Dosimetric consideration of individual 125I source strength measurement and a large-scale comparison of that measured with a nominal value in permanent prostate implant brachytherapy

Purpose We investigated the difference between measured and manufacturer's nominal source strength in a large sample of a single model of ¹²⁵I seeds. Physical characteristics of single seed measurement by the well-type ionization chamber were also investigated to provide dosimetric data. Materials and methods A well-type ionization chamber with a single seed holder was used to measure source strength of all 1935 ¹²⁵I seeds implanted in the initial 28 patients in our hospital. Physical characteristics including linearity of readings for different integral time intervals, reproducibility, isotropy, and axial positional sensitivity were assessed. To calculate the source strength, the integral charge during 30 s was measured and converted to air kerma strength. The nominal activity stated by the manufacturer was compared with the measured value. Results Linearity, reproducibility, and isotropy of the well-type ionization chamber were within 0.2%. Measured source strength was on average 2.1% (range −7.6% to +7.2%), lower than the nominal value. Standard deviation of all measured seeds was 2.0%. The maximum difference between the measured and the manufacturer's nominal source strength in each patient was −3.7%. The standard deviation averaged 1.6%. Conclusion The nominal source strength of the ¹²⁵I seeds agreed well with the measured value. Our study can be helpful as guidance for individual ¹²⁵I seed source strength measurement.     

Long-term outcomes analysis of low-dose-rate brachytherapy in clinically T3 high-risk prostate cancer

PurposeThe available data demonstrating that superiority of LDR brachytherapy (LDR-BT) boost in high-risk prostate cancer patients under represents patients with extracapsular extension (T3a) and/or seminal vesicle invasion (T3b) have been limited. We report long-term clinical outcomes data for patients with cT3a/b disease receiving LDR-BT.Methods and MaterialsNinety-nine men (median age: 69.4 years) with cT3a/bN0M0 high-risk prostate adenocarcinoma received definitive LDR-BT or LDR-BT boost after external beam radiation therapy (EBRT) at a single institution between 1998 and 2007. About 86% of patients received androgen deprivation therapy. Freedom from biochemical failure (FFBF), prostate cancer–specific survival (PCSS), and overall survival (OS) was calculated using the Kaplan–Meier method with the Phoenix definition used as definition of failure. Cox regression analysis was used to compare outcomes between clinical stage, initial PSA, Gleason Score, and percent core positive rate.ResultsWith a median followup of 7 years, 7-year rate of FFBF, PCSS, and OS for the entire cohort was 65.2% (±5.6%), 90.1% (±3.6%), and 77.9% (±4.7%), respectively. LDR-BT boost patients achieved a 7-year FFBF rate of 73.5 (±6.5%). No significant difference in outcomes was present between T3a or T3b disease, Gleason score, iPSA stratification and percent core positive rates.ConclusionsLDR-BT, primarily as a boost in conjunction with ADT and EBRT, is not only feasible, but also highly effective in men with cT3a and cT3b high-risk prostate cancer resulting in excellent biochemical control and survival outcomes. LDR-BT boost implantation of patients should be strongly considered for cT3 patients given the merits of trimodality care.     

Preliminary study of correction of original metal artifacts due to 1-125 seeds in postimplant dosimetry for prostate permanent implant brachytherapy

Purpose We investigated a subtraction-based reprojection approach to reduce CT metal artifacts due to I-125 seeds and evaluated the clinical implications in postimplant dosimetry for prostate permanent implant brachytherapy. Materials and Methods The raw projection data were used to reduce metal artifacts due to I-125 seeds. CT images of the metal parts only were separated from the original CT images by setting the threshold for pixel value to that of the I-125 seeds. Using these images, sinograms of CT images with and without seeds were obtained by inverse Radon transform (iRT), and the sinogram of the metal image was subtracted from that of the original image. Finally, the image was reconstructed using the sinogram by Radon transform (RT). This technique was applied to a prostate phantom and to a patient undergoing prostate permanent implant brachytherapy. Results Metal artifacts from I-125 seeds were reduced in both the phantom and patient studies. This technique decreased the density of the inner region of seeds but enhanced the density of the seed edge, thereby facilitating the identification of seed number, orientation, and location. Conclusion This method reduces metal artifacts from I-125 seeds, and has potential for decreasing the time required for and improving the accuracy of postimplant dosimetry. This study was partly supported by a Grant-in-Aid for Scientific Research (Grant No. 177908826807) of the Japan Society for the Promotion of Science (JSPS).     

Differential effects of CLDR and PDR brachytherapy on cell cycle progression in a syngeneic rat prostate tumour model

Purpose: The study consisted of two treatment arms comparing the effects of CLDR (continuous low dose rate) and PDR (pulsed dose rate) brachytherapy on cell cycle progression in a radioresistant rat prostate tumour model.

Materials and methods: Interstitial PDR and CLDR brachytherapy (both 192-Ir, 0.75 Gy/h) were administered to Dunning prostate R3327-AT1 carcinomas transplanted subcutaneously into the thigh of Copenhagen rats. Increasing doses of up to 20 as well as up to 40 Gy were applied. Cell cycle distributions of the aneuploid tumour cell subpopulations were determined at 4 h (3 Gy), 24 h (18 Gy), 48 h (20 and 36 Gy), as well as during the subsequent redistribution period (20 and 40 Gy) at 72, 96, and 120 h. Tumours either implemented with an empty tubing system (n = 5) or under undisturbed growth (n = 5) served as controls. Three animals were irradiated per time point and exposure condition. At least two flow cytometrical analyses were carried out per animal.

Results: The aneuploid cells possessed a constant DNA-Index of 1.9 ± 0.06. In contrast to sham-treated controls, the aneuploid cell fraction with G2/M DNA content was significantly increased (p < 0.05) after initiation of both, CLDR and PDR brachytherapy. However, CLDR resulted in an earlier accumulation of tumour cells in G2/M (24 h: 28% CLDR vs. 19% PDR, p < 0.05) with a concomitant reduction of cells in G1, whereas PDR yielded delayed, but then more pronounced cell cycle changes, particularly expressed during the redistribution period after both 20 and 40 Gy.

Conclusion: CLDR and PDR brachytherapy showed differential effects on cell cycle progression. The induction of a significantly earlier but also less persistent G2/M cell cycle arrest after CLDR compared to PDR brachytherapy implies that a substantially higher fraction of tumour cells are irradiated in G2/M after CLDR.     

不同活度125I粒子植入后不同时间肿瘤吸收剂量对比

目的 探讨周边剂量相同时不同活度125I粒子植入后不同时间点肿瘤吸收剂量的差异.方法 利用计算机三维治疗计划系统(3D-TPS)勾画出边长3.5 cm正方体模拟肿瘤,分别载入125I粒子0.8 mCi(A组)、0.3 mCi(B组)并周边分布,处方剂量145 Gy,得出剂量-体积直方图(DVH)及100％靶体积吸收剂量(D100)、90％靶体积吸收剂量(D90)、150％处方剂量覆盖的体积占靶体积百分比(V150)、90％处方剂量覆盖的体积占靶体积百分比(V90)、最高剂量点等指标.根据125I粒子衰变规律公式,分别计算A、B组粒子植入后1、2、3、4、5、6个月时粒子活度,计算两组粒子植入后各时间点肿瘤实际吸收剂量,比较两组各时间点肿瘤实际吸收剂量、D100、D90、V150 V90最高剂量点等指标.结果 A组、B组粒子植入后1、2、3、4、5、6个月时肿瘤实际吸收剂量均值相同,均为(81.43±46.20) Gy;D100分别为(49.14±34.65) Gy、(38.86±27.43) Gy,差异有统计学意义(P=0.009);D90均为(64.57±46.20) Gy;V150分别为(7.96±8.62)％、(7.58±10.65)％,差异无统计学意义(P=0.398);V90分别为(25.83±35.76)％、(26.16±35.97)％,差异无统计学意义(P=0.866);最高剂量点分别为(798.29±568.07) Gy、(359.29±256.36) Gy,差异有统计学意义(P=0.010).结论 周边剂量相同时125I粒子植入后不同时间点肿瘤吸收剂量相同,粒子活度对肿瘤吸收剂量速率无影响,高活度组粒子靶区内最高剂量点明显高于低活度组,高剂量区持续时间较长于低活度组.     

125I植入对小鼠移植性实体瘤抑制效果

目的观察12I籽源组织间植入对小鼠移植性实体瘤的治疗效果.方法建立小鼠艾氏腹水瘤细胞移植性实体肿瘤模型.治疗组在肿瘤组织内平均植入4粒表面放射活性为8.14MBq的BT-125-Ⅰ型125I籽源,对照组植入4粒无放射活性的空心籽源.治疗28 d,记录小鼠存活率.处死存活的小鼠,测量残存肿瘤的体积、重量并计算肿瘤体积抑制率.对摘除的肿瘤组织进行常规病理切片检查,观察籽源对肿瘤组织的破坏程度和范围.结果治疗28 d,治疗组和对照组小鼠存活率分别为75%和50%;平均瘤重分别为(0.347±0.25)g,(5.162±1.75)g(t=6.164,P＜0.05);肿瘤平均体积分别为(175.9±147.9)mm3,(3974.1±1507.7)mm3(t=5.618,P＜0.05),肿瘤体积抑制率为95.6%.常规病理切片结果显示,125I籽源周围0～3 mm范围内肿瘤细胞病理变化由凝固坏死向外逐渐减弱为变性坏死;空心籽源周边区域仅有机械刺激导致的轻微水肿和纤维化.结论125I籽源组织间植入对小鼠实体肿瘤具有显著的治疗效果.     

磁共振弥散加权成像在125Ⅰ粒子组织间植入治疗胰腺癌疗效评估中的应用

目的探讨磁共振（MRI）弥散加权（DWI）成像对¹²⁵Ⅰ粒子组织间植入治疗人胰腺癌裸鼠移植瘤疗效的评估价值。方法将人胰腺癌SWI990细胞株接种于BABL/C裸鼠右下肢旁腹股沟区偏背侧皮下,待瘤体长至8～10 mm进行干预,共有16只裸鼠的成瘤大小适用于实验,分为实验组8只,植入¹²⁵Ⅰ粒子,和对照组8只,植入空载粒子。粒子植入前及治疗后2周和2个月时分别行MRI常规扫描及DWI成像。取瘤体标本行组织病理学检查。结果实验组肿瘤细胞坏死明显,而对照组肿瘤细胞无明显或有少许坏死。裸鼠心、肝、肺、肾及脾脏等组织无明显放射炎症表现。常规MRI成像评价¹²⁵Ⅰ粒子治疗胰腺癌疗效的价值有限。DWI显示实验组内整个肿瘤组织的表观弥散系数（ADC）值在治疗前为（0.001 15±0.000 13）mm²/s,治疗后2周为（0.00I 29±0.000 038）mm²/s,治疗后2个月为（0.002 08±0.000 14）mm²/s,与治疗前相比差异有统计学意义（P<0.05）。实验组肿瘤实质区的ADC值亦较治疗前及对照组增高,但低于坏死区ADC值。结论 ¹²⁵Ⅰ粒子组织间植入治疗人胰腺癌裸鼠移植瘤可导致肿瘤坏死.并对周围脏器是安全的。用常规MRI及DWI成像观察裸鼠皮下移植瘤可行。DWI对疗效评估有重要价值。     

Patient-reported health-related quality of life for men treated with low-dose-rate prostate brachytherapy as monotherapy with 125-iodine, 103-palladium,or 131-cesium: Results of a prospective phase II study

PurposeTo compare quality of life (QoL) after brachytherapy with one of the three approved radioactive isotopes.Methods and MaterialsPatients with mostly favorable intermediate-risk prostate cancer were treated on this prospective phase II trial with brachytherapy as monotherapy, without hormonal therapy. QoL was recorded at baseline and each follow-up by using the Expanded Prostate Cancer Index Composite instrument. The minimal clinically important difference was defined as half the standard deviation of the baseline score for each domain. Mixed effect models were used to compare the different isotopes, and time-driven activity-based costing was used to compute costs.ResultsFrom 2006 to 2013, 300 patients were treated with iodine-125 (I-125, n = 98, prescribed dose [PD] = 145 Gy), palladium-103 (Pd-103, n = 102, PD = 125 Gy), or cesium-131 (Cs-131, n = 100, PD = 115 Gy). Median age was 64.9 years. Median follow-up time was 5.1 years for the entire cohort, and 7.1, 4.8 and 3.3 years for I-125, Pd-103, and Cs-131 groups, respectively. All three isotope groups showed an initial drop in QoL at first follow-up, which gradually improved over the first 2 years for urinary and bowel domains. QoL profiles were similar between I-125 and Pd-103, whereas Cs-131 showed a statistically significant decrease in QoL regarding bowel and sexual function at 12 months compared with Pd-103. However, these differences did not reach the minimal clinically important difference. Compared with I-125, the use of Pd-103 or Cs-131 resulted in cost increases of 18% and 34% respectively.ConclusionsThe three different isotopes produced a similar QoL profile. Statistically significant differences favored Pd-103/I-125 over Cs-131 for bowel and sexual QoL, but this did not reach clinical significance.     

腮腺癌术后 125I 粒子组织间近距离治疗靶区确定方法的探讨

目的 探讨腮腺癌术后¹²⁵I粒子组织间近距离治疗靶区的确定方法。方法 2002年10月至2006年11月北京大学口腔医院的31例腮腺癌患者,男女比例14 ∶17,平均年龄38.2岁,肿瘤有包膜外浸润并与面神经关系密切(黏连或神经侵犯),采用保留面神经的肿瘤及腺体切除术,术后行¹²⁵I粒子组织间近距离治疗,匹配周缘剂量60 Gy。治疗前后行薄层螺旋CT扫描以制定治疗计划和质量验证,以腮腺周围骨性结构和肌组织为参照确定计划靶区和临床靶区,并比较治疗前后靶体积、靶区D₉₀值的差异,同时计算粒子植入后颌骨、中耳D₉₀值以及脊髓最大接受剂量。结果 ¹²⁵I粒子治疗前后靶体积、靶区D₉₀值差异无统计学意义,粒子植入后靶区D₉₀值均大于匹配周缘剂量。本组病例随访时间3~7年,未见肿瘤复发。结论 根据目前随访结果,采用本方法确定¹²⁵I粒子腮腺区组织间近距离治疗靶区,临床治疗效果满意。     

Dosimetric characterization of a newly designed encapsulated interstitial brachytherapy source of iodine-125—model LS-1 BrachyseedTM

A newly designed encapsulated ¹²⁵I source has been introduced (Model LS-1 BrachySeed^TM manufactured by DRAXIMAGE Inc.) for interstitial brachytherapy . In this source ¹²⁵I radionuclide is contained in two ceramic beads positioned at each end of a titanium capsule. The source contains a rod of Pt–Ir, which serves as a radiographic marker for source localization in the patient. Principle photon emissions are 27.4 and 31.0 keV X-rays and a 35.5 keV gamma-ray. The 22.2 and 25.5 keV silver X-rays produced by fluorescence of the silver dopant in the ceramic bead radioisotope carriers, are also emitted. In this work, the dosimetric characteristics of the ¹²⁵I source were measured with micro LiF TLD chips and dosimetry parameters were characterized based upon the American Association of Physicists in Medicine, Task Group, No. 43 formalism. The corrected 1999 National Institute of Standards and Technology standard for low energy interstitial brachytherapy sources was used to specify the air kerma strength of the sources used in this study. The dose rate constant of the sources was determined to be 1.02±0.07 cGyh⁻¹ U⁻¹. The radial dose function was measured and was found to be similar to that of the silver-based model 6711 ¹²⁵I source. However, the anisotropy function of the Model LS-1 BrachySeed^TM source is considerably better than that of model 6711 ¹²⁵I source, especially on the points along and close to the longitudinal axis of the source. The BrachySeed^TM model LS-1 provides more isotropic angular dose distribution in tissue than model 6711 ¹²⁵I source. The anisotropy constant for the model LS-1 source was determined to be 1.006, which is considerably better than the value of 0.93 for the model 6711 source.     

超声引导125I粒子治疗前列腺癌引起的直肠并发症

目的探讨经会阴超声引导放射性^125I粒子近距离治疗前列腺癌的直肠并发症。方法80例前列腺癌患者实施经会阴超声引导放射性^125I粒子植入术，其中68例单纯粒子植入治疗，12例行粒子治疗联合外放疗。单纯^125I粒子治疗肿瘤匹配周边剂量（matched peripheral dose，MPD）为140～160Gy，联合组^125I粒子植入MPD为90～110Gy。联合组外照射剂量为40～50Gy/4～5周，20Gy/次，5次/周，4野照射，粒子植入后4周进行。根据术中计划，利用Mick枪后退式植入粒子，活度为0．35～0．50mCi，中位植入粒子65颗（平均19～100颗）。术后1个月行盆腔CT扫描，进行质量验证。结果68例单纯放射性^125I粒子植入治疗前列腺癌后直肠Ⅰ级、Ⅱ级、Ⅲ级和Ⅳ级副反应发生率分别为7．3％、4．4％、2．9％和1．5％，而12例^125I粒子植入治疗和联合外放疗直肠副反应Ⅰ级和Ⅱ级发生率分别为10％和10％，没有Ⅲ级以上直肠副反应。直肠反应出现中位时间12月（1～16个月）。结论超声引导经会阴放射性^125I粒子植入治疗前列腺癌直肠并发症发生率可以接受，需要进一步明确直肠剂量与发生副反应的关系。     

6711型125I种子源剂量学参量的蒙特卡罗模拟研究

目的 计算6711型125I种子源的剂量特性.方法 使用EGSnrc蒙特卡罗模拟程序对种子源的各向异性函数、径向剂量函数和剂量率常数进行计算,并给出了不同介质中的空间剂量率分布,将计算结果与美国医学物理师协会(AAPM)TG43-U1号报告中的推荐值和其他已发表的相关数据进行了比较.结果 各向异性函数与其他最新发表的数据符合较好;径向剂量函数与TG43-U1推荐值符合较好;剂量率常数为0.951 cGy·h-1·U-1,与TG43-U1推荐值在1.45%内吻合.结论 6711型125I种子源剂量场具有低剂量率,高梯度的特点;各向异性函数在近距离小角度处存在小突起的结构.     

125I粒子近距离治疗在局部晚期腮腺腺样囊性癌的应用

目的单纯应用¹²⁵I放射性粒子组织间植入治疗局部晚期腮腺腺样囊性癌,评估疗效并分析相关预后因素,为局部晚期腮腺腺样囊性癌的治疗提供临床参考。方法回顾性纳入2007年8月至2018年1月于北京大学口腔医院接受单纯应用¹²⁵I放射性粒子植入治疗的局部晚期腮腺腺样囊性癌患者,分析其总生存率(OS)、无进展生存率(PFS)和局部控制率(LCR)及相关影响因素,并观察近、远期放射不良反应情况。结果本组病例共16例(cT4bN0M0),女性患者占多数(11/16,68.7%),中位年龄55.4岁。随访8~104个月(中位时间41.5个月),1、3、5年LCR分别为93.7%、80%、68.7%,1、3、5年OS分别为86.7%、72%、54%;1、3、5年PFS分别为74%、53%、18.9%。9例(56.2%)患者出现不同部位器官转移,以颅内转移、肺转移常见;其中6例术前伴有颅底骨质侵犯者出现多器官转移,肿瘤侵犯颈动脉是影响远处转移的危险因素(HR=12,P=0.045)。共有8例(8/16,50%)患者出现不同程度远期放射性不良反应。结论单纯应用¹²⁵I放射性粒子植入治疗局部晚期腮腺腺样囊性癌的5年局部控制率为68.7%,肿瘤侵犯颅底骨质、包绕颈动脉是其预后不佳与发生多器官远处转移的主要因素。     

甲状腺癌患者131I治疗过程中的外照射剂量水平分析

目的 通过测量甲状腺癌患者¹³¹I治疗过程中患者周围剂量当量率及住院期间胸前体表的累积剂量,探讨加强¹³¹I治疗过程中辐射防护问题。方法 在某开展甲状腺癌患者¹³¹I治疗的医院,选取接受¹³¹I治疗的患者78名,用γ辐射巡测仪测量患者服用¹³¹I药物后10 min、1、2、5 d共5个时间点的周围剂量当量率;测量距离分别为体表5、0.5和1 m处;测量方向为患者前后左右4个方向。用光激发光剂量计测量患者胸前位置住院期间（6 d）接受的累积吸收剂量。结果 服药后10 min患者胸前体表5 cm处周围剂量当量率最高可达4.81 mSv/h,患者出院前胸前体表5 cm处周围剂量当量率范围在2.6~64.1 μSv/h,住院期间患者胸前体表的累积剂量在15.9~58.8 mGy之间。服药10 min后3.7 GBq药剂量组与5.55 GBq药剂量组患者体表5 cm处剂量率差异有统计学意义（t=-6.11,P<0.05）,服药10 min后男性与女性患者体表5 cm处剂量率差异有统计学意义（t=4.52,P<0.05）,其他组别差异无统计学意义（P>0.05）。结论 在甲状腺癌患者¹³¹I治疗过程中,患者周围具有较高的辐射水平,应加强对患者的防护及管理,减少周围公众不必要的照射。     

分化型甲状腺癌患者131I治疗后体内残留放射性活度的评估

目的 评估分化型甲状腺癌(DTC)患者¹³¹I治疗后体内残留放射性活度.方法 本次前瞻性研究包括49例DTC患者,分为“清甲”(¹³¹I摧毁术后残留的甲状腺组织)与“清灶”(¹³¹I治疗甲状腺床残留甲状腺癌、甲状腺床复发灶和转移灶)组,于服¹³¹I后收集患者每次排泄尿液,测定患者每天每次通过尿液排泄的放射性活度及排泄的总放射性活度,进而估算患者体内残留的放射性活度.分别于服¹³¹I后2、6、24、48、72 h进行1 m处剂量当量率的测定,估算患者体内残留放射性活度达到400 MBq时1 m处剂量当量率.结果 服¹³¹I后2、6、24、48、72 h体内残留¹³¹I活度占服¹³¹I初始活度的百分比,“清甲”组分别为99%、72%、25%、15%、7%,1 m处剂量当量率分别为157、120、35、11、9 μSv/h;"清灶"组对应百分比分别为99%、71%、18%、7%、3%,1 m处剂量当量率分别为232、182、48、11、2 μSv/h.体内残留的放射性活度与1 m处剂量当量率呈正相关(r=0.94,P<0.001).“清甲”与“清灶”组服¹³¹I后48~72 h体内残留放射性活度分别为548~259及451~248 MBq,对应的1 m处剂量当量率为8~10 μSv/h.结论 DTC患者于服¹³¹I后48~72 h体内残留放射性活度达到国家标准规定的400 MBq,即DTC患者1 m处剂量当量率达到8~10 μSv/h方可出院.     

Patient-reported outcomes of prostate high-dose-rate brachytherapy boost comparing an outpatient and inpatient protocol: a two-center chronologic cohort study

Purpose

To determine patients’ self-reported experiences of outpatient high-dose-rate prostate brachytherapy boost, and compare with previous cohort treated as inpatients.

Methods and Materials

Using the Prostate Brachytherapy Questionnaire, we previously examined patients’ subjective experience of the brachytherapy procedure when it involved one implant and hospitalization with the template in situ for 2 days (Group 1). The protocol was subsequently changed to two implants, 2 weeks apart as outpatients. Fifty-eight patients treated with the new protocol (Group 2) completed the same questionnaire. We compared the self-reported experiences between Groups 1 and 2 and also between the first and second implant for those in Group 2. Our hypothesis was that the worst rated issues in Group 1 might be reduced with the new approach.

Results

Group 2 patients were less troubled overall by the procedure (mean scores 2.3 vs. 3.2, p = 0.0293). Specifically, they were less troubled by “discomfort” (2.8 vs. 3.8, p = 0.0254); “being stuck in bed” (1.7 vs. 4.2 p < 0.0001); “feeling helpless” (1.3 vs. 2.8, p = 0.0009); “fear of opening my bowels” (2.1 vs. 3.3, p = 0.0055); and “fear of coping with the implant” (1.3 vs. 2.5, p = 0.0004). There was no significant increase in “thought of implant” or “fear of implant” before the second implant. However, more patients rated worse than expected “fear of passing urine” during the second implant.

Conclusions

Patients rated high-dose-rate brachytherapy less troublesome when delivered as outpatient with two implants, 2 weeks apart than as inpatient over 3 days, despite the additional invasive procedure and anesthesia.     

肝动脉化疗栓塞联合射频消融或放射性粒子组织间放疗对原发性肝癌的疗效比较研究

目的 评价比较肝动脉化疗栓塞(TACE)联合射频消融(RFA),以及TACE联合放射性粒子组织间放疗治疗原发性肝癌的效果.方法 50例患者接受TACE联合RFA,34例患者接受TACE联合125I组织问放疗.术后4周复查动态增强CT或MR,对病灶碘油聚集不良者,再次行TACE,术后定期复查,观察疗效.结果 TACE联合RFA或125I放疗后1个月.肿瘤局部控制率分别为98.0%和97.1%,两组间差异无统计学意义.结论 TACE联合RFA和125I植入放疗是肝细胞性肝癌的有效的治疗方法,是单纯TACE疗效不佳者的理想选择.