超声引导下125I粒子植入治疗前列腺癌术后血清PSA变化与效果评估

目的:分析超声引导下125I粒子植入治疗前列腺癌术后血清PSA变化与效果。方法:纳入我院2019年11月至2020年1月的前列腺癌患者共6例,均接受超声引导下全麻行前列腺癌放射性碘125粒子植入术,6例患者治疗前后临床指标比较。结果:6例患者置入时间1~2.0h,平均(1.02±0.23)h,植入穿刺针8~15,平均10根,植入粒子40~80粒,平均42粒。治疗后前列腺病灶体积明显低于治疗前,数据有统计学差异(P<0.05)。治疗后血清PSA低于治疗前,数据有统计学差异(P<0.05)。结论:对于前列腺癌患者采用经超声引导125I粒子植入治疗可降低血清PSA值,缩小前列腺病灶体积,值得临床应用与推广。     

经直肠超声引导经直肠植入术及其在前列腺癌~(125)I粒子植入中的应用

目的 探讨经直肠超声(transrectal ultrasonography,TRUS)引导并经直肠穿刺植入~(125)I粒子技术的可行性及其在前列腺癌治疗中的应用.方法 术前运用TRUS对本组42例前列腺癌患者进行前列腺体积研究;通过治疗计划系统(treatment plan system,TPS)制定计划;采用TRUS引导经直肠穿刺将~(125)I粒子植入前列腺实施治疗方案;术后多排螺旋CT扫描判断粒子分布情况并作剂量分布评估,定期随访治疗效果和并发症情况.结果 42例患者手术顺利完成,无因经直肠穿刺引起的严重并发症;术后运用CT扫描见粒子分布符合预定计划;剂量分布评估满意.结论 TRUS引导经直肠穿刺~(125)I粒子植入治疗前列腺癌技术简便快速、安全有效.     

CT导向下植入125I粒子治疗直肠癌盆腔复发患者的护理

目的总结直肠癌盆腔复发患者行CT导向下125I粒子组织间植入治疗的护理。方法对直肠癌术后化放疗后盆腔复发的15例患者行CT导向下125I粒子组织间植入,同时加强心理护理并采取相应防护措施。结果15例病人术后均未出现出血、穿孔、吻合口漏等并发症,术后第8天行X线片检查显示粒子无移位;随访1—6个月,其中1例死亡,3例发生直肠癌远处转移。结论CT引导下掰I粒子组织间植入治疗直肠癌盆腔复发的近期效果好,同时加强对直肠癌盆腔复发行125I植入治疗患者的心理护理,有利于其预后。     

粒子组织植入治疗难治性海绵血管瘤的临床应用

目的：探讨^125粒子组织植入在难治性海绵血管瘤治疗中的可行性。方法：选择2005-01／2006-03长海医院整形外科收治的海绵血管瘤患者4例，经患者知情同意后行^125粒子组织植入治疗，且得到医院伦理道德委员会批准。术前行CT／MRI或，和B型超声波检查，详细计算瘤体体积和所需处方剂量。植入粒子时应该避开神经，距离应大于17mm为宜。放射性粒子采用中国原子能科学院生产的外形为圆柱状钛合金封体的^125放射粒子源（批号：国药准字H20045969），长4．5mm，直径O．8mm，平均能量27~35keY，半衰期60．1d，半价层0．025mmPb，组织穿能力为1．7cm。术中经皮组织间永久植入^125粒子，粒子以1．5-2．0 cm的间距均匀排布于血管瘤组织中。术后应用CT／MRl检查血管瘤的体积变化．应用X射线检查有无粒子丢失或游走。结果：4例患者全部进入结果分析，无脱落。①全部病例共植入^125粒子97粒，平均24-25粒，其中最少20粒，最多30粒。粒子平均活度1．85x10^7Bq，共1．79x10^8Bq。②术中患者未见不良反应，术后血液学检查正常。③所有病例均获得随访，随访时间分别为10，12，14，24个月。随访期内CT／MRI检查可见肿瘤体积均有不同程度的缩小；肿瘤无复发，无明显放疗反应；X射线监测无粒子丢失或游走。结论：应用^125粒子植入治疗血管瘤，具有操作简单、患者痛苦小、见效快等优点，初步结果满意，有望成为治疗血管瘤的新方法。     

125I微粒子植入术联合内分泌治疗局部晚期前列腺癌(附14例报告)

目的探讨放射性微粒子植入术联合内分泌治疗局部晚期前列腺癌。方法回顾14例局部晚期前列腺癌患者,术前经直肠超声(TRUS)确定前列腺体积,描绘前列腺的轮廓和横断面,运用三维治疗计划系统制定放射治疗方案,在TRUS引导下,植入放射性粒子125I。结果14例患者随访18～24月,治疗后PSA值、前列腺体积、IPSS评分均较术前有明显改善(P<0.05),一例出现放射性直肠炎并发症,经中药保留灌肠治疗后好转。结论TRUS引导下125I粒子植入联合内分泌治疗是治疗晚期局部前列腺癌的一种可行的方法,有较好的疗效。     

全雄激素阻断与全雄激素阻断结合^125I放射性粒子植入治疗中晚期前列腺癌的疗效比较

目的：比较全雄激素阻断（双侧睾丸切除＋抗雄激素药物）与全雄激素阻断结合^125I放射性粒子植入治疗中晚期前列腺癌的临床疗效,探讨治疗中晚期前列腺癌的有效方法。方法：中晚期前列腺癌患者40例,其中12例应用全雄激素阻断治疗（A组）,28例应用全雄激素阻断结合^125I放射性粒子植入近距离放射治疗（B组）。比较治疗前后前列腺特异性抗原的变化及术后3年生存率。结果：术后1个月2组前列腺特异性抗原均快速下降,2组比较差异无统计学意义（P〉0．05）;术后6个月,B组前列腺特异性抗原明显低于A组,差异有统计学意义（P〈0．05）;2组术后3年生存率差异有统计学意义（P〈0．05）。结论：全雄激素阻断治疗及全雄激素阻断结合^125I放射微粒植入近距离放射治疗,均是治疗中晚期前列腺癌的有效方法,而后者疗效更加肯定。     

经膀胱^125Ⅰ粒子植入联合雄激素阻断治疗中晚期前列腺癌

目的 观察经膀胱径路前列腺内植入^125Ⅰ粒子联合全雄激素阻断治疗中晚期前列腺癌的临床疗效。方法 对21例C期及D期的前列腺癌患者，经膀胱前列腺内植入^125Ⅰ粒子，同时行膀胱造瘘、双侧睾丸切除，并口服氟他胺等治疗。结果随访6～38个月（平均18．6个月），除一例死亡外，其余20例全部存活，术后6月，PSA0．1～2．4ng／ml，平均1．4ng／ml，前列腺体积平均缩小24．7％。术后9个月时，C期前列腺癌PSA正常，2例D期PSA复又升高。术后12个月，除3例D期患者PSA明显升高外，其余C期患者PSA〈4ng／ml。术后无直肠溃疡、穿孔等并发症，术后21例中有7例拔除造瘘管，自行排尿。结论放射性^125I粒子植入联合全雄激素阻断治疗可发挥两者优势，并发症少，是治疗C期前列癌的有效方法之一。     

全雄激素阻断与全雄激素阻断结合125Ⅰ放射性粒子植入治疗中晚期前列腺癌的疗效比较

目的:比较全雄激素阻断(双侧睾丸切除+抗雄激素药物)与全雄激素阻断结合125Ⅰ放射性粒子植入治疗中晚期前列腺癌的临床疗效,探讨治疗中晚期前列腺癌的有效方法。方法:中晚期前列腺癌患者40例,其中12例应用全雄激素阻断治疗(A组),28例应用全雄激素阻断结合125Ⅰ放射性粒子植入近距离放射治疗(B组)。比较治疗前后前列腺特异性抗原的变化及术后3年生存率。结果:术后1个月2组前列腺特异性抗原均快速下降,2组比较差异无统计学意义(P>0.05);术后6个月,B组前列腺特异性抗原明显低于A组,差异有统计学意义(P<0.05);2组术后3年生存率差异有统计学意义(P<0.05)。结论:全雄激素阻断治疗及全雄激素阻断结合125Ⅰ放射微粒植入近距离放射治疗,均是治疗中晚期前列腺癌的有效方法,而后者疗效更加肯定。     

CT引导下125I放射性粒子植入治疗肺癌纵隔淋巴结4R组转移进针路径的临床研究

目的 探讨CT引导下经皮穿刺对肺癌4R组纵隔淋巴结转移灶进行125I放射性粒子植入治疗的路径选择.方法 选取2004年6月至2011年4月在我院接受治疗的经病理学明确诊断的伴有4R组纵隔淋巴结转移的晚期肺癌患者36例,其中10例患者出现上腔静脉综合征.对该组患者的淋巴结转移灶行CT引导下经皮穿刺125I放射性粒子植入治疗,采取自右前胸壁、右侧胸壁及右后胸壁三种进针路径进行粒子植入.术后6个月复查胸部CT,与粒子植入前比较肿瘤变化,按照国际标准判定疗效.随访自2004年12月至2011年10月.结果 全部患者顺利完成粒子植入治疗,靶区接受的平均照射剂量为(236.8±12.9)Gy,D100(94.8±9.8)Gy,D90(139.6±11.6)Gy.植入术后6个月随访,有效率80.6%,行PET-CT检查的8例患者中有3例显示病灶活性完全消失.出现上腔静脉综合征的10例患者中症状及体征完全消失2例,好转6例.术中9例患者出现气胸,其中6例行胸腔闭式引流术,3例行胸腔穿刺抽气;6例患者出现肺内出血,其中2例伴有咳血,无进行性血胸,止血处理后症状消失,1个月后复查出血吸收.结论 对4R组纵隔淋巴结转移癌进行CT引导下125I放射性粒子植入治疗,术中选择恰当的进针路径进行放射性粒子植入,使放射剂量分布合理提高疗效,并可减少穿刺损伤等并发症.     

超声引导下~(125)I放射性粒子植入治疗前列腺癌疗效观察

目的探讨超声引导下经会阴穿刺植入125I放射性粒子治疗前列腺癌的疗效。方法 40例前列腺癌患者在直肠超声引导下行经会阴125I粒子植入术。其中29例行单纯粒子治疗,11例术后加外放疗。首先对前列腺进行超声扫描,将图像传送到计算机制定种植治疗计划,并在种植前计算放射线对前列腺体积的有效覆盖,以患者血前列腺特异性抗原(prostate-specific antigen,PSA)作为疗效评价标准。结果粒子植入术前和术后各时期PSA值相比明显下降(差异均有显著统计学意义,P≤0.01),其中10人14次出现PSA反弹,而单纯粒子组与联合治疗患者组PSA反弹发生率差异无统计学意义(22.2%vs 27.3%)。结论超声引导经会阴125I放射性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。     

^125I粒子组织间植入对小鼠Lewis肺癌细胞VEGF—C和COX-2表达影响

目的探讨^125I粒子组织间植入对小鼠Lewis肺癌细胞血管内皮生长因子c（VEGF-C）和环氧化酶2（COX-2）表达的影响。方法建立小鼠Lewis肺癌模型，治疗组（n=17）在瘤体内植入2粒放射活性为9．25MBq的^125I籽源，对照组（n=16）植入2粒无放射活性的空心籽源。治疗21d，记录小鼠的存活率；处死存活小鼠，计算肿瘤体积抑制率。摘除的肿瘤组织行常规病理学检查。采用免疫组织化学方法检测两组VEGF-C和COX-2表达情况。结果治疗组和对照组小鼠存活率分别为82．35％和62．50％，差异无显著性（x^2=1．64，P〉0．05）；治疗组肿瘤体积抑制率为71．13％。病理检查显示治疗组近^125I籽源处肿瘤细胞变性坏死，对照组近空心籽源处可见存活肿瘤细胞。免疫组织化学显示，治疗组COX-2及VEGF-C表达水平低于对照组，差异有显著性（x^2=6．52、9．45，P〈0．01）。结论^125I粒子组织间植入可以抑制小鼠Lewis肺癌细胞的增殖、迁移能力，其效应可能通过抑制COX-2活性进而抑制VEGF-C的表达来实现。     

前列腺癌近距离治疗疗效

  目的  探讨前列腺癌患者近距离治疗疗效及并发症。  方法  前列腺癌患者27例, 年龄63~81岁, 平均75岁。临床分期:T1cN0M016例, T2aN0M011例; Gleason评分:5分14例, 6分13例; 血清前列腺特异性抗原(prostate specific antigen, PSA)2.8~14.6 μg/L, 平均8.5 μg/L。采用¹²⁵I粒子近距离治疗, 治疗剂量D90为140~155 Gy, 观察治疗疗效及并发症。27例患者治疗前后均未使用内分泌治疗。  结果  27例患者随访12~74个月, 平均44个月。近距离治疗后27例前列腺癌患者最低血清PSA中位数为0.18 μg/L, 2例患者最低血清PSA在1.0 μg/L以上; 治疗后1年患者血清PSA中位数为0.71 μg/L, 平均为0.92 μg/L, 17例患者血清PSA在1.0 μg/L以下; 2例患者分别于治疗后30及48个月出现生化复发, 复发率7%(2/27)。治疗后2例患者出现急性尿潴留, 予保留导尿1周后好转; 24例治疗后出现不同程度的尿路刺激症, 均在治疗后6~12个月内好转; 无1例出现前列腺直肠瘘。治疗前17例有勃起功能; 治疗后10例仍保留不同程度的勃起功能, 7例出现勃起功能障碍(占41%)。  结论  前列腺癌近距离治疗对于中低危前列腺癌疗效肯定, 并发症少, 多数患者可以保留性功能。     

超声引导下125Ⅰ放射性粒子植入治疗前列腺癌疗效观察

目的 探讨超声引导下经会阴穿刺植入125Ⅰ放射性粒子治疗前列腺癌的疗效.方法 40例前列昧癌患者在直肠超声引导下行经会阴125Ⅰ粒子植入术.其中29例行单纯粒子治疗.11例术后加外放疗.首先对前列腺进行超声扫描,将图像传送到计算机制定种植治疗计划,并在种植前计算放射线对前列腺体积的有效覆盖,以患者血前列腺特异性抗原(prostate-specific antigen,PSA)作为疗效评价标准.结果 粒子植入术前和术后各时期PSA值相比明显下降(差异均有显著统计学意义.P≤0.01),其中10人14次出现PSA反弹,而单纯粒子组与联合治疗患者组PsA反弹发生率差异无统计学意义(22.2％vs 27.3％).结论 超声引导经会阴125Ⅰ放射性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.     

Radioactive seed immobilization techniques for interstitial brachytherapy

Purpose

In prostate brachytherapy, seeds can detach from their deposited sites and move locally in the pelvis or migrate to distant sites including the pulmonary and cardiac regions. Undesirable consequences of seed migration include inadequate dose coverage of the prostate and tissue irradiation effects at the site of migration. Thus, it is clinically important to develop seed immobilization techniques.

Methods

We first analyze the possible causes for seed movement, and propose three potential techniques for seed immobilization: (1) surgical glue, (2) laser coagulation and (3) diathermy coagulation. The feasibility of each method is explored. Experiments were carried out using fresh bovine livers to investigate the efficacy of seed immobilization using surgical glue.

Results

Results have shown that the surgical glue can effectively immobilize the seeds. Evaluation of the radiation dose distribution revealed that the non-immobilized seed movement would change the planned isodose distribution considerably; while by using surgical glue method to immobilize the seeds, the changes were negligible.

Conclusions

Prostate brachytherapy seed immobilization is necessary and three alternative mechanisms are promising for addressing this issue. Experiments for exploring the efficacy of the other two proposed methods are ongoing. Devices compatible with the brachytherapy procedure will be designed in future.     

晚期胰腺癌^125I粒子植入术后并发胃瘫综合征的临床观察与护理

目的 分析晚期胰腺癌^125I粒子植入术后并发胃瘫综合征（postoperative gastroparesis syndrome，PGS）的相关因素，从护理角度探讨预防和促进康复的有效措施。方法回顾性分析了48例不能根治切除的晚期胰腺癌病例，了解PGS发生率和不同姑息性手术术式的关系，包括粒子植入数目、位置等对发生PGS的影响。结果^125I粒子植入术病例PGS发生率高于其他手术组；随着粒子数目增加，PGS的发生奉培高。结论 ^125I粒子植入术治疗晚期胰腺癌可导致术后发生PGS，护理人员应正确认识其发生的相关因素；严密观察病情，识别胃瘫的早期症状，及时治疗；同时，要重视患者的心理护理和发挥家庭支持作用。     

Short-lag spatial coherence beamforming of photoacoustic images for enhanced visualization of prostate brachytherapy seeds

Prostate brachytherapy, administered by implanting tiny radioactive seeds to treat prostate cancer, currently relies on transrectal ultrasound imaging for intraoperative visualization of the metallic seeds. Photoacoustic (PA) imaging has been suggested as a feasible alternative to ultrasound imaging due to its superior sensitivity to metal surrounded by tissue. However, PA images suffer from poor contrast when seeds are distant from the light source. We propose a transperineal light delivery method and investigate the application of a short-lag spatial coherence (SLSC) beamformer to enhance low-contrast photoacoustic signals that are distant from this type of light source. Performance is compared to a conventional delay-and-sum beamformer. A pure gelatin phantom was implanted with black ink-coated brachytherapy seeds and the mean contrast was improved by 3–25 dB with the SLSC beamformer for fiber-seed distances ranging 0.6–6.3 cm, when approximately 10% of the receive aperture elements were included in the short-lag sum. For fiber-seed distances greater than 3–4 cm, the mean contrast-to-noise ratio (CNR) was approximately doubled with the SLSC beamformer, while mean signal-to-noise ratios (SNR) were mostly similar with both beamformers. Lateral resolution was decreased by 2 mm, but improved with larger short-lag values at the expense of poorer CNR and SNR. Similar contrast and CNR improvements were achieved with an uncoated brachytherapy seed implanted in ex vivo tissue. Results indicate that the SLSC beamformer has potential to enhance the visualization of prostate brachytherapy seeds that are distant from the light source.OCIS codes: (170.5120) Photoacoustic imaging, (100.0100) Image processing, (100.3010) Image reconstruction techniques, (030.1640) Coherence, (170.1650) Coherence imaging, (170.7230) Urology     

Intra-operative 3D guidance and edema detection in prostate brachytherapy using a non-isocentric C-arm

PurposeBrachytherapy (radioactive seed insertion) has emerged as one of the most effective treatment options for patients with prostate cancer, with the added benefit of a convenient outpatient procedure. The main limitation in contemporary brachytherapy is faulty seed placement, predominantly due to the presence of intra-operative edema (tissue expansion). Though currently not available, the capability to intra-operatively monitor the seed distribution, can make a significant improvement in cancer control. We present such a system here.MethodsIntra-operative measurement of edema in prostate brachytherapy requires localization of inserted radioactive seeds relative to the prostate. Seeds were reconstructed using a typical non-isocentric C-arm, and exported to a commercial brachytherapy treatment planning system. Technical obstacles for 3D reconstruction on a non-isocentric C-arm include pose-dependent C-arm calibration; distortion correction; pose estimation of C-arm images; seed reconstruction; and C-arm to TRUS registration.ResultsIn precision-machined hard phantoms with 40–100 seeds and soft tissue phantoms with 45–87 seeds, we correctly reconstructed the seed implant shape with an average 3D precision of 0.35 mm and 0.24 mm, respectively. In a DoD Phase-1 clinical trial on six patients with 48–82 planned seeds, we achieved intra-operative monitoring of seed distribution and dosimetry, correcting for dose inhomogeneities by inserting an average of over four additional seeds in the six enrolled patients (minimum 1; maximum 9). Additionally, in each patient, the system automatically detected intra-operative seed migration induced due to edema (mean 3.84 mm, STD 2.13 mm, Max 16.19 mm).ConclusionsThe proposed system is the first of a kind that makes intra-operative detection of edema (and subsequent re-optimization) possible on any typical non-isocentric C-arm, at negligible additional cost to the existing clinical installation. It achieves a significantly more homogeneous seed distribution, and has the potential to affect a paradigm shift in clinical practice. Large scale studies and commercialization are currently underway.     

放射性^125I粒子治疗头颈部复发恶性肿瘤35例近期疗效观察

【目的】探讨利用B超或CT引导下放射性^125I粒子组织间植入内照射治疗术后不能耐受放化疗或放化疗失效后复发的头颈部恶性肿瘤临床价值。【方法]2008年7月至2010年5月共收治35例头颈部恶性肿瘤综合治疗后复发患者,其中男21例,女14例,中位年龄49（22～76）岁,局部麻醉,间距1cm,以术前治疗计划系统（TPS）计划的粒子数及进针方向做参考,注意避开重要血管及神经,在B超或CT定位下用粒子针进行植入,粒子针插植边缘达到肿瘤影像学边缘,粒子间距0．5～1cm,术后即行超声复查,了解粒子分布状况,必要时进行补植入,避免剂量冷区。粒子活度为1．85×10^7Bq～2．96×10^7Bq,中位植入粒子数27（3～58）粒。【结果】根据疗效评估标准,1～6个月后进行CT扫描,其中CR25．7％（9／35）,PR51．4％（18／35）,NC14．3％（5／35）,PD8．6％（3／35）,总有效率CR＋PR77．1％（27／35）。随访6～28个月,6个月局部控制率91．4％,1年57．8％,2年40．1％。6个月,1年,2年总生存率分别为100％,55．2％,30．2％。【结论】在B超和CT引导下植入^125I粒子进行肿瘤体内照射,植入精确可控,微创,安全,近期疗效确切,是治疗头颈部复发恶性肿瘤的新方法。     

Segmentation of iodine brachytherapy implants in fluoroscopy

Purpose

In prostate brachytherapy, intraoperative dosimetry would allow for evaluation of the implant quality while the patient is still in treatment position. Such a mechanism, however, requires 3-D visualization of the deposited seeds relative to the prostate. It follows that accurate and robust seed segmentation is of critical importance in achieving intraoperative dosimetry.

Methods

Implanted iodine brachytherapy seeds are segmented via a region-based implicit active contour model. Overlapping seed groups are then resolved using a template-based declustering technique.

Results

Ground truth seed coordinates were obtained through manual segmentation. A total of 57 clinical C-arm images from 10 patients were used to validate the proposed algorithm. This resulted in two failed images and a 96.0% automatic detection rate with a corresponding 2.2% false-positive rate in the remaining 55 images. The mean centroid error between the manual and automatic segmentations was 1.2 pixels.

Conclusions

Robust and accurate iodine seed segmentation can be achieved through the proposed segmentation workflow.