CT导向下~(125)I粒子植入术治疗恶性肿瘤(英文)

背景:放射性粒子植入近距离内照射治疗恶性肿瘤是一种新的放疗手段,随着粒子植入治疗计划系统的出现和CT、超声引导下精确定位系统的逐步完善,使放射性粒子组织间植入治疗得到进一步应用。目的:评价CT导向下瘤体内125I粒子植入治疗恶性肿瘤的操作方法、可行性、安全性及其技术特征。设计:前后对照观察。单位:合肥市第一人民医院。对象:选择2004-01/2005-03合肥市第一人民医院收治的不适合外科手术治疗的恶性肿瘤患者21例,共26个病灶,其中原发性病灶9个,转移性病灶17个。方法:在CT导向下将125I粒子植入恶性肿瘤病灶内,采用治疗计划系统计算布源,125I粒子的放射性活度为22,26,30,33MBq/粒,病灶中心选择较大活度的粒子,病灶边缘及重要器官附近选择较小活度的粒子,较大活度的粒子间距为1.5cm,较小活度的粒子间距为1.0cm。主要观察指标:观察粒子在瘤体内的分布、有无并发症及植入粒子后病灶大小变化。结果:①21例粒子植入均顺利完成,术中无并发症发生,粒子在病灶内的分布与植入前计划基本一致。21例全部进入结果分析。②每个瘤体内植入125I粒子数为5￣40粒(平均14粒)。10例恶性骨肿瘤患者植入术后疼痛均有明显缓解。术后随诊复查CT,18个病灶明显缩小,4个病灶内出现坏死组织,4个病灶大小无明显变化。③11例14个病灶随访5～7个月,植入后平均病灶大小明显小于植入前(1.84cm比3.41cm,t=5.7237,P<0.001);10例12个病灶随访8～10个月,植入后平均病灶大小也明显小于植入前(1.96cm比3.43cm,t=5.5778,P<0.002)。结论:CT导向下瘤体内植入125I粒子近距离放射治疗恶性肿瘤是一种安全、有效治疗方法。

CT-guided iodine-125 implantation in the treatment of malignant tumor

BACKGROUND: As a new radiotherapy for malignant tumor, brachytherapy of radioactive seed implantation enables the inter-tissue implantation of radioactive seeds to be applied further with the appearance of seed implantation treatment planning system (TPS), and the gradual consummation of ultrasound and CT-guided precise positioning system.OBJECTIVE: To evaluate the methods, feasibility, safety and efficacy of CT-guided iodine-125 (125I) implantation for malignant tumors.DESIGN: A controlled observation before and after implantation.SETTING: The First People's Hospital of Hefei City.PARTICIPANTS: Twenty-one patients with malignant tumors, who were not suitable for surgical treatments of operation,were selected from the First People's Hospital of Hefei City from January 2004 to March 2005. There were 26 lesions, including 9 lesions of primary unresectable carcinoma and 17 lesions of metastasis tumors.METHODS: Under CT guidance, 125I seeds were implanted into malignant tumor according to TPS, the radioactivity quantum were 22, 26, 30 and 33 MBq per granule. Larger radiation 125I wes suitable for the implantation in the center of a lesion and smaller ones were for the margin of the lesion and the peripheral region of some important organisms such as vessels and nerves. The interval between larger seeds was about 1.5 cm whereas the interval between smaller ones was about 1.0 cm.MAIN OUTCOME MEASURES: The seed distribution, existence of complication and changes of the size of lesion after implantation were observed.RESULTS: ① The seeds were implanted successfully in all the 21 cases. No complication was observed. The practical distribution of the implanted seeds was basically the same as the scheduled scheme before implantation. All the 21 patients were involved in the analysis of results. ② The number of seeds implanted in one lesion was 5 to 40 (mean 14).Pain relief was obtained in all 10 cases of malignant tumors of bone after implantation. Follow-up CT reexamination demonstrated that 18 lesions were obviously diminished, necrosis was found in 4 lesions and remaining 4 lesions had no significant changes in size. ③ The average sizes of 14 lesions in 11 patients at 5-7 months after implantation were obviously smaller than those before implantation (1.84 cm vs 3.41 cm, t =5.7237, P ＜ 0.001). The average sizes of 12 lesions in 10 patients at 8-10 months after implantation were also obviously smaller than those before implantation (1.96 cm vs 3.43 cm, t =5.577 8, P ＜ 0.002).CONCLUSION: CT-guided 125I implantation is a safe, effective and feasible method for the treatment of malignant tumor.