CT导向下125I粒子植入治疗多发骨转移瘤

目的 评价CT导向下125I粒子植入治疗多发骨转移瘤的临床价值.方法 回顾性分析2007年1月至2008年1月来自于第三军医大学西南医院28例经CT导向下125I粒子植入治疗的多发骨转移瘤患者的临床资料,重点总结与分析此类病变的疗效评价.本组共28例,其中男13例,女15例,年龄34～71岁,中位年龄50岁,其中肺腺癌6例,肺鳞状细胞癌、前列腺癌、肾透明细胞癌各4例,肝细胞癌、结肠癌各3例,乳腺癌2例、恶性神经鞘瘤1例、胰腺癌1例.28例转移灶数目为116个,平均每人4.2个.125I粒子活度和数量经北京科霖众医学技术研究所的"三维放射性粒子源植入治疗计划系统V 1. 5"计算获得.在CT导向下按共轴针法将125I粒子植入靶区内.采用临床症状的改善和影像学进行综合疗效评价.结果 28例患者疼痛缓解情况:16例显效,7例有效,5例无效,有效率82.1%,平均术后3～7 d疼痛缓解.2个月后CT复查,116个病灶中局部控制93个,无变化17个,进展6个,总有效率80.2%.术后发现1例累及腰椎神经根(L3～L4)转移性病灶;1例腰椎转移灶在粒子植入,穿刺针途经腰大肌时,引起针道内出血,形成较大椎旁腰大肌血肿;术后2周,2例患者近期出现轻度白细胞下降;术后随访,未见放射性脊髓炎及神经损伤.结论 CT导向下125I粒子植入治疗多发骨转移瘤具有疗效好,创伤小,并发症发生率低等优点,是一种较好的微创治疗方法.

CT guided radioactive seed 125I implantation in treating multiple bone metastasis

Objective To investigate the clinical value of CT guided radioactive seed 125Iimplantation in treating bone metastasis. Methods 28 multiple bone metastatic tumor patients with 116metastatic lesions totally, adenocarcinoma of lung in 6 cases, squamous cell carcinoma of lung, renal clear-cell carcinoma, and carcinoma of prostate in 4 cases each, hepatocellular carcinoma and colon carcinoma in3 cases each, breast carcinoma in 2 cases, and malignant schwannoma and pancreatic cancer in 1 case each,13 males and 15 females, aged 49.8, underwent CT guided radioactive seed125I implantation into bonemetastatic lesions. Results In these 28 cases, complete pain relief (CR) was observed in 16 cases, partialrelief (PR) in 7 cases, and no change (NC) in 5 cases with an effective rate of 82. 1%. Among the 116lesions in these 28 cases local control (LC) was seen in 93 cases, NC in 17, and PD in 6. The responserate was 80. 2%. Conclusion CT guided radioactive seed 125I implantation procedure has good clinicaleffects in treating bone metastasis with minimal invasive and few complications.