超声引导下125I粒子组织间植入治疗卵巢癌术后复发的临床疗效

目的:探讨超声引导下125I粒子组织间植入治疗卵巢癌术后复发的临床疗效。方法:采用三维治疗计划系统（3D2TPS）对28例术后复发卵巢癌患者,32个病灶（3个位于腹壁,29个位于阴道断端）超声引导下将125I粒子（经阴式或经腹式探头）植入卵巢复发肿瘤内。结果:32个可评价的病灶完全缓解（CR）25个,部分缓解（PR）3个,无变化（SD）2个,进展（PD）2个,总有效率87.5%。28例患者血清CA125下降21例,升高5例,血无明显变化2例。结论:超声引导下125I组织间植入治疗复发卵巢癌安全、有效,可提高患者生活质量。     

CT引导下放射性125I粒子植入治疗恶性肿瘤的临床研究

目的:探讨CT引导下放射性125I粒子植入治疗恶性肿瘤的疗效。方法:回顾性分析2007年7月至2008年12月恶性肿瘤68例,均行125I粒子植入治疗。植入前用三维治疗计划系统计算术中所需125I粒子的总活度及粒子的数量,CT引导下植入病灶中,粒子活度为0.6-0.8mCi,处方剂量90-110Gy,术后验证粒子植入剂量分布。植入后复查并随访,统计有效率、局部控制率及不良反应等情况。结果:68例患者粒子植入均顺利完成。6个月有效率(包括完全缓解及部分缓解)88.2%。术后随访6-24个月,局部控制率为76.5%,术中4例出现气胸,经治疗好转,术后出现粒子迁移3例,无严重并发症发生。结论:CT导向125I粒子植入治疗恶性肿瘤是一种安全而有效的方法。     

腹腔镜下微波消融联合125I粒子植入治疗不可切除肝细胞癌

目的 对比单纯微波消融,探讨腹腔镜辅助下微波消融联合125I粒子植入治疗不可切除肝细胞癌的安全性及有效性.方法 对我院2005年3月至2010年5月收治的65例不能手术切除的肝细胞癌患者,随机分为单纯微波消融治疗组(30例)和微波消融治疗联合125I粒子植入治疗组(35例),所有患者均行CT增强扫描,并按病灶大小分为A...     

姑息手术^125I粒子植入联合热疗及化疗治疗晚期肺癌

目的评价姑息性手术125I粒子植入联合热疗及化疗综合治疗晚期肺癌的方法和疗效.方法 28例肺癌中原发性非小细胞肺癌(NSCLC)15例(ⅢA期9例,ⅢB期6例),NSCLC手术后局部复发6例,转移性肺癌7例(其中结肠癌肺转移3例,乳癌肺转移4例).采用开胸姑息切除 125I粒子植入 体外高频透热治疗(HFDT) 化疗17例,胸腔镜附加小切口行局部肿块(楔形)切除 125I粒子植入 HFDT 化疗6例,肿瘤内射频消融(RFA) 125I粒子植入 化疗5例.结果全组随访12～32个月(平均16.9个月).CR 21例,PR 6例,NR 1例.1年后局部复发4例,2例经再次植入125I又得到控制.5例患者死亡,1例因局部复发,4例因远处转移.所有患者植入125I粒子后无白细胞、血小板降低,无肝肾功能损害,均能较好耐受同时化疗.结论本治疗方法安全可行,有较高的肿瘤局部控制率,患者生活质量高,生存期延长.     

I 125放射性粒子植入在口腔颌面部恶性肿瘤治疗中的应用

  目的  研究I125放射性粒子组织间近距离植入治疗口腔颌面部恶性肿瘤的近期疗效及副反应, 探讨其在恶性肿瘤综合治疗中的应用价值。   方法  根据制定的相应放射性粒子植入治疗计划, 对38例口腔颌面部恶性肿瘤患者应用手术配合I125粒子植入治疗或单纯粒子植入治疗, 术后随访观察疗效及副反应。   结果  所有病例随访12~28个月, 平均20个月, 其中23例手术配合粒子植入者局部未见明显新生肿物, 15例单纯粒子植入病例均见病灶不同程度缩小, 不适症状有所减轻。除2例患者出现局部皮肤色素沉着, 1例患者咽部不适1周后缓解, 余病例均未出现明显粒子植入后副反应。   结论  放射性粒子植入治疗对口腔颌面部恶性肿瘤的近期疗效显著, 为综合治疗口腔颌面部恶性肿瘤提供了新的发展方向。      

手术联合（125）I粒子术中植入治疗12例恶性胸腺瘤近期疗效

[目的]探讨手术联合125I粒子植入在恶性胸腺瘤综合治疗的应用价值。[方法]回顾性分析2003年1月至2010年12月在手术姑息切除同时进行125I粒子植入治疗12例恶性胸腺瘤患者临床资料,观察并发症,评价肿瘤变化及复发转移。[结果]术后粒子分布满意率66.7%,并发咯血2例,粒子移位4例。12例患者随访9个月～7年,术后出现肌无力危象呼吸衰竭1例,局部复发转移3例,死亡4例。[结论]手术联合125I粒子术中植入治疗无法手术根治的恶性胸腺瘤,可以提高手术疗效,降低局部复发率。     

放射性粒子125I植入治疗12例早期肾癌的临床观察

目的:评价CT引导下瘤体内125I粒子植入治疗早期肾癌的可行性、安全性及其疗效.方法:对12例肾癌患者的15个病灶在CT引导下行瘤体内125I粒子植入治疗,植入术后立即CT扫描观察粒子在瘤体内的分布,术后随访观察有无并发症发生.结果:12例患者均顺利完成手术,平均时间43(30～50) min.单个瘤体内植入125I粒子数为1～19粒(平均8粒).术后6个月CT扫描显示粒子分布满意,15个病灶中4个消失,7个明显缩小,3 个病灶稳定,1个进展.1例孤立肾患者术后3个月发现肉眼血尿,经保守治疗后消失.12例患者未见治疗相关的放射损伤.平均随访36(6～52)个月,1例术后13个月死于心肌梗死,2例术后18和22个月死于多发肺转移.余9例正常生存.结论:CT导引下125I粒子植入治疗对早期肾癌是一种可供选择的安全、有效治疗方法.     

放射性粒子~（125）I植入治疗12例早期肾癌的临床观察

目的：评价CT引导下瘤体内125I粒子植入治疗早期肾癌的可行性、安全性及其疗效。方法：对12例肾癌患者的15个病灶在CT引导下行瘤体内125I粒子植入治疗,植入术后立即CT扫描观察粒子在瘤体内的分布,术后随访观察有无并发症发生。结果：12例患者均顺利完成手术,平均时间43（30～50）min。单个瘤体内植入125I粒子数为1～19粒（平均8粒）。术后6个月CT扫描显示粒子分布满意,15个病灶中4个消失,7个明显缩小,3个病灶稳定,1个进展。1例孤立肾患者术后3个月发现肉眼血尿,经保守治疗后消失。12例患者未见治疗相关的放射损伤。平均随访36（6～52）个月,1例术后13个月死于心肌梗死,2例术后18和22个月死于多发肺转移。余9例正常生存。结论：CT导引下125I粒子植入治疗对早期肾癌是一种可供选择的安全、有效治疗方法。     

放射性125I粒子植入治疗腹膜后淋巴结转移癌的疗效分析

目的探讨CT引导下放射性125I粒子植入治疗腹膜后淋巴结转移癌的疗效和安全性。方法采用三维治疗计划系统计算出术中所需放射性粒子的总活度和数量,在CT引导下对40例腹膜后淋巴结转移癌患者行肿瘤内放射性125I粒子植入治疗,并根据肿瘤病理性质,采用相应化疗方案。结果 40例患者中,21例患者疼痛完全消失,17例患者疼痛症状明显改善,其余2例止痛效果欠佳;2个月后评价疗效,21例肿瘤完全缓解,19例病灶有不同程度缩小。术后并发症主要为术后局部疼痛、术后手术部位疼痛、术后发热、术后静脉血栓,经对症处理后均可缓解,无严重并发症发生,无手术死亡患者。40例患者术后均获得随访,随访时间4~18个月,中位随访时间8个月,13例因原发肿瘤进展死亡,其余27例均生存。结论 CT引导下放射性125I粒子植入治疗腹膜后淋巴结转移癌疗效好,创伤轻,安全性高,值得临床推广应用。     

125I粒子植入治疗复发性恶性肿瘤31例

目的:探讨125I粒子植入治疗复发性恶性肿瘤的疗效及安全性.方法:31例复发性恶性肿瘤患者,男22例,女9例,年龄19岁-76岁,平均51岁,其中脑胶质瘤1例,鼻咽癌4例,鼻窦癌2例,口咽癌2例,食道癌3例,肺癌5例,乳腺癌1例,肝癌4例,直肠癌3例,宫颈癌1例,骨肉瘤3例,纤维肉瘤2例,31例共36个病灶.在CT或B超引导下将125I粒子植入肿瘤病灶内,采用放射性粒子治疗计划系统(TPS)设计布源,将放射性活度为23.31MBq-29.97MBq的125I粒子按10mm层间距植入.结果:31例36个病灶,完全缓解(CR)8个,部分缓解18个,总有效率72.2%.术中11例出现少量渗血;术后出现胸背痛1例,1例出现少量气胸(肺压缩小于30%),保守治疗后恢复;食道气道瘘1例.结论:125I粒子植入作为常规放化疗治疗复发性恶性肿瘤的一种补充治疗手段,局部控制率高,创伤小,安全性好.     

Treatment of recurrent gynecologic malignancies with iodine-125 permanent interstitial irradiation

PURPOSE: To analyze the outcome of permanent 125I interstitial radiotherapy for unresectable retroperitoneal recurrences of gynecologic malignancies. METHODS AND MATERIALS: A retrospective review of 20 patients treated between 1979 and 1993 was performed to evaluate survival and morbidity associated with the interstitial 125I technique. RESULTS: Nineteen tumors were located on the lateral pelvic wall and one in the para-aortic region. Eight patients, not previously irradiated, received external beam radiotherapy (EBRT) along with 125I interstitial implants placed at the time of celiotomy. Nineteen (95%) are dead of disease at 1-69 months of follow-up. The median survival was 7.7 months for patients treated with 125I alone and 25.4 months for those treated with both 125I and EBRT. One patient is alive without evidence of disease 69 months after 125I implantation. Fistulas, bowel obstructions, and fatal complications occurred only among patients previously irradiated. CONCLUSIONS: When used in a previously irradiated field, 125I interstitial radiotherapy has major morbidity and is unlikely to be associated with cure or long-term survival. In radiotherapy-naive patients with unresectable isolated recurrent gynecologic malignancies, 125I implants and EBRT are feasible and occasionally may contribute to long-term disease-free survival.     

Permanent low-activity iodine-125 implants for cerebral metastases

Beginning in 1987, selected patients with metastatic braintumors were treated with permanent implants of low-activityradioactive iodine-125 (¹²⁵I) seeds. These patients underwent craniotomy,gross total resection of the metastatic lesion, andplacement of the seeds. In general, criteria fortreatment included the presence of a recurrent tumorwith a volume too large to permit radiosurgery,and a Karnofsky Performance Score of 70 orhigher. Thirteen patients underwent 14 implant procedures; allreceived external whole-brain radiotherapy. Implant dose ranged from43 Gy to 132 Gy, with a meanof 83 Gy. Survival after implantation ranged from2 weeks to almost 9 years, with amedian of 9 months. Clinical and radiographic localcontrol was obtained in 9 patients. Two patientsdied of acute, postoperative complications within a monthof implantation, so no information regarding tumor controlis available for them. Late complications included abone flap infection in one patient and aCSF leak in another; both were treated withoutfurther sequelae.These results demonstrate that permanent ¹²⁵I implants canresult in good survival and quality of life,and occasionally can yield long-term survival. Potentially, itis a cost-effective treatment in that a separateprocedure for stereotactic implantation or radiosurgery is notneeded, as is the case with the useof temporary high-activity seeds. The permanent implantation itselfadds less than 10 minutes to the craniotomy,and the risk of symptomatic radiation necrosis islow. We recommend consideration of this procedure inpatients harboring large, recurrent metastatic tumors that requirefurther surgery.     

CT导向下125I粒子植入治疗晚期头颈肿瘤的近期疗效

目的：评价CT导向下125I放射性粒子植入治疗晚期头颈肿瘤的临床价值。方法：回顾分析2007年10月-2008年8月接受CT导向下125I放射性粒子植入治疗的10例晚期头颈癌患者的临床资料。采用计算机立体计划系统计算布源,在CT导向下125I粒子平面插植。手术结束后1—3个月复查CT。结果：10例患者中8例术后5—14天疼痛缓解,有效率80％,2例无效。10例患者局部肿瘤完全缓解8例（80％）,部分缓解1例,无效1例。无明显并发症发生。结论：协I粒子植入治疗晚期头颈肿瘤近期疗效好,安全性高,创伤小,并发症发生率低。     

CT引导下125I 粒子植入联合化疗治疗复发性卵巢癌

目的:探讨CT引导下125I 粒子植入联合化疗治疗复发性卵巢癌患者的临床疗效及安全性。方法:回顾性分析采用125I粒子植入联合化疗治疗的21例复发性卵巢癌患者资料。共29处可评价病灶,其中25处适合125I 粒子植入治疗。应用治疗计划系统制定125I 粒子植入计划,在CT引导下植入粒子。粒子植入术后3 d 内行紫杉醇脂质体静脉化疗,次日经肿瘤供血动脉灌注卡铂,每3 周重复1 次,随访观察治疗效果及并发症。结果:2 个疗程化疗结束后125I 粒子植入治疗的25处病灶中完全缓解（CR）为16%（4/25）、部分缓解（PR）为56%（14/25）、疾病稳定（SD）为12%（3/25）、疾病进展（PD）为16%（4/25）,总有效率（CR+PR）为72%（18/25）,疼痛缓解率为82.4%（14/17）,KPS 评分较治疗前升高（P=0.019）。 中位无进展生存时间（PFS）为6.8 个月,中位生存时间（OS）为14.2 个月,1 年生存率为42.9%（9/21）,主要为血液学及消化道不良反应,所有患者未发生严重的放射性损伤并发症。结论:125I粒子植入治疗联合化疗能够提高复发性卵巢癌患者的临床缓解率,改善临床症状,并且耐受性良好。      

CT引导下125I粒子永久植入治疗难治性恶性肿瘤

[目的]评价在CT引导下经皮穿刺125Ⅰ粒子组织间植入治疗临床难治性恶性肿瘤的安全性、疗效.[方法]14例难治性恶性肿瘤15个病灶,瘤体直径5.0cm～10.0cm,平均7.0cm.根据粒子植入术前14d内CT图像,采用治疗计划系统(treatment plan system,TPS)制定粒子植入计划,按计划在CT引导下经皮穿刺准确植入125I粒子.植入后即刻及术后1～8个月CT复查观察粒子在瘤体内的分布、有无并发症发生及疗效.[结果]14例粒子植入均顺利完成,11例粒子分布满意,3例粒子分布欠均匀,2例分别于术后4周和8周对肿瘤冷区进行粒子补充,另1例患者拒绝再次植入术.单个瘤体内植入粒子数为9～85粒(平均47粒).14例患者15个病灶,完全缓解(CR)2个;部分缓解(PR)12个;无变化(SD)0个;进展(PD)1个.总有效率93.3%(14/15).除1例阴道癌术后盆腔转移患者粒子植入术后联合静脉化疗出现重度骨髓抑制,其余13例未见急性并发症和治疗相关的放射损伤.[结论]CT引导下经皮穿刺125I粒子组织间植入治疗常规放化疗无效的恶性肿瘤是一种安全、有效的治疗手段.     

消化道恶性肿瘤根治术中125I放射性粒子近距离治疗104例

目的 探讨125I粒子近距离治疗消化道恶性肿瘤的临床疗效.方法 对Ⅱ～Ⅲ期消化道肿瘤患者104例行肿瘤根治术,术中将125I粒子植入可能残留癌组织的区域和癌细胞转移途径的淋巴结区域.术后5～7 d查血常规和免疫球蛋白的变化,X线片检查观察125I粒子分布状况,了解肿瘤复发或转移情况.结果 全组患者均获随访,无死亡.其中发生肠瘘1例,经积极治疗痊愈.8例患者1周内白细胞(WBC)降至3×109/L,经对症治疗后,WBC回升到4 ×109/L以上,免疫指标测定低于正常值.其他生存患者随访中未出现因植入粒子而导致的严重并发症.结论 125I粒子植入近距离治疗Ⅱ～Ⅲ期消化道恶性肿瘤方法 简单、疗效确切,是一种治疗恶性肿瘤的理想方法之一,尤其在基层具有良好的应用前景.     

Permanent iodine 125 brachytherapy in patients with progressive or recurrent glioblastoma multiforme

This study reports the initial experience at the University of California San Francisco (UCSF) with tumor resection and permanent, low-activity iodine 125 (125I) brachytherapy in patients with progressive or recurrent glioblastoma multiforme (GM) and compares these results to those of similar patients treated previously at UCSF with temporary brachytherapy without tumor resection. Thirty-eight patients with progressive or recurrent GM were treated at UCSF with repeat craniotomy, tumor resection, and permanent, low-activity 125I brachytherapy between June 1997 and May 1998. Selection criteria were Karnofsky performance score > or =60, unifocal, contrast-enhancing, well-circumscribed progressive or recurrent GM that was judged to be completely resectable, and no evidence of leptomeningeal or subependymal spread. The median brachytherapy dose 5 mm exterior to the resection cavity was 300 Gy (range, 150-500 Gy). One patient was excluded from analysis. Median survival was 52 weeks from the date of brachytherapy. Age, Karnofsky performance score, and preimplant tumor volume were all statistically significant on univariate analyses. Multivariate analysis for survival showed only age to be significant. Median time to progression was 16 weeks. Both univariate and multivariate analysis of freedom from progression showed only preoperative tumor volume to be significant. Comparison to temporary brachytherapy patients showed no apparent difference in survival time. Chronic steroid requirements were low in patients with minimal postoperative residual tumor. We conclude that permanent 125I brachytherapy for recurrent or progressive GM is well tolerated. Survival time was comparable to that of a similar group of patients treated with temporary brachytherapy.     

Radical surgical resection and high-dose intraoperative radiation therapy (HDR-IORT) in patients with recurrent gynecologic cancers

OBJECTIVE: To determine the outcome for patients with recurrent gynecologic tumors treated with radical resection and combined high-dose intraoperative radiation therapy (HDR-IORT). METHODS AND MATERIALS: Between November 1993 and June 1998, 17 patients with recurrent gynecologic malignancies underwent radical surgical resection and high-dose-rate brachytherapy. The mean age of the study group was 49 years (range 28-72 years). The site of the primary tumor was the cervix in 9 (53%) patients, the uterus in 7 (41%) patients, and the vagina in 1 (6%) patient. The treatment for the primary disease was surgery with or without adjuvant radiation in 14 (82%) patients and definitive radiation in 3 (18%) patients. The current surgery consisted of exenterative surgery in 10 (59%) patients and tumor resection in 7 (41%) patients. Complete gross resection was achieved in 13 (76%) patients. The mean HDR-IORT dose was 14 Gy (range 12-15). Additional radiation in the form of permanent Iodine-125 implant was given to 3 of 4 patients with gross residual disease. The median peripheral dose was 140 Gy. RESULTS: With a median follow-up of 20 months (range 3-65 months), the 3-year actuarial local control (LC) rate was 67%. In patients with complete gross resection, the 3-year LC rate was 83%, compared to 25% in patients with gross residual disease, p < 0.01. The 3-year distant metastasis disease-free and overall survival rates were 54% and 54%, respectively. The complications were as follows: gastrointestinal obstruction, 4 (24%); wound complications, 4 (24%); abscesses, 3 (18%); peripheral neuropathy, 3 (18%); rectovaginal fistula, 2 (12%); and ureteral obstruction, 2 (12%). CONCLUSION: Radical surgical resection and combined IORT for patients with recurrent gynecologic tumors seems to provide a reasonable local-control rate in patients who have failed prior surgery and/or definitive radiation. Patient selection is very important, however, as only those patients with complete gross resection at completion of surgery appear to benefit most from this radical approach in the salvage setting.     

非小细胞肺癌患者放射性125I粒子植入治疗后近期血清肿瘤标志物变化

  目的   测定放射性粒子植入治疗前后患者血清癌胚抗原（CEA）、糖类抗原125（CA125）、鳞状细胞癌相关抗原（SCC-Ag）、细胞角蛋白19片段（CYFRA21-1）等肿瘤标志物水平,通过比对其动态变化,观察125I粒子植入治疗非小细胞肺癌的疗效与肿瘤标志物水平的关系。   方法   选取自2009年1月至2012年6月在天津医科大学第三医院接受治疗的经病理明确诊断为非小细胞肺癌患者72例,对全部患者行CT引导下放射性125I粒子植入治疗。分别于术前3 d及术后1、2、3、6个月取患者空腹静脉血,送检测定血清肿瘤标志物水平。   结果   125I粒子植入1个月后,肺癌患者血清中CEA、CA125、SCC-Ag、CYFRA21-1等肿瘤标志物较植入前即出现明显变化（P < 0.01）。125I粒子植入后1、2、3、6个月上述肿瘤标志物水平各组间比较无明显差异。   结论   125I粒子植入治疗肺癌能够有效的降低多项肿瘤标志物的水平,不同疗效分级患者的肿瘤标志物水平明显不同。      

手术加125I粒子永久性植入治疗肺癌单发脑转移瘤的临床疗效及放射性脑损伤程度的研究

背景与目的:研究证实全脑放射治疗可引起放射性脑损伤,因此,探索一条能取代全脑照射而不影响疗效的新的治疗方法十分必要。本研究的目的就是评价手术加125I粒子永久性组织间植入治疗非小细胞肺癌单发脑转移瘤的疗效及放射性脑损伤程度。方法:将67例非小细胞肺癌单发脑转移瘤随机分为:手术加125I粒子植入组(植入组)32例(47.8%);全脑加小野照射组(常规组)35例(52.2%)。所有患者均经病理证实为非小细胞肺癌,其中鳞癌42例,腺癌25例。CT或MRI证实67例患者颅内有转移灶且为单发。植入组行局部脑转移瘤切除术,术后根据肿瘤大小、部位、125I粒子排列距离和每粒粒子剂量大小确定插入粒子数量。粒子植入部位:在肿瘤切除部位及周围组织或手术区域肿瘤可能残存或复发部位。常规组先行全脑照射,2～3Gy/次,5次/周,照射至剂量为30～39Gy/3～4周后缩小野加量,总剂量达45～55Gy/5～6周。结果:植入组局控率、复发率、中位复发时间分别为96.9%、15.6%和9个月;常规组分别为82.9%、17.1%和7个月,两组比较均无统计学意义(P>0.05)。植入组的中位生存时间、1年生存率、1年死亡率分别为12个月、40.6%以及28.1%;常规组为9个月、31.4%以及37.1%,两组比较均有显著性差异(P<0.05)。植入组急性放射性反应明显轻于常规组,其放射性损伤也