放射性125I粒子组织间植入或联合放化疗治疗复发直肠癌

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,女4例,男11例.硬膜外麻醉,2例经阴道超声引导,13例CT引导,行放射性125I粒子植入术.肿瘤匹配周边剂量为90～110 Gy,每颗粒子活度为0.50～0.70 mCi,植入33～70颗.术后24～48 h拍胸、盆腔X线片了解粒子是否发生移位.术后6例加三维适形放疗,4～6野/次,200～300 cGy/次,5次/周,总剂量为4 500～5 000 cGy,间隔4周.2例粒子治疗后加草酸铂、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12例完全缓解,2例部分缓解,1例无变化,有效率93%(14/15).9例肿瘤完全缓解,2例部分缓解,4例局部进展,局部控制率73%(11/15).2例术后6个月和12个月时死于肺转移.1例1颗粒子移位至盆壁,随访12个月无症状.无治疗相关并发症和副作用发生. 结论经超声或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.

125Iodine seed interstitial implantation combined with external radiotherapy and systemic chemotherapy for recurrent rectal cancers

Objective To investigate the feasibility, short-term efficacy and adverse effects of 125 I seed implantation guided by ultrasonography or CT in the treatment of recurrent rectal cancers. Methods A total of 15 patients (4 women and 11 men) with recurrent rectal cancer entered the study. Uneer epidural anesthesia, the patients were treated with 125 I seed implantation under the guidance of either transvaginal ultrasonography or CT scans. The prescribed matched peripheral dose (MPD) was 90~110 Gy, with an activity per seed of 0.50~0.70 mCi and the total number of sources implanted of 33~70. Chest and pelvic X-ray examinations were performed within 24~48 hours after implantation to determine whether or not seed misplacement or migration existed. An additional three-dimensional conformal radiation therapy with a 4~6 fields technique was required in 6 patients 4 weeks postoperatively, with 200~300 cGy/fx, 5 fx/week, up to a total dose of 4500~5 000 cGy. Additional chemotherapy with oxaliplatin, 5-fluorouracil and tetrahydrofolic acid for one treatment course was given in 2 patients. The patients were followed for 3~15 months and the tumors were evaluated by CT findings. Results Relief from pain was achieved at a mean of 7 days after procedure, offering a complete relief in 12 patients, a partial relief in 2, and no change in 1, the effective rate being 93%(14/15). Nine patients showed a complete remission, 2 showed a partial remission, 4 showed a progressive disease, the local control rate being 73%(11/15). Two patients died of the dissemination to lungs. In 1 patient 1 seed had migrated to the pelvic side-wall and did not cause any clinical morbidity in a follow-up of 12 months. Conclusion 125 I implantation 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.