组织间植入放射碘-125粒子辅助治疗直肠癌的临床研究

目的 :探讨组织间植入放射碘 - 1 2 5 ( 12 5I)粒子近距离放疗辅助治疗直肠癌的疗效。方法 :对 1 997～ 1 998年间 1 1 2例施行前切除加全直肠系膜切除手术 ( TME)的直肠癌患者进行前瞻性对照性治疗研究。患者分 TME+静脉化疗 (四氢叶酸钙 + 5 Fu) +顺铂 ( DDP)腹腔灌注 +术中 12 5I植入组 (实验组 49例 )和 TME+静脉化疗 + DDP腹腔灌注 +术后放疗组 (对照组 63例 ) ,随访比较两组间控便功能、并发症、局部复发率、转移率和 5年生存率等。结果 :两组术后控便功能、吻合口瘘、吻合口狭窄发生率和远处转移率差异无统计学意义 ;实验组 Duke C、D期局部复发率低于对照组 ( P<0 .0 5 ) ,5年生存率高于对照组 ( P<0 .0 5 ) ,实验组放射反应少于对照组 ( P<0 .0 1 ) ;粒子植入数量超过 5 0枚时吻合口瘘的发生率增加( P<0 .0 5 ) ,并影响控便功能 ( P<0 .0 5 ) ,而 5年生存率并无增加。结论 :组织间植入 12 5I粒子近距离放疗辅助治疗直肠癌疗效优于外照射 ,能降低 Duke C、D期的局部复发率和提高 5年生存率 ,无严重放射反应。但可能会增加吻合口瘘的发生率 ,故应恰当使用放射剂量 ,以避免吻合口瘘的发生

A Prospective Investigation of Interstitial Radiactive Iodine-125 Seeds Implantation for Accessory Treatment of Rectal Carcinoma

Objective: To probe into the curative effect of interstitial iodine 125( 125 I) radiation on rectal carcinomas. Methods: 112 during the time from 1997 to 1998 cases with resectable rectal carcinoma subjected to anterior excision plus total mesorectal excision (TME) were divided into two groups.49 cases of experimental group were treated with TME plus intravenous chemotherapy(leucovorin calcium and 5 fluorouracil) plus bdominal infusion of DDP plus 125 I interstitial implantation during the operation without further postoperative radiotherapy, 63 cases of the control group were treated in the same ways plus postoperative radiotherapy without interstitial 125 I radiation. Through follow ups,controlly function defection complications recurrence rate, metastasis rate and 5 year survival rate of the experimental group were compared with those of control group. Results: As shown in the study, the differences in the controlling function of defecation, the occurrence rates of the stoma constriction, leakage, and the rates of far distance metastasis were of no significance between the two groups. The 5 year survival rate was higher( P <0.05), and the rate of local recurrence and radiation reaction in experimental group was lower than those in control group( P <0.01). However, the occurrence rate of anastomotic leakage might be raised when the particles implanted were over 50( P <0.05). Conclusions: The curative effect of interstitial 125 I radiation was better than that of outside radiotherapy; it can reduce the occurrence rate of radiation reaction and local recurrence, and raise the 5 year survival rate. But proper dosage should be adopted to prevent anastomotic leakage.