） developed pneumothorax after the implantation, 3 of them were cured by chest drainage; 9 patients（28.1% ） bad hemorrhage including 5 cases of intrapulmonary bleeding and 4 cases of emptysis. In 3 cases （9.4%） , the seeds missed the target, and dropped into the diaphragmatic muscle at the thoracic cavity （2 cases） or out of the target area （ 1 case）. No seeds migration or radiation-induced lung injury was found. Conclusion Implantation of 125I seeds combined with radiotherapy and/or chemotherapy is effective for patients with local recurrent lung cancer at a late stage.