放射性^125I粒子植入联合内分泌治疗早期前列腺癌

目的：探讨经会阴超声引导放射性^125I粒子植入联合去势治疗早期前列腺癌疗效和不良反应。方法：39例早期前列腺癌实施经会阴超声引导和适时计划指导放射性^125I粒子植入治疗,7例粒子术前行去势术,21例粒子植入后同时行去势术,11例粒子治疗后联合药物去势治疗。粒子治疗的匹配周边剂量（matched peripheral doses,MPD）为145—160Gy,尿道剂量低于400Gy。^125I粒子活度0．35—0．50mCi,中位植入69颗（19—97颗）。结果：失败标准为前列腺特异抗原（prostate specific antigen,PSA）治疗后升高〉4ng／ml,≤〈4ng／ml为生物化学无进展生存（biochemical disease—free survival,BDFS）。全部患者顺利完成粒子植入术。36例粒子治疗后达到BDFS,3例分别在粒子治疗后6、8和36个月PSA升高,2例行内分泌治疗,1例行外放疗联合内分泌治疗。2年和3年BDFS分别为94．8％（37／39）和92．3％（36／39）。粒子植入治疗后Ⅰ级和Ⅱ级直肠不良反应发生率分别为5．1％（2／39）和7．7％（3／39）,没有Ⅲ级和Ⅳ级直肠反应。粒子植入治疗后Ⅰ级、Ⅱ级和Ⅲ级尿道不良反应发生率分别为53．8％（20／39）、17．9％（7／39）和2．6％（1／39）,对症处理好转。2例粒子移位,没有相关并发症。结论：经会阴超声引导放射性^125I粒子植入治疗前列腺癌具有安全、微创、并发症发生率低等优点。     

放射性125I粒子植入联合内分泌治疗早期前列腺癌

目的:探讨经会阴超声引导放射性125I粒子植入联合去势治疗早期前列腺癌疗效和不良反应.方法: 39例早期前列腺癌实施经会阴超声引导和适时计划指导放射性125I粒子植入治疗,7例粒子术前行去势术,21例粒子植入后同时行去势术,11例粒子治疗后联合药物去势治疗.粒子治疗的匹配周边剂量(matched peripheral doses,MPD)为145-160Gy,尿道剂量低于400Gy.125I粒子活度0.35-0.50mCi,中位植入69颗(19-97颗).结果: 失败标准为前列腺特异抗原(prostate specific antigen,PSA)治疗后升高>4ng/ml,≤4ng/ml为生物化学无进展生存(biochemical disease-free survival,BDFS).全部患者顺利完成粒子植入术.36例粒子治疗后达到BDFS,3例分别在粒子治疗后6、8和36个月PSA升高,2例行内分泌治疗,1例行外放疗联合内分泌治疗.2年和3年BDFS分别为94.8%(37/39)和92.3%(36/39).粒子植入治疗后Ⅰ级和Ⅱ级直肠不良反应发生率分别为5.1%(2/39)和7.7%(3/39),没有Ⅲ级和Ⅳ级直肠反应.粒子植入治疗后Ⅰ级、Ⅱ级和Ⅲ级尿道不良反应发生率分别为53.8%(20/39)、17.9%(7/39)和2.6%(1/39),对症处理好转.2例粒子移位,没有相关并发症.结论: 经会阴超声引导放射性125I粒子植入治疗前列腺癌具有安全、微创、并发症发生率低等优点.     

放射性 125 I粒子植入治疗睾丸切除术后复发性前列腺癌

目的探讨超声引导放射性 125 I粒子植入治疗复发前列腺癌.方法8例前列腺癌去势术后复发实施超声引导放射性 125 I粒子植入治疗.2例单纯粒子植入治疗,肿瘤匹配周边剂量为(matched peripheral dose,MPD)90～145 Gy,2例先行外放疗,外放疗剂量为40～45 Gy.粒子活度0.35～0.40 mCi.随访3～29个月,连续3次前列腺特异抗原(prostate specific antigen,PSA)升高即为生物化学失败(biochemical failure).结果粒子治疗前后PSA分别为(7.53±7.64)ng/mL 和(1.25±1.19)ng/mL,统计学处理明显下降,t=2.297,P=0.038.2例生物化学失败,生物化学控制率(biochemical control rate)为6/8例,1例出现1级泌尿道并发症,1例出现2级泌尿道并发症.1/8例患者粒子发生移位,但是并没有引起临床相关并发症,没有粒子移位到肺.结论超声引导经会阴放射性 125 I粒子植入治疗复发前列腺癌具有安全、微创、并发症发生率低和疗效肯定,是一种较理想的补救治疗手段.     

辅助内分泌治疗配合放射性粒子组织间植入治疗局限性前列腺癌

 目的 探讨辅助内分泌治疗配合放射性粒子组织间植入治疗局限性前列腺癌的安全性和有效性。方法 22例T1 ~ T2c前列腺癌患者在采用直肠超声引导经会阴穿刺放射性125I粒子组织间植入治疗前后，给予辅助内分泌治疗4 ~ 7个月。术前2 ~ 4个月，术后1 ~ 4个月。结果 22例手术均顺利完成，手术时间60 ~ 120 min，植入125I粒子40 ~ 75枚，术后随访12 ~ 48个月，前列腺特异性抗原（PSA）＜1 ng／ml 15例，1 ng／ml≤PSA＜2 ng／ml 2例，PSA≥2 ng／ml 5例。结论 辅助内分泌治疗配合放射性粒子组织间植入治疗局限性前列腺癌安全有效     

脊柱软骨肉瘤术后复发CT引导下放射性^125I粒子植入的初步观察

目的评价脊柱软骨肉瘤术后复发cT引导下放射性^125I粒子植入的初步结果。方法采用cT引导放射性125I粒子植入的方法对5例脊柱软骨肉瘤术后复发患者进行治疗,术前应用三维治疗计划系统制定粒子分布计划,术中间距0．5～1．0cm植入粒子,距离危险器官的安全距离大于1．0cm,术后进行质量验证。结果本组平均随访时间15．2个月（2—41个月）,局部有效率60．0％。平均局部控制时间11．4个月,1年局部控制率60．0％。平均生存期15．2个月,1年生存率为66．7％。术前和术后NRS评分分别为6．00±2．65分和1．00±1．00分,二者差异有显著性（P值〈O．05）,镇痛有效率100．0％。结论CT引导下放射性^125I粒子植入治疗脊柱软骨肉瘤术后复发病例效果确切．疼痛缓解满意,临床应用价值较高。     

肝动脉化疗栓塞分别联合经皮微波凝固治疗与^125I放射性粒子植入治疗原发性大肝癌的疗效观察

目的评价和比较肝动脉化疗栓塞（TACE）联合经皮微波凝固治疗（PMCT）与TACE联合^125I放射性粒子植入治疗原发性大肝癌的效果。方法46例原发性大肝癌患者接受TACE联合PMCT治疗,20例接受TACE联合^125I放射性粒子植入治疗。术后2个月、3个月分别行动态增强CT复查。观察并比较两组疗效、毒副反应及并发症发生的情况。结果综合治疗后3个月,TACE联合PMCT组的有效率为82．61％,明显高于TACE联合^125I放射性粒子植入组的有效率55．00％（P〈0．05）。两组的临床总控制率分别为93．47％、85．00％（P〉0．05）。两组发生的毒副反应无明显差异,均未出现严重并发症。结论TACE联合PMCT及TACE联合^125I放射性粒子植入均为原发性大肝癌安全、有效的治疗方法,两组毒副反应及并发症的发生率相当,前者治疗效果较为理想,值得临床应用。     

CT引导下经阴道穿刺放射性125I粒子种植治疗宫颈癌局部复发

目的探讨CT引导下经阴道穿刺放射性^125I粒子种植治疗局部复发宫颈癌的治疗方法，观察临床疗效及不良反应。方法2004年4月至2004年9月，采用CT引导下经阴道穿刺放射性^125I粒子种植治疗局部复发宫颈癌患者10例，所有患者都是术后放化疗后或单纯放疗后局部复发或盆腔复发者。术前使用治疗计划系统(TPS)制定预计划，术后进行位置验证和质量评估，全部患者均植入0．5—0．8mCT的^125I放射性粒子，平均每例患者植入的粒子数为24颗。结果10例患者均成功植入，术中及术后未出现明显不良反应，术后X线及CT验证未见粒子游走及丢失，计划剂量分布比较满意，术后随访肿块明显缩小，环境污染监测符合国家标准。结论CT引导下经阴道穿刺放射性^125I粒子种植治疗的方法安全可行、创伤小，近期疗效显著，并发症少，是宫颈癌局部复发患者有效的综合治疗手段之一。     

转移及复发性骨肿瘤的放射性125I粒子植入治疗初探

目的探讨放射性^125I粒子组织间种植治疗转移及复发性骨肿瘤的技术方法和疗效。方法对14例转移及复发性骨肿瘤患者行肿瘤内^125I粒子植入治疗，粒子植入数目为3～145颗，粒子活度为18．5～29．6MBq（0．5～0．8mCi），肿瘤匹配周边剂量为115～145Gy。术后行质量验证并观察患者临床指标改善情况。结果随访7～29个月（平均12．4个月）。^125I粒子治疗90％肿瘤靶体积接受的最小剂量（D90）中位值为108．12Gy（27～166Gy），10例脊柱或椎旁肿瘤患者脊髓的中位D90为31．9Gy（6．2～74．0Gy）。粒子植入前伴有疼痛的12例患者，术后疼痛完全缓解率达82％，止痛有效率为92％。10例脊柱或椎旁肿瘤患者中，70％的患者疗后行走能力改善或恢复正常。1年局部控制率为82％，1年生存率为53％，围手术期无3级以上严重并发症发生。结论放射性^125I粒子植入安全、高效，是治疗转移及复发性骨肿瘤的一种有前途的新方法。     

CT引导下放射性他^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。     

手术联合^125I粒子及缓释化疗粒子靶向治疗胶质瘤的临床研究

目的探讨术中应用^125I粒子及化疗粒子联合植入法治疗胶质瘤的可行性和疗效。方法南阳医专附院自2003年12月至2007年12月,应用术中放、化疗粒子联合植入法治疗胶质瘤41例。治疗中交替植入卡莫司汀（BCNU）缓释化疗粒子和放射性^125I粒子。放射性粒子的肿瘤匹配周边剂量（MPD）为90～100Gy。结果41例患者均顺利完成治疗,术后3—6个月CT复查肿瘤变化,显示瘤体不同程度缩小,其中6例完全缓解,24例部分缓解,8例稳定,局部控制率为73％。随访6—28个月,最长1例随访时间为术后4年,现仍存活。1例术后6个月死于胶质瘤复发。结论手术联合放射性^125I粒子和BCNU缓释化疗粒子联合应用局部植入技术安全、副作用小、费用低及并发症发生率低,是综合治疗胶质瘤的有效手段之一。     

超声引导放射性125I粒子植入治疗舌癌的方法建立与近期疗效

目的探讨超声引导放射性125I粒子组织间植入治疗舌癌技术的可行性和近期疗效.方法9例舌癌患者,除1例为T2N0M0,其余均为局部晚期(T3～T4)或术后放疗后局部复发患者.4例采用全身麻醉,5例采用局部麻醉.舌后1/3经颌下超声引导,舌前2/3经口腔直视下行放射性125I粒子植入治疗,肿瘤周边匹配剂量(matched peripheral dose,MPD)90～110 Gy,每颗粒子活度0.40～0.60 mCi,每个病灶植入125I粒子4～84颗.术后即刻拍头颈正侧位平片或CT行质量验证.术后24～48 h拍胸部X-线片了解有无粒子移位或游走.结果随访1～31个月,1例完全缓解,3例部分缓解,4例稳定,1例进展,局部控制率88.8%.1例粒子移位至上颚,2例患者在随访过程中发生粒子脱失,但无治疗相关并发症发生.结论经颌下超声引导放射性粒子植入治疗舌癌可行、安全、微创.     

^125I对比^103Pd治疗低危前列腺癌的系统评价

背景与目的：粒子植入近距离放射治疗是早期前列腺癌的主要治疗手段．常用核素粒子为^125I或^103Pd,二者在前列腺癌治疗的并发症和结果方面存有差异。本文用系统评价的方法分析^125I或^103Pd近距离放射治疗低危前列腺癌的疗效和副作用,为临床决策提供指导性依据。方法：采用文献检索和手工检索的方式搜集2008年5月以前有关^125I或^103Pd治疗低危前列腺癌的随机对照试验的文献资料,根据Cochrane Handbook4．2．6质量评价标准进行评价,由两位研究者交叉核对纳入试验的结果,用RevMan5．0进行统计学分析。结果：共纳入6个随机对照研究．1406例患者。^125I或^103Pd治疗低危前列腺癌生物学无进展生存率差异没有统计学意义（RR=0．97,95％CI=0．93～1．01）;治疗后1个月^103Pd组副作用较^125I组明显,治疗后6个月^125I组副作用较^103Pd明显,治疗后12个月两种核素副作用无差别。结论：使用^125I或^103Pd治疗低危前列腺癌疗效相似,副作用在治疗后不同时间点有差异。     

放射性^125I粒子植入治疗椎体及椎旁肿瘤

目的：评价放射性^125I粒子组织间永久性植入治疗椎体及椎旁肿瘤的疗效和安全性。方法：对16例椎体及椎旁肿瘤患者（3例原发肿瘤,13例转移瘤）共28个病灶,行CT引导下或者术中^125I粒子永久性植入治疗。粒子活度0．5—0．8mCi,每个病灶植入粒子数目7—100颗。肿瘤最小周边剂量（mPD）110—160Gy。术后行质量验证。结果：中位随访时间26．5个月（5—61个月）。疼痛缓解率93．7％。神经功能恢复或者保留率93．75％。1年局部控制率64％,2年局部控制率50％,3年局部控制率32％,5年局部控制率4％。中位局部控制时间32个月。1年生存率73％,2年生存率59％,5年生存率41％。中位生存期36个月。1例患者因肿瘤进展出现截瘫,其余患者未出现明显的不良反应。结论：放射性^125I粒子植入术单独或联合手术治疗椎体及椎旁肿瘤安伞、不良反席小．耐受性好。临床疗效尚需进一步临床研究证实。     

Seed fixity in the prostate/periprostatic region following brachytherapy

PURPOSE: Although postoperative dosimetric analyses of prostate brachytherapy are commonly reported, the long-term persistence, or fixity, of seeds implanted in the prostate gland and periprostatic region remains unclear, with only a few reports regarding the loss or migration of the seeds in the implanted region and none which correlate lung embolization to pelvic seed loss. METHODS AND MATERIALS: The study population consisted of 175 consecutive patients implanted with either 125I (95 patients) or 103Pd (80 patients) using a mean of 136 seeds in a modified uniform loading approach to cover a planning volume that was 1.64 times the ultrasound prostate volume. An average of 64% of 125I seeds were embedded in braided vicryl suture, and these seeds were used on the periphery and extra prostatic regions. Following CT-based dosimetric analysis on day 0, all patients had orthogonal plain films of the pelvis obtained from day 0 to day 502, with an average of 2.3 film pairs per patient. Routine diagnostic PA and lateral chest X rays were obtained for 156 patients over the same time period. RESULTS: The mean pelvic seed fixity was greater than 98% throughout the time covered by this study. The seed fixity rates for 125I and 103Pd, although nearly equal, were significantly different up to 60 days post implant. The median 125I seed loss per patient was only 1 seed through 180 days while for 103Pd, the median seed loss was 2 seeds at 28 and 60 days and 3 seeds at 180 days. The fraction of patients experiencing no seed loss decreased from 40% at 28 days to 20% at 180 days for 125I and from 24% to 7% for 103Pd over the same time interval. Patient and treatment parameters closely correlated to local seed loss include the number of seeds implanted, the planning volume, and the number of loose seeds, and for 125I, the fraction of seeds in suture. The fraction of seeds placed outside the gland was not correlated with seed loss. Of the seeds lost from the pelvis, about 10% were found to embolize to the lungs. Among the 156 patients with post-implant chest X rays, the fraction of patients with pulmonary seed embolization was 34/156 (21.8%). Of the 20 patients who had post-implant chest X rays obtained within 14 days of brachytherapy, none had seeds detected in the lungs, while of the 136 patients who had chest X rays obtained greater than 30 days following implantation, 25.0% (34 patients) were noted to have seeds visualized in the lungs. CONCLUSIONS: With a median follow-up of 9 months, 125I seeds embedded in a vicryl suture or 103Pd seeds can be safely implanted in the prostate and periprostatic tissue with a high probability of prostate bed seed fixity and a low incidence of radioactive seed embolization to the lungs.     

125 I粒子组织间植入治疗乳腺癌术后胸壁复发的临床疗效

目的：探讨放射性125 I粒子组织间植入治疗在乳腺癌术岳胸壁复发中的临床价值。方法：对2008年1月-2010年1月我院21咧乳腺癌术后胸壁复发28个病灶采用放射性 125I粒子组织间植入治疗。21例病例除胸壁复发外均还伴有远处转移。胸壁复发肿瘤周边剂量设定为50—60Gy。通过放射性粒子近距离治疗TPS计划系统,对治疗靶区进行三维重建,给出三维等剂量曲线图、植入粒子数目和植入位置。借助模板定位或直接经皮穿刺技术完成粒子植入治疗。结果：21例28个病灶完全缓解（CR）21个,部分缓解（PR）6个．无变化（NC）1个。总有效率96．4％。15例病侧胸壁疼痛患者疼痛均有缓解,缓解率为100％。结论：放射性125 I粒子组织间植入治疗可作为乳腺癌术后晚期胸壁复发的有效治疗手段。     

碘[125I]粒子植入对人肝癌细胞裸鼠HepG2移植瘤抑制作用的实验研究

[目的]探讨不同剂量碘[125I]粒子组织间植入对人肝癌细胞裸鼠HepG2移植瘤生长的抑制作用。[方法]构建20只人肝癌HepG2的裸鼠移植瘤模型,随机分为4组,每组5只。3个治疗组分别接受18.5MBq（A组）、29.6MBq（B组）、37MBq（C组）的碘[125I]粒子治疗,对照组（D组）不接受治疗。采用经皮肿瘤组织直接植入的方式分别将不同剂量的碘[125I]粒子植入各治疗组小鼠的瘤体内,每只小鼠瘤体内植入一粒碘[125I]粒子。观察各组小鼠的体重及瘤体体积的变化。至治疗第28d时处死所有小鼠,剥离肿瘤并称重。[结果]各治疗组小鼠瘤体的体积增长速度随碘[125I]粒子的剂量增加而逐渐降低。A、B、C组小鼠与D组小鼠的肿瘤体积相比,抑瘤率分别是41.81%、64.45%和69.69%;A、B、C组小鼠与D组小鼠的肿瘤重量相比,抑瘤率分别是31.11%、62.22%和64.44%。[结论]碘[125I]粒子组织间植入治疗可抑制荷HepG2肝癌裸鼠肿瘤的生长,抑瘤作用与剂量呈正相关。     

Image-guided percutaneous (125)I seed implantation as a salvage treatment for recurrent soft tissue sarcomas after surgery and radiotherapy

The purpose of this study was to evaluate the safety and efficacy of percutaneous iodine-125 ((125)I) seed implantation using computed tomography (CT) or ultrasound guidance in the treatment of recurrent soft tissue malignancies after surgery and radiotherapy. From February 2002 to September 2009, 18 patients with recurrent soft tissue sarcomas were treated under ultrasound or CT guidance. The actuarial median number of (125)I seeds implanted was 35 (range, 6-129), and the actuarial D90 of the implanted (125)I seeds ranged from 107.9 to 204.4 Gy (median, 147.1 Gy). The activity of the seeds ranged from 0.4 to 0.8?mCi (median, 0.7?mCi). Follow-up times ranged from 4 to 78 months (median, 20 months). The median local control was 41 months (95% CI, 15.9-66.1 months). The 1-, 2-, 3-, 4-, and 5-year local controls were 78.8%, 78.8%, 78.8%, 26.3%, and 0%, respectively. The median survival was 32 months (95% CI, 16-48 months). The actuarial 1-, 2-, 3-, 4-, and 5-year survivals were 76.6%, 61.3%, 39.4%, 39.4%, and 39.4%, respectively. Seven (7) patients (38.9%) experienced recurrence after seed implantation. Six (6) patients (33.3%) died of distant metastases and 1 died of stroke. Two (2) patients developed ulceration, 1 case caused by recurrence and another by a reaction of the skin to radiation. Percutaneous (125)I seed implantation for recurrent soft tissue malignancies under CT or ultrasound guidance is safe and is associated with high efficacy and low morbidity.     

Fiducial markers implanted during prostate brachytherapy for guiding conformal external beam radiation therapy

Prostate movement imposes limits on safe dose-escalation with external beam radiation therapy. If the precise daily location of the prostate is known, dose escalation becomes more feasible. We have developed an approach to dose escalation using a combination of prostate brachytherapy followed by external beam radiation therapy in which fiducial markers are placed along with (125)I seeds during transperineal interstitial permanent prostate brachytherapy. These markers serve to verify daily prostate location during the subsequent external beam radiotherapy. Prior to implementing this approach, preliminary studies were performed to test visibility of the markers. Three different (125)I seed models, as well as gold and silver marker seeds were placed within tissue-equivalent phantoms. Images were obtained with conventional x-rays (75-85 kV) and 6 MV photons from a linear accelerator. All (125)I seed models were clearly visible on conventional x-rays but none were seen with 6 MV photons. The gold markers were visible with both energies. The silver markers were visible with conventional x-rays and 6 MV x-rays, but not as clearly as the gold seeds at 6 MV. Subsequently, conventional x-rays, CT scans, and 6 MV port films were obtained in 29 patients in whom fiducial gold marker seeds were implanted into the prostate during (125)I prostate brachytherapy. To address the possibility of "seed migration" within the prostate, CT scans were repeated 5 weeks apart in 14 patients and relative positions of the gold seeds were evaluated. The repeated CT scans showed no change in intraprostatic gold marker location, suggesting minimal migration. The gold seeds were visible with conventional x-rays, CT, and 6 MV port films in all patients. During the course of external beam radiation therapy, the gold markers were visible on routine 6 MV port films and were seen in different locations from film to film suggesting prostate motion. Mean daily displacement was 4-5 mm in the anterior-posterior, and 4-5 mm in superior-inferior dimensions. Left-right displacement appeared less, averaging 2-3 mm. We conclude that implantation of gold marker seeds during prostate brachytherapy represents an easily implemented and practical means of prostate localization during subsequent image-guided external beam radiotherapy. With such markers, conformality of the external beam component can be confidently improved without expensive new equipment.