^125I粒子植入治疗前列腺癌122例临床分析

目的探讨125I粒子植入在前列腺癌治疗中的临床应用价值。方法 122例前列腺癌患者行粒子植入,经直肠B超引导,计算机确定治疗计划,经会阴穿刺植入前列腺125I放射粒子。结果全组手术顺利,平均植入125I放射粒子46粒,平均手术时间68min,术后平均住院时间6.5d。术后完整随访资料102例,随访时间为术后3个月～5年不等,平均PSA由12.50ng/ml降至0.18ng/ml;9例术后生化复发,经全激素阻断治疗后渐下降到0.15ng/ml以下,无1例出现严重的并发症。结论 125放射性粒子植入是一种可供选择的有效、微创的治疗前列腺癌的方法。     

^125I粒子植入治疗的防护措施

^125I粒子植入治疗恶性肿瘤是近年来肿瘤治疗学的热门研究课题，^125I粒子植入亦称体内伽玛刀。它是将微型放射源植入肿瘤组织内进行治疗的一种方法。我院自2002年4月开展了31例，为了减少放射性^125I粒子对人体的辐射，采取相应的防护措施，以减少对工作人员的不良反应，现将有关防护措施介绍如下。     

浅析^125I粒子植入治疗恶性肿瘤

近10年来，放射性粒子植入治疗肿瘤的近距离放射治疗逐渐受到临床医生的关注和重视，在临床上应用迅速发展，其中^125I粒子是粒子植入治疗中最常用的一种粒子源。与外放射治疗相比，其优点是连续低剂量长时间的放疗，对正常组织的影响最少。有学者认为有效的治疗剂量与肿瘤细胞的倍增时间有关，如果肿瘤倍增时间较短，需用开始剂量高的放疗方法，因此，近距离组织间放疗对于倍增时间较长的肿瘤组织更为合适。现结合近年文献进行综述如下。     

CT导向下^125I粒子植入治疗肺转移瘤的疗效观察及护理

[目的]观察CT导向下^125I粒子植入治疗肺转移瘤的临床疗效。[方法]58例肺转移瘤病人，病灶数为97个，病灶平均直径为2.5cm。在CT导向下将^125I粒子植入肺转移瘤灶内，同时给予积极有效的护理。[结果]58例97个病灶，完全缓解（CR）48个，部分缓解（PR）21个，无变化（NC）19个，进展（PD）9个。15例出现气胸，经保守治疗好转，术后1周痰中带血33例，未见其他严重并发症。[结论]放射性粒子植入治疗肺部转移瘤临床疗效好、创伤小、并发症发生率低。     

粒子植入法联合热疗等综合措施治疗晚期恶性实体瘤

目的探讨粒子植入联合热疗、化疗等微创综合治疗恶性实体瘤的疗效。方法对25例(35个病灶)恶性肿瘤采用CT、B超定位和术中碘125粒子植入联合热疗、化疗、射频消融和免疫治疗同步综合治疗实体肿瘤,治疗后1～3个月复查CT随访。结果 25例35个病灶,完全缓解7个,部分缓解11个,稳定11个,进展6个,总有效率51.4%(18/35);总局控率82.9%(29/35);35个病灶治疗前瘤体直径平均为(5.77±2.48)cm,治疗后明显缩小为(3.64±2.89)cm(t=2.68,P0.05)。结论粒子植入联合热疗等微创综合治疗中晚期和复发恶性实体瘤是一种安全有效的治疗方法 。     

手术加^125I粒子植入治疗肺癌的初步评价

目的：探讨术中直视下植入^125I粒子与外科手术联合应用治疗肺癌的方法，并初步评价其治疗效果。方法：选择我院20例肺癌患者，在治疗计划系统指导下，常规手术切除肺瘤体后，术中直视下将^125I粒子植入到肿瘤残留部分，手术无法切除的转移的淋巴结或细胞易播散部位，观察并初步评价其疗效。结果：本组20例患者术后观察2～10个月，均生存而无肿瘤复发，其中3例肿瘤残留部分明显缩小，1例患者治疗后6个月出现脑转移，1例患者治疗后1个月出现骨转移；所有患者术后恢复均良好,无明显不良反应及并发症。结论：术中直视下植入^125I粒子并与手术相结合治疗肺癌初期疗效显著．弥补了化疗和常规外放疗的不足，为难以治疗的或部分晚期的肺癌患者提供了生存机会，提高了患者的生活质量。     

^125I粒子瘤内永久植入治疗脑胶质瘤疗效观察

目的：探讨^125I粒子瘤内永久植入治疗脑胶质瘤的临床意义及可行性。方法：对我院近2 a入院治疗的胶质瘤患者（37例）分为两组,治疗组18例、对照组19例,治疗组给予肿瘤切除手术结合125I粒子置入瘤巢行持续内照射;对照组仅行肿瘤手术切除。比较两组肿瘤复发时间、生存时间、2 a生存率和3 a生存率（P〈0.05为差异有显著性）。结果：治疗组和对照组比较,复发时间明显延长,生存时间增加（P〈0.01,P〈0.05）,2 a生存率和3 a生存率均明显提高（P〈0.005）。结论：^125I粒子永久植入治疗脑胶质瘤可延长患者复发时间及生存时间,提高脑胶质瘤患者的生存质量。     

放射性粒子植入治疗肿瘤的术后护理

目的：探讨放射性粒子植入治疗肿瘤的术后护理。方法：通过微创外科手术把粒子植入34例患肿瘤内，术后对患进行系统的护理管理，做好健康宣教，加强营养，积极预防术后并发症，使患在微创治疗中，达到局限性实体瘤的理想治疗效果。结果：术中种植成功率达100％，术后无并发症发生。结论：放射性粒子永久植入人体治疗肿瘤是一种比较新的放疗模式。术后加强综合治疗，规范扩理行为，预防并发症的发生，能提高患生存率，降低死亡率，改善预后。     

放射性粒子植入治疗恶性肿瘤的护理23例

肿瘤是当今世界上对人类健康与生命危害最大的疾病之一,其发病率与死亡率呈逐年上升的趋势〔1〕。肿瘤常规的治疗手段有手术治疗、放疗、化疗等。放射性粒子永久植入人体近距离照射杀伤肿瘤组织是一种新的放疗手段,是近几年放射治疗的研究重点之一〔2〕,它具有创伤小、精度高和疗效肯定的优势,可以有效延长病人的生存期,提高生活质量。我院肿瘤治疗中心2004年10月至2006年4月对23例住院肿瘤患者进行放射性粒子植入术治疗,取得了良好的效果,现将有关护理报告如下。1临床资料1.1一般资料本组肿瘤患者23例,男20例,女3例,年龄51~79岁。肺癌12例,…     

^125I放射性粒子近距离治疗肿瘤患者的护理

笔者报道^125I放射粒子治疗肿瘤患者的护理特点。认为术前与患者及家属必要的交流有助于减轻患者及家属的心理压力．使患者早日康复。做好术后护理。加强对^125I射线的防护，如医护人员与病人之间的防护，病人间的防护，病人与家属之间的防护．可以减少护士及家属被射线的辐射。     

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.     

裸鼠肿瘤新生血管光栅X线相衬成像的初步研究

目的:研究利用同步辐射光栅X线相衬成像技术,在无对比剂的情况下,对离体裸鼠胃癌肺转移灶及其内部血管结构进行清晰成像。方法:通过裸鼠尾静脉注射中分化胃癌细胞株SGC-7901,建立血行转移模型,处死小鼠后,开胸取出两肺,均匀切割标本,经4%甲醛溶液(10%福尔马林溶液)固定备用。实验于上海同步辐射光源(Shanghai Synchrotron Radiation Facility,SSRF)X线成像线站BL13W1进行。常规切片作苏木精-伊红(hematoxylin eosin staining,HE)染色,并与光栅X线相衬成像图像进行对比。结果:在无对比剂的情况下,第三代同步辐射光栅X线相衬技术能对胃癌肺转移灶及血管结构进行清晰成像,显示血管直径达到15~30μm,近似低倍光学显微镜下的图像。结论:光栅X线相衬成像对显示裸鼠胃癌肺转移灶中的新生血管具有较高应用价值。     

Mechanism of rejection of virus persistently infected tumor cells by athymic nude mice

Cell lines known to be tumorigenic in the nude mouse were modified by rendering them persistently infected (P.I.) with a variety of RNA viruses, including measles, mumps, vesicular stomatitis virus, and influenza. Although as few as 100 HeLa or BHK cells produced tumors in 100% of nude mice, as many as 2 x 10(7) of the same cells P.I. with viruses failed to produce tumors. An active host response responsible for restricting the growth of the P.I. cells was suggested by the findings of marked mononuclear cell infiltrates at the inoculation sites and the inability of irradiated nude mice to reject them. An analysis of the in vitro cytotoxic activity of spleen cells from normal nude mice indicated that: (a) P.I. cell lines, but not uninfected cell lines, were susceptible to spontaneous cytotoxicity; (b) in vivo inoculation of P.I. lines induced an enhanced cytotoxic activity for P.I. targets in vitro, and this induction was not specific either for inducing virus or cell line; and (c) the effector cell had the characteristics for natural killer (NK) cells. Although the specificity of recognition of the various P.I. cell lines remains unclear, cold competition experiments indicated that blocking the killing of one P.I. cell line, e.g. HeLa-measles, could be achieved only by unlabeled homologous cells, i.e. HeLa-measles, and not by uninfected cells or other P.I. lines. A variant subline of BHK cells P.I. with VSV was selected for its ability to withstand the rejection process in nude mice. These cells formed metastatic and invasive tumors in nude mice. Although they were the most potent inducers in vivo of NK cell activity against various P.I. targets, they were the most resistant of the P.I. lines to NK cell cytotoxicity in vitro. In this system there was a good correlation between tumor rejection in vivo and susceptibility to NK cells in vitro. The present results suggest that NK cells may play a significant role in both rejection of tumor cells, and in resistance to viruses, particularly persistent infections.     

Rifampicin and rifapentine in treatment of experimental listeriosis in normal mice and athymic (nude) mice

Rifampicin and rifapentine were used in the treatment of Listeria monocytogenes infections in normal mice and congenitally athymic (nude) mice. Results were compared with untreated controls and with the results obtained from a previous study of ampicillin in which this model was used. Low doses of rifampicin or rifapentine were adequate to cure normal mice. The efficacy of these antibiotic treatment schedules was lost in nude mice. Prolonged antibiotic treatment schedules with increased dosages were also unsuccessful. These studies show that rifampicin and rifapentine , two antimicrobial agents being capable of destroying intracellular bacteria, were not effective in curing the Listeria infection in mice with impaired host defenses.     

B cell repertoire diversity in athymic mice

The extent of B cell repertoire diversity among nu/nu BALB/c mice has been assessed and compared with that of normal BALB/c mice. This was accomplished through the characterization of monoclonal, influenza hemagglutinin-specific antibodies by reactivity pattern analysis. The results indicate that the repertoire of athymic mice is equivalent in diversity to that of normal mice. Moreover, because these responses were obtained in recipients that were histocompatible but distinct at immunoglobulin allotype loci, these findings indicate that a very diverse array of B cell clonotypes may be stimulated in the absence of allotype-identical T cells.     

Junin virus infection in genetically athymic mice

The progression of Junin virus infection was studied in congenitally athymic mice. Immunocompetent littermates were used as infected controls. As expected, the latter developed lethal encephalitis, with viremia and considerable viral replication in the brain. The mortality rate was almost 100%; the few surviving controls exhibited high serum neutralizing antibody levels and a total absence of virus in blood and brain. In contrast, nude mice did not contract the disease; all survived with persistent viremia and virus in brain, but no serum neutralizing antibodies were detected. These results confirm previous research on thymectomized mice and those treated with anti-lymphocyte serum and tend to support the important role of cellular immunity in the pathogenesis of this viral disease.     

Effectiveness of nanoparticle-bound ampicillin in the treatment of Listeria monocytogenes infection in athymic nude mice.

The effectiveness of nanoparticle-bound ampicillin was tested in the treatment of experimental Listeria monocytogenes infection in congenitally athymic nude mice. Nanoparticles of polyisohexylcyanoacrylate (PIHCA) 187 +/- 13 nm in diameter were bound to ampicillin at an ampicillin/PIHCA ratio of 0.2:1. The proportion of ampicillin bound was 90% +/- 3%. After adsorption onto nanoparticles, the therapeutic activity of ampicillin increased dramatically over that in the free state. Thus, 2.4 mg of nanoparticle-bound ampicillin (three doses of 0.8 mg each) had a greater therapeutic effect than 48 mg of free ampicillin (three doses of 16 mg each). These results might provide an incentive for further development of intracellular targeting of antibiotics on biodegradable polymeric carriers.     

Sunflower seed oil-enriched product can inhibit Ehrlich solid tumor growth in mice

BACKGROUND: Sunflower seed oil (SSO) effect on solid and ascitic forms of Ehrlich tumor was evaluated. METHODS: Solid or ascitic Ehrlich tumor-bearing Swiss mice were treated daily, by subcutaneous route, with 200 microl of SSO. The solid tumor-bearing footpad was measured every 3 days and ascitic tumor-bearing mice had their ascites collected and quantified. At the end of the SSO treatment, the total cell number in lymphoid organs was quantified. RESULTS: Subcutaneous treatment with SSO inhibits the solid tumor growth and increases lymph node cell number in animals with solid tumor, but has no effect on animals with ascitic tumor. CONCLUSIONS: SSO can delay the solid tumor growth, possibly due to better absorption of this treatment by draining lymph nodes.     

Induction of Junin virus persistence in adult athymic mice

To determine the role of T lymphocytes in adult mice infected with Junin virus, 60-day-old athymic (nu/nu) mice and their immunocompetent (nu/+) littermates were inoculated intracerebrally with 10(3) TCD50 of the XJ strain. None of them exhibited neurologic illness during a 6-month observation period, and mortality was 3% for nu/nu and 7% for nu/+ animals. The main features in infected nu/nu mice were: high viral titers in brain, reaching a late peak (6.5 log/ml) 32 days postinoculation and persisting at least 6 months; low, late viremia appearing simultaneously with the viral peak in the central nervous system (CNS) and persisting up to 3 months after infection; absence of signs of neurologic disease or histologic lesions in brain and almost no mortality; and lack of detectable circulating antibodies either in IgM or in other immunoglobulins (Igs). Circulating anti-Junin antibodies were demonstrated in IgM and other Igs in immunocompetent mice, although no infectious virus or histologic lesions could be detected. These results show an important role for T lymphocytes in the clearance of Junin virus in the CNS, as demonstrated by viral persistence induced in adult athymic mice.