CT引导下125I粒子植入治疗放疗后复发头颈部肿瘤的临床效果

目的 分析¹²⁵I粒子植入治疗放疗后复发头颈部肿瘤的疗效及安全性。方法 纳入自2007-2015年于我科接受CT引导下¹²⁵I粒子植入治疗的头颈部肿瘤放疗后复发患者数据,共101例,以往接受外照射中位积累剂量66 Gy。粒子植入后剂量(D₉₀)中位数117 Gy。Kaplan-Meier法计算生存率,Logrank 检验和单因素分析,Cox模型多因素分析。结果 中位随防12.2个月。患者5年局部无进展生存率为26.6%,5年总生存率为15.5%。单因素分析显示与局控相关因素为年龄、病理类型、植入部位、病灶体积、D₉₀、近期疗效(P均<0.05),与生存相关因素为KPS、病灶体积、D90及近期疗效(P均<0.05)。多因素分析显示病理类型、病灶体积、D₉₀、近期疗效为与局控相关的影响因素(P=0.000、0.002、0.003、0.014)。不良反应方面,皮肤/黏膜破溃25.7%,疼痛13.9%。尚未发现不良反应与剂量的相关性。结论 ¹²⁵I粒子植入治疗放疗后复发头颈部肿瘤有良好的有效性及安全性,非鳞癌、病灶体积小、D₉₀高预示较好的局控。     

CT引导125I粒子植入治疗局部复发直肠癌疗效和剂量学分析

目的 观察CT引导放射性¹²⁵I粒子植入治疗局部复发直肠癌疗效,分析剂量学参数与预后间关系。方法 回顾分析2003—2011年间本院CT引导下放射性¹²⁵I粒子植入治疗的36例局部复发直肠癌资料。¹²⁵I粒子植入术后即刻行CT扫描剂量验证,评估D₉₀、D₁₀₀、V₁₀₀和V₁₅₀。本组患者粒子活度中位数为0.7(0.4~0.8) mCi,植入粒子中位数为74(33~137)个。评价患者OS时间和LC时间及其与D₉₀、D₁₀₀、V₁₀₀和V₁₅₀的关系。Kaplan-Meier计算LC率和OS率,Logrank单因素分析,Cox模型多因素分析。结果 中位OS期为16.2(95% CI为13.5~18.9)个月。中位LC时间为10.0(95% CI为6.2~13.8)个月。D₉₀为(118.6±25.1) Gy,V₁₀₀为(90.0±0.3)%。单因素分析提示D₉₀与LC时间相关(P=0.048),V₁₀₀与OS时间相关(P=0.035)。多因素分析显示V₁₀₀>90%是OS影响因素(P=0.044)。结论 CT引导放射性¹²⁵I粒子植入治疗局部复发直肠癌,术后验证计划D₉₀>140 Gy、V₁₀₀>90%有利于提高肿瘤LC率和OS率。术后验证计划D₉₀和V₁₀₀可能预测患者治疗疗效。     

CT引导下放射性125I粒子植入治疗复发性宫颈癌的疗效及生存分析#br#

目的  探讨CT引导下放射性125I粒子植入治疗复发性宫颈癌的安全性和有效性。方法  回顾性分析自2018年1月至2020年12月在江苏省肿瘤医院行放射性125I粒子植入近距离放射治疗的31例复发性宫颈癌,患者的病史、剂量－体积直方图参数、并发症、局部控制（LC）、总生存（OS）和影响因素。结果31例复发性宫颈癌患者共有43个病灶进行放射性125I粒子植入。截至2021年3月17日,中位随访时间为10个月。中位LC及OS时间分别为9个月（1～27个月）和10个月（2～36个月）。1年和2年的局部控制率分别为733％和432％,1年和2年的总生存率分别为818％和513％。8例因肿瘤进展死亡,2例因非肿瘤原因死亡。与粒子植入手术相关的并发症包括气胸、坐骨神经损伤、呕吐、尿频、腹泻、皮肤黏膜毒性,均为1～2级,未发生严重不良反应和并发症。多因素分析显示保形指数（CI）（HR=5713,95%CI：1324～24646,P=0019）及短期疗效（HR=47009,95％CI:6674～331085,P＜0001）是影响LC的独立影响因素,高目标区域外部指数（EI）（HR=5334,95％CI：1099～25877,P=0038）是OS的独立影响因素。结论CT引导下放射性125I粒子植入作为复发性宫颈癌局部治疗的一种手段,具有安全、有效、微创等特点,值得临床推广应用。     

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~(125)Ⅰ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~(125)Ⅰ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~(125)Ⅰ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:~(125)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。     

125I放射性粒子植入治疗乏氧肿瘤近期疗效的临床研究

目的 研究¹²⁵I放射性粒子在CT引导下植入治疗乏氧性肿瘤的近期疗效。方法 通过多普勒彩色超声仪检测实体瘤内血流信号,将2014—2016年于我科行¹²⁵I放射性粒子植入治疗22例肿瘤患者分为少血供组(乏氧组)12例和多血供组(非乏氧组)10例。经增强CT定位扫描后将影像学数据传输至三维粒子植入TPS上设计术前计划,然后行¹²⁵I粒子植入治疗。术后剂量学验证靶区剂量D90为106~128 cGy;术后1~3个月按照WHO标准评价病灶缓解情况。结果 两组术后3个月总有效率为82%;乏氧组和非乏氧组有效率(CR+PR)相近,术后1个月P=0.840,术后2个月P=0.696,术后3个月P=0.840。结论 ¹²⁵I放射性粒子植入治疗实体恶性肿瘤可以克服乏氧性肿瘤体外放疗的抗拒性并获得满意近期疗效。     

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。     

125I放射性粒子植入术后患者周围辐射剂量的监测

背景与目的:影像引导下125I放射性粒子植入治疗是微创治疗的一种新技术,作为恶性肿瘤综合治疗方法之一,它具有创伤小、定位准、疗效确切等特点,因此应用越来越广泛,而125I放射性粒子对患者及周围人群的辐射损害及其防护也越来越受到重视.本研究旨在探讨125I放射性粒子植入术后患者周围辐射剂量的监测.方法:随机抽取2004年10月至2005年12月在中山大学肿瘤防治中心在CT引导下行125I放射性粒子植入治疗恶性肿瘤患者20例,用γ射线监测仪在术后即时及2、4、6个月后对125I放射性粒子辐射剂量进行监测,将监测结果与室内天然本底剂量进行比较.结果:随着与放射源距离的增大,辐射剂量迅速减少,在距离患者体表50 cm时,测得的剂量已接近室内天然本底辐射剂量;辐射剂量随着时间的推移而递减,在6个月后体表测得的剂量已基本接近室内天然本底剂量.结论:在125I放射性粒子植入术前后对辐射的防护应积极采取隔离防护措施,并注意距离防护、时间防护.只要严格采取了必要的防护措施,125I放射性粒子植入治疗对于患者及周围人群是安全的.     

结直肠癌患者放射性粒子125I植入后近期不良反应观察

目的探讨放射性粒子植入的安全性。方法手术切除肿瘤后在瘤区、相应引流血管根部或瘤体内植入不同剂量的放射性粒子^125I。结果血液系统的不良反应，粒子植入组与非粒子植入组患者之间差异无显著性。粒子植入组患者腹部并发症的发生率为14．0％，非粒子植入组为7．8％（P〉0．05）。粒子植入组患者中，年龄〈60、60～69和≥70岁三组腹部并发症率分别为4．3％、8．6％和30．8％（P〈0．005）；有、无并存疾病患者并发症率为25．9％和4．5％（P〈0．005）。结论手术中放射性粒子植入较为安全，但是，高龄和并存疾病可能增加放射性粒子植入后腹部并发症发生的危险性，对于高龄及有并存疾病的患者要慎重。     

Intraoperative electron beam radiation therapy for locally recurrent rectal carcinoma.

PURPOSE: Treatment results for locally recurrent rectal cancers are poor. This is a result of the fact that surgery is hampered due to the severance of the anatomical planes during the primary procedure and that radiotherapy is limited by normal tissue tolerance, especially after previous irradiation. This paper describes the results of a combined treatment modality in this patient group. METHODS AND MATERIALS: From 1994 to 1998, 37 patients with locally recurrent rectal cancer, but without distant metastatic disease, received a combined treatment consisting of 50.4 Gy preoperative irradiation or, in case of previous radiotherapy, 30 Gy reirradiation or no irradiation, followed by radical surgery and intraoperative electron beam radiotherapy boost. RESULTS: Fifteen patients received a radical resection (R0), eight a microscopic irradical resection (R1), and 14 a macroscopic irradical resection (R2). The overall 3-year local control (LC), disease-free survival (DFS), and overall survival rates were 60%, 32%, and 58% respectively. Radicality of resection (R0/R1 vs. R2) turned out to be the significant factor for improved survival (p < 0.05), DFS (p = 0.0008), and LC (p = 0.01). Preoperative (re-)irradiation is the other significant factor in survival (p = 0.005) and DFS (p = 0.001) and was almost significant for LC (p = 0.08). After external beam radiation therapy (EBRT) a significantly higher resection rate was obtained (R0/R1 vs. R2 p = 0.001). Symptomatic peripheral local recurrences have a significantly worse prognosis and higher rate of R2-resection (p = 0.0005). CONCLUSION: Centralization of locally recurrent rectal cancer patients enabled the development of an aggressive multimodality treatment, which in turn led to promising results. Distant failure is still a drawback.     

放射性粒子植入治疗消化系统肿瘤常见并发症

放射性粒子植入已广泛应用于治疗多种恶性肿瘤,尤其在食管、胃肠、肝胆、胰腺等晚期消化系统肿瘤的治疗中,是一种可行、有效的补充治疗手段,并取得了较好的疗效,但治疗中不可避免会有消化道反应、感染、出血、溃疡、瘘、粒子游走、肺栓塞等并发症的发生.     

CT引导下~(125)I粒子植入治疗鼻咽癌放疗后残留病灶的疗效

目的:评价CT引导下~(125)I粒子植入治疗鼻咽癌放疗后残留肿瘤病灶的疗效.方法:2007年1月-2008年1月本院25例放疗后有残留肿瘤病灶的鼻咽癌患者接受了~(125)I粒子植入治疗.采用三维治疗计划系统(treatment planning system, TPS)计算植入~(125)I粒子数量和总剂量.CT引导下将~(125)I放射性粒子植入残留肿瘤病灶中,并对植入的~(125)I放射性粒子剂量分布进行验证.术后3、6和12个月定期进行鼻咽内窥镜和CT检查,并评价近期疗效和不良反应.结果:术后12个月时,25例患者中完全缓解20例、部分缓解2例、无变化2例、疾病进展1例,总有效率(完全缓解+部分缓解)为88.0%.所有患者于术中和术后均未发生严重并发症.结论:CT引导下~(125)I粒子植入治疗鼻咽癌放疗后残留肿瘤病灶是一种安全而有效的治疗方法.     

125I放射性粒子植入治疗复发直肠癌

直肠癌术后复发率高,再治疗困难,单纯化疗和再手术疗效不佳,因而放射治疗受到重视.125I放射性粒子植入是一种新兴的近距离放疗手段.因其独特的优势故在复发直肠癌的治疗中居重要地位.125I放射性粒子植入用于复发直肠癌的治疗至今只有20年的历史,其技术上及临床实践中还存在许多亟待解决的问题.     

Intraoperative electron beam radiation therapy for recurrent locally advanced rectal or rectosigmoid carcinoma

A multimodality approach of moderate-dose to high-dose preoperative radiation therapy, surgical resection, and intraoperative electron beam radiation therapy (IORT) has been used for patients with locally recurrent rectal or rectosigmoid carcinoma. The 5-year actuarial local control and disease-free survival for 30 patients undergoing this treatment program were 26% and 19%, respectively. The most important factor predicting a favorable outcome was complete resection with negative pathologic resection margins. The determinant local control and disease-free survival for 13 patients undergoing complete resection were 62% and 54%, respectively, whereas for 17 patients undergoing partial resection these figures were 18% and 6%, respectively. There did not appear to be a difference in local control or survival based on the original surgical resection (abdominoperineal resection versus low anterior resection). However, the likelihood of obtaining a complete resection after preoperative radiation therapy was higher in patients who had previously undergone a low anterior resection than patients undergoing prior abdominoperineal resection. For the 30 patients undergoing external beam irradiation, resection, and IORT, the most significant toxicities were soft tissue or sacral injury and pelvic neuropathy. Efforts to further improve local control are directed toward the concurrent use of chemotherapy (5-fluorouracil with and without leucovorin) as radiation dose modifiers during external beam irradiation and the use of additional postoperative radiation therapy.     

CT引导下经皮~(125)I放射粒子植入治疗肺恶性肿瘤临床观察

目的探讨CT引导下经皮~(125)I放射粒子植入治疗肺恶性肿瘤的临床效果。方法选取2012年6月至2013年8月间上海交通大学医学院附属仁济医院肿瘤介入科收治的52例肺癌患者,采用随机数字表法分为观察组和对照组,每组26例。观察组患者采用CT透视引导下经皮~(125)I放射粒子植入治疗,对照组患者采用序贯放化疗法治疗,比较两组患者近期疗效,中位生存时间、1年及2年生存率、并发症和不良反应发生率。结果观察组患者近期有效率为88.5%,对照组患者为61.5%,两组比较,差异有统计学意义(P<0.05)。观察组患者的中位生存时间为19个月,1年生存率为88.5%,对照组患者的中位生存时间为14个月,1年生存率为57.7%,两组中位生存时间和1年生存率比较,差异有统计学意义(P<0.05),观察组2年生存率与对照组比较,差异无统计学意义(P>0.05)。对照组患者胃肠道反应发生率(26.9%)高于观察组(3.8%),两组相比,差异有统计学意义(P<0.05),而两组在血象异常、气胸和出血发生率方面差异无统计学意义(P>0.05)。结论CT引导下经皮~(125)I放射粒子植入治疗肺恶性肿瘤近期临床疗效显著,可增加1年生存率,降低因放化疗引起的胃肠道反应发生率。     

Permanent implantation of iodine-125 seeds as a salvage therapy for recurrent head and neck carcinoma after radiotherapy

Seventeen patients with head and neck recurrent carcinoma underwent (125)I seed implantation under CT or ultrasound guidance. The actuarial D90 of the (125)I seeds implanted was 90-160 Gy (median, 126 Gy). Median follow-up was 10 months (range, 3-48 months). The median local control time was 16 months; the 1- and 2-year local control rates were 66.5% and 49.9%, respectively. The 1- and 2-year survival rates were 51.3% and 38.5%, respectively (median, 16 months). None of the patients experienced grade 4 toxicity. (125)I seed implantation was a feasible and effective salvage treatment for patients with recurrent head and neck cancers.     

Long term results of radioactive gold grain implantation for the treatment of persistent and recurrent nasopharyngeal carcinoma

BACKGROUND: Brachytherapy is useful for the reirradiation of nasopharyngeal carcinoma. In the current study, the long term treatment results of permanent radioactive gold(198) grain interstitial implantation in patients with persistent and recurrent nasopharyngeal carcinoma were reviewed. METHODS: Gold grain implantation was performed under direct vision with a split palate approach to provide 60 grays (Gy) 0.5 cm away from the plane of implantation. Between August 1986 and May 1999, 106 patients were treated with gold grain implantation (45 patients for persistent disease, 53 patients for first recurrence, and 8 patients for second recurrence in the nasopharynx). All patients had histologically proven disease by biopsy before undergoing implantation. RESULTS: Patients with persistent disease and those with first recurrence did well with the gold grain implantation. The 5-year local control rates for patients with persistent disease, first recurrence, and second recurrence in the nasopharynx were 87.2%, 62.7%, and 23.4%, respectively (P = 0.0004). The 5-year metastasis free survival rates were 68.1%, 60.3%, and 40%, respectively, for the 3 groups (P = 0.048). The overall survival rates at 5 years for the 3 groups were 79.1%, 53.6%, and 42.9%, respectively (P = 0.0047). Patients with computed tomography evidence of disease extension outside the nasopharynx had a lower local control rate compared with patients whose disease was confined to the nasopharynx (5-year local control rate of 52% vs. 72.3%; P = 0.031). The size of the lesion was not found to be an independent prognostic factor for local control after implantation. Multivariate analysis showed only an indication for implantation (persistent disease, first recurrence, and second recurrence) to be a significant prognostic factor for local control. Complications attributed to gold grain implantation included headache, palatal fistula, and mucosal radiation necrosis at the site of implantation, and were reported to occur in 28.3%, 18.9%, and 16%, respectively, of patients. CONCLUSIONS: For selected patients with disease confined to the nasopharynx, gold grain implantation is an effective salvage treatment for persistent and recurrent nasopharyngeal carcinoma.     

3D打印非共面模板辅助CT引导放射性粒子植入治疗胸部恶性肿瘤剂量学评估

目的 对比3D打印模板辅助放射性粒子植入治疗胸部恶性肿瘤的术前、术后计划的剂量学结果,探讨该技术对放射性粒子植入治疗精确性的影响。 方法 2016年接受3D打印模板辅助CT引导放射性 ¹²⁵I粒子植入胸部肿瘤患者共 21例,处方剂量 110~180 Gy。患者行术前计划设计、个体化模板制作、穿刺及植入粒子,术后实际剂量学结果与术前计划进行比较,评估参数包括GTV的 D₉₀、MPD、V₁₀₀、V₁₅₀、CI、EI、HI以及脊髓和胸主动脉 D_2cc、患侧肺 D_mean和 V₂₀。采用Wilcoxon非参数相关样本检验。 结果 设计并制作3D打印模板共21块。入组患者GTV平均体积为77.1 cm³,平均植入粒子68颗,术后GTV平均 D₉₀为147.3 Gy。各剂量学参数术后较术前略有变化,但差异均无统计学意义(P>0.05)。 结论 3D打印模板技术应用于胸部肿瘤的放射性粒子植入定位准确,术后与术前计划的剂量学一致性良好,提示3D打印模板应用于该部位有良好的治疗精确性。     

放射性125I粒子组织间植入治疗肝移植癌的实验研究

目的:研究瘤体内植入125I粒子治疗兔VX2肝移植癌的疗效及其病理变化,探讨125I粒子组织间植入治疗肝癌的可行性.方法:建立荷瘤兔肝移植癌动物模型.对照组(A组)植入空白剂量(OmCi)125I粒子,B组植入1.0mCi125I粒子,C组植入0.7mCi125I粒子,D组植入0.4mCi125I粒子.观察植入前后各组肿瘤体积并计算抑瘤率,切除肿瘤组织进行常规病理检查.结果:各治疗组肿瘤大小在治疗前后比较具有显著差异(P<0.01),均小于同期对照组(P<0.01).在不同观察时期抑瘤率差别均有统计学意义(P<0.05),治疗1周后抑瘤率变化显著;各个组间抑瘤率差异在治疗后2周最为明显(P<0.01),以后减小,但均高于D组(P<0.01).病理切片显示靠近125I粒子处肿瘤细胞坏死,但远离粒子处仍可见存活肿瘤细胞.1.0mCi粒子对正常肝组织损伤较大.结论:125I粒子组织间植入治疗肝癌有效,单个粒子活度以0.7mCi左右较为适宜.     

三维适形放疗同步替吉奥化疗治疗术后复发直肠癌的疗效观察

目的 观察三维适形放疗同步替吉奥化疗治疗术后复发直肠癌的近期疗效和毒副反应.方法 40例直肠癌术后复发患者,应用三维适形放疗(1.8～2.0 Gy/次,5次/周,总剂量54～65Gy)同步口服替吉奥胶囊化疔(40 mg/m2,2次/d,口服,连服28 d,42 d为1个周期,放疗结束后继续化疗2个周期).结果 全组患者均完成治疗,依从性好.总有效率为70.0%,症状改善率为90.0%.1年生存率为70.0%,1年局部控制率为62.5%.主要毒副反应为消化道反应、血液学毒性、放射性皮肤反应,多为1、2级,仅见1例3级腹泻.结论 三维适形放疗同步替吉奥化疗治疗直肠癌术后复发的疗效确切,毒副反应可耐受,能明显改善患者的生活质量.

Abstract：

Objective To observe the local control rate, survival time and side effect of threedimensional eonformal radiation therapy combined with Tegafur for postoperative recurrent rectal carcinoma.Methods Forty patients with postoperative recurrent rectal carcinoma received three-dimensional conformal radiation therapy, 1.8-2.0 Gy/once, 5 times every week and the total dose was 54-65 Gy.At the same time, the patients took Tegafur orally 40 mg/m2 twice per day for consecutive 28 days, and one cycle lasted for 42 days.The chemotherapy was applied for 2 cycles after radiotherapy.Results The total effective rate ( CR + PR) was 70.0%, improvement rate was 90.0%, 1-year survival rate was 70.0%, and 1-year local control rate was 62.5%.There was only a little side effect.Conclusions Three-dimensional conformal radiation therapy combired with Tegafur for postoperative recurrent rectal carcinoma have definite effect, with a high local control rate, and patients well tolerance the treatment without serious side effect.It can apparently improve the life quality of the patients.