术中超声引导放射性125I粒子组织间植入治疗胰腺癌

目的探讨术中超声引导放射性~(125)Ⅰ粒子组织间植入治疗胰腺癌的手术方法、近期疗效和副反应。方法27例无法切除的晚期胰腺癌,行术中超声引导~(125)Ⅰ粒子组织间植入治疗,11例行胃肠或胆肠短路术。腹部正中切口,暴露肿瘤,利用术中超声探及肿瘤大小、范围,确立进针方向和范围。插植粒子针边界外放1.0～1.5 cm,避开血管和胰管,间隔1cm。Mick枪后退式植入粒子,粒子间隔1cm。~(125)Ⅰ粒子活度为0.40～0.70 mCi/颗,D_(90)为110～160 Gy。6例术后4周加外放疗,2～3 Gy/次,5次/周,总剂量39～50 Gy。5例术后顺铂 吉西他滨化疗,2～4周期。结果20例伴有上腹部疼痛患者,粒子治疗后有17例疼痛完全或部分缓解,有效率85%,显效时间1～30 d,中位起效时间5 d。全组局部控制率为74%,Ⅱ Ⅲ期1、2年生存率分别为25%、15%,中位生存时间8个月,Ⅳ期1年生存率为8%,中位生存时间5个月。3例术后1个月复查时发现5颗粒子迁徙到肝脏。3例术后6周到6个月出现乳糜瘘,2例对症处理后缓解,2例复发合并上消化道出血,没有感染和胰瘘等并发症。结论放射性~(125)Ⅰ粒子组织间植入治疗胰腺癌具有很好的姑息止疼疗效,部分局部晚期患者可获得长期生存,而且并发症发生率较低。     

术中125I放射性粒子植入治疗胰腺癌18例

 目的　探讨125I放射性粒子术中植入近距离照射治疗中晚期胰腺癌的价值。方法　2003年5月至2007年6月行手术治疗胰腺癌75例,其中行肿瘤切除31例（A组）,胆肠吻合伴或不伴胃肠吻合结合125I放射性粒子术中植入18例（B组）,单纯胆肠吻合伴或不伴胃肠吻合26例（C组）。结果　全组67例获得随访,A、B、C组中位生存时间分别为19、12、7个月;术中125I放射性粒子植入近距离照射对术前疼痛的患者止痛有效率为80 %,肿瘤治疗有效率为59 %。对B组的患者经术后CT检查验证,粒子丢失率为2.6 ％,与术前治疗计划系统制定的粒子空间分布符合率为56 %。结论　积极行手术切除肿瘤是胰腺癌患者获得长期生存的重要途径,胆肠吻合伴或不伴胃肠吻合结合125I放射性粒子术中植入近距离放射治疗对中晚期胰腺癌有一定疗效,如何做到术中采集图像,实时制定治疗计划来实现治疗适形性仍需进一步探讨。     

术中超声引导放射性^125Ⅰ粒子组织间植入治疗胰腺癌

目的探讨术中超声引导放射性^125Ⅰ粒子组织间植入治疗胰腺癌的手术方法、近期疗效和副反应。方法27例无法切除的晚期胰腺癌，行术中超声引导^125Ⅰ粒子组织间植入治疗，11例行胃肠或胆肠短路术。腹部正中切口，暴露肿瘤，利用术中超声探及肿瘤大小、范围，确立进针方向和范围。插植粒子针边界外放1．0～1．5cm，避开血管和胰管，间隔1cm。Mick枪后退式植入粒子，粒子间隔1cm。^125Ⅰ粒子活度为0．40～0．70mCi／颗，D90为110～160Gy。6例术后4周加外放疗，2～3Gy／次，5次／周，总剂量39～50Gy。5例术后顺铂＋吉西他滨化疗，2～4周期。结果20例伴有上腹部疼痛患者，粒子治疗后有17例疼痛完全或部分缓解，有效率85％，显效时间1～30d，中位起效时间5d。全组局部控制率为74％，Ⅱ＋Ⅲ期1、2年生存率分别为25％、15％，中位生存时间8个月，Ⅳ期1年生存率为8％，中位生存时间5个月。3例术后1个月复查时发现5颗粒子迁徙到肝脏。3例术后6周到6个月出现乳糜瘘，2例对症处理后缓解，2例复发合并上消化道出血，没有感染和胰瘘等并发症。结论放射性^125Ⅰ粒子组织间植入治疗胰腺癌具有很好的姑息止疼疗效，部分局部晚期患者可获得长期生存，而且并发症发生率较低。     

125I放射性粒子术中植入治疗晚期胰腺癌的疗效评价

目的初步分析^125Ⅰ放射性粒子术中植入内照射治疗晚期胰腺癌的临床疗效。方法对10例手术不能切除的晚期胰腺癌在术中植入^125Ⅰ放射性粒子进行组织间内照射。结果全组10例获得2-13个月的随访，中位6个月。生存期达12个月1例，6个月3例，3个月4例，1个月2例。中位生存期4．6个月。肿瘤完全缓解(CR)2例，部分缓解(PR)3例，无变化(NC)4例，进展(PD)1例。总有效率(CR PR)为50％。止痛有效率为60%。经术后X线片验证，粒子数目符合率为100％，粒子空间分布符合率仅为30％。结论^125Ⅰ放射性粒子术中植入内照射治疗晚期胰腺癌有一定疗效，但在按照粒子计算机治疗计划完成术中粒子空间分布技术方面尚须进一步完善。     

Interstitial iodine-125 implant in the management of unresectable pancreatic carcinoma

Eighteen patients with locally advanced adenocarcinoma of the head, body and tail of the pancreas were treated by a combination of biliary bypass, external and interstitial irradiation at Southern California Cancer Center of California Hospital Medical Center, Los Angeles, and Memorial Hospital Medical Center of Long Beach, Long Beach, CA, from July 31, 1975 to December 31, 1980. A dose of 3000 to 5000 rad was delivered to the pancreas and regional lymph nodes by external irradiation utilizing megavoltage units and 10,000 to 15,000 rad to the pancreas and metastatic lymph nodes by permanent Iodine-125 implants. In this group of 18 patients with unresectable carcinoma of the pancreas, excellent palliation of pain, jaundice and vomiting was achieved, with a median survival of 14 months.     

125I放射性粒子植入治疗无法手术切除的胰腺癌疗效分析

目的：探讨^125I放射粒子植入术治疗手术无法切除的胰腺癌的治疗疗效。方法：选择胰腺癌患者50例,内放射治疗组30例,肿瘤内部^125I放射粒子植入,有梗阻症状者,加行胆-肠吻合术和胃-空肠吻合术;对照组20例,均行单纯剖腹探查或胆-肠吻合术和（或）胃-空肠吻合术。观察肝肾功能和总胆红素变化、肿瘤大小变化、并发症发生情况、腹痛和背痛变化等。结果：两组患者总胆红素术后4周时均接近正常,肝功能明显改善,手术前后比较差异均有统计学意义;粒子植入组患者手术前后腹痛和腰痛明显改善。有效率100％（30／30）,完全缓解率97％;粒子植入组肿瘤直径有缩小趋势,对照组无明显变化;两组患者均无吻合口瘘、胆瘘、胰瘘、腹腔出血和腹腔感染。结论：^125I粒子植入对不可切除的胰腺癌具有确定疗效,不仅可以明显延长患者生存期,提高生活质量,而且对胰腺癌引起的疼痛有明显的缓解效果。     

放射性粒子植入治疗中晚期胰腺癌疗效分析

目的:探讨125I放射粒子植入术治疗手术无法切除的胰腺癌的疗效。方法:选择胰腺癌患者50例。内放射治疗组30例,肿瘤内部125I放射粒子植入,有梗阻症状者,加行胆-肠吻合术和胃-空肠吻合术;对照组20例,均行单纯剖腹探查或胆-肠吻合术和/或胃-空肠吻合术。观察肝肾功能、总胆红素变化;肿瘤大小变化;并发症发生情况;腹痛、背痛变化等。结果:两组患者总胆红素术后4周时均接近正常,肝功能明显改善,手术前后比较均具有统计学意义;粒子植入组患者手术前后腹痛、腰痛改善明显。有效率100%(30/30),完全缓解率97%;粒子植入组肿瘤直径有缩小趋势,对照组无明显变化;两组患者均无吻合口瘘、胆瘘、胰瘘、腹腔出血和腹腔感染。结论:125I粒子植入对不可切除的胰腺癌具有确定疗效,不仅可以明显延长患者生存期,提高生活质量,且对胰腺癌引起的疼痛有明显的缓解效果。     

Intraoperative radiotherapy of unresectable pancreatic carcinoma

Twenty-eight cases of unresectable pancreatic carcinoma were treated with intraoperative radiotherapy (IOR) with or without postoperative radiotherapy (POR) from 1975 to 1982 at Tokyo Women's Medical College. The results were as follows. IOR was effective for pain relief, and the response rate was 93%. Twenty-five Gy of IOR, considering sequential POR, was a reasonable dose in about an 8 X 8 cm to 10 X 10 cm radiation field. Precise staging and marking of the tumor edge at operation were important for the treatment planning after IOR. Radiotherapy should be considered in the multimodal treatment of pancreatic carcinoma.     

Ultrasonically guided percutaneous implantation of iodine-125 seeds in pancreatic carcinoma.

Cancer of the pancreas is most often not diagnosed before it has reached unresectable stages. The development of effective palliative treatment for these patients and for those with recurrence after resection is clearly needed. The present study reports the results of ultrasonically guided percutaneous implantation of 125I seeds in 19 patients with cancer of the pancreas. Twelve patients had further adjuvant external radiation. Despite satisfactory seed placement and delivery of the planned radiation dose in most cases, clinical improvement was lacking or only slight and short-lived. No difference in survival or palliation was observed between patients treated with seeds alone compared with patients treated with seeds and external radiation. Survival after seed implantation was short (median 140 days, range 7-401 days). Ultrasonically guided percutaneous implantation of 125I seeds cannot be recommended in the treatment of unresectable carcinoma of the pancreas.     

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.     

Patterns of failure after iodine-125 seed implantation for prostate cancer

Purpose

To determine the site of relapse when biochemical failure (BF) occurs after iodine-125 seed implantation for prostate cancer.

Materials and methods

From 2001–2009, 500 men underwent implantation in Wellington, New Zealand. Men who sustained BF were placed on relapse guidelines that delayed restaging and intervention until the prostate-specific antigen (PSA) was ?20 ng/mL.

Results

Most implants (86%) had a prostate D90 of ?90%, and multivariate analysis showed that this parameter was not a variable that affected the risk of BF. Of 21 BFs that occurred, the site of failure was discovered to be local in one case and distant in nine cases. Restaging failed to identify the site of relapse in two cases. In nine cases the trigger for restaging had not been reached.

Conclusions

If post-implant dosimetry is generally within the optimal range, distant rather than local failure appears to be the main cause of BF. Hormone treatment is therefore the most commonly indicated secondary treatment intervention (STI). Delaying the start of STI prevents the unnecessary treatment of men who undergo PSA ‘bounce’ and have PSA dynamics initially mimicking those of BF.     

术中超声引导~(125)I放射性粒子植入治疗14例晚期胰腺癌体会

为了探讨经超声引导下125I粒子植入治疗晚期胰腺癌的效果,2004年1月~2006年6月收集我院14例不能切除的晚期胰腺癌经开腹、术中超声引导行125I粒子植入术,术后观察疼痛缓解及原发灶疗效。术后疼痛CR9例,PR2例,疼痛有效率91.7%(11/12),对肿瘤原发灶的有效率78.6%(11/14)。初步研究结果提示,经超声引导下粒子分布更均匀,局部剂量高,对原发灶的控制疗效确切,具有很好的止痛疗效,是治疗晚期胰腺癌的有效方法。     

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。     

The investigation of <Superscript>125</Superscript>I seed implantation as a salvage modality for unresectable pancreatic carcinoma

Background

To assess the efficacy of intraoperative ultrasound-guided implantation of ¹²⁵I seeds for the treatment of unresectable pancreatic carcinoma, and analyze the associated prognostic factors.

Methods

Twenty-eight patients with pancreatic carcinoma who underwent laparotomy and were considered to have unresectable tumors were included in this study. Nine patients were pathologically diagnosed with Stage II disease, and nineteen patients with Stage III disease. Twenty-eight patients received intraoperative ultrasound-guided ¹²⁵I seed implantation and received a D₉₀ (at least 90% of the tumor volume received the reference dose) ranging from 60 to 163 Gy, with a median of 120 Gy. Seven patients received an additional 35–50 Gy external beam radiotherapy after seed implantation, and ten patients received two to ten cycles of chemotherapy. Overall survival of the patients was calculated and prognostic factors were evaluated.

Results

Of the patients, 94.1% (16/17) achieved good to medium pain relief. The tumor response rate was 78.6% (22/28), and local control was achieved in 85.7% (24/28) of patients. The 1-, 2- and 3-year survival rates were 30%, 11% and 4%, and the median survival was 10.1 months (95% CI: 9.0-10.9). Analysis using the Cox proportional hazards model suggested that patients younger than 60 years and patients who received a D₉₀ higher than 110 Gy may survive for a longer period.

Conclusions

I seed implantation provides a safe and effective method to relieve pain, control local tumor growth and, to some extent, prolong the survival of patients with stage II and III pancreatic disease, without additional complications. Age and accumulated dose may be factors predictive of a favorable outcome for patients with unresectable pancreatic carcinoma treated with ¹²⁵I seeds. These findings need to be validated by conducting further studies with larger cohorts.

     

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。     

Changes in the tumor microenvironment during low-dose-rate permanent seed implantation iodine-125 brachytherapy

PURPOSE: There is a lack of data regarding how the tumor microenvironment (e.g., perfusion and oxygen partial pressure [pO2]) changes in response to low-dose-rate (LDR) brachytherapy. This may be why some clinical issues remain unresolved, such as the appropriate use of adjuvant external beam radiation therapy (EBRT). The purpose of this work was to obtain some basic preclinical data on how the tumor microenvironment evolves in response to LDR brachytherapy. METHODS AND MATERIALS: In an experimental mouse tumor, pO2 (measured by electron paramagnetic resonance) and perfusion (measured by dynamic contrast-enhanced magnetic resonance imaging) were monitored as a function of time (0-6 days) and distance (0-2 mm and 2-4 mm) from an implanted 0.5 mCi iodine-125 brachytherapy seed. RESULTS: For most of the experiments, including controls, tumors remained hypoxic at all times. At distances of 2-4 mm from radioactive seeds ( approximately 1.5 Gy/day), however, there was an early, significant increase in pO2 within 24 h. The pO2 in that region remained elevated through Day 3. Additionally, the perfusion in that region was significantly higher than for controls starting at Day 3. CONCLUSION: It may be advantageous to give adjuvant EBRT shortly (approximately 1 to 2 days) after commencement of clinical LDR brachytherapy, when the pO2 in the spatial regions between seeds should be elevated. If chemotherapy is given adjuvantly, it may best be administered just a little later (approximately 3 or 4 days) after the start of LDR brachytherapy, when perfusion should be elevated.     

含洛铂方案经肝动脉化疗栓塞联合125I粒子植入术治疗不能手术的中晚期肝癌的疗效观察

背景与目的：应用经肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)治疗肝癌存在着坏死率低的不足,¹²⁵I粒子植入术作为一项新的放疗技术具有靶向性强的优点。本研究旨在观察含洛铂方案TACE联合¹²⁵I粒子植入术对不能手术的中晚期肝癌患者的临床疗效及3年生存情况,为肝癌的临床治疗提供参考。方法：前瞻性研究设计,选取2010年1月—2013年1月郑州大学附属肿瘤医院收治的中晚期肝癌患者102例,随机数字表法分为观察组和对照组,每组51例。对照组患者接受含洛铂方案TACE治疗,观察组患者在对照组治疗方案的基础上加用125I粒子植入术。观察两组患者治疗前和治疗后6个月的甲胎蛋白(alphafetoprotein,AFP)、肝功能指标、细胞免疫指标变化情况及肿瘤转移情况,比较两组患者治疗后的近期疗效及3年生存率,并记录随访期内不良反应发生情况。结果：治疗前两组患者一般资料及临床相关指标比较差异均无统计学意义(P均>0.05)。经不同方案治疗后,观察组近期有效率(86.3%)显著高于对照组(68.6%);治疗后6个月,两组患者血清AFP检测水平较治疗前明显降低,其中观察组患者血清AFP水平下降幅度显著大于对照组(P<0.05);两组患者肝功能指标及细胞免疫指标比较差异无统计学意义(P>0.05);观察组治疗后6个月远处转移的发生率(7.8%)明显低于对照组(23.5%),术后1、2和3年内生存率分别为68.6%、43.1%和31.4%,均明显高于对照组(41.2%、29.4%和13.7%),差异均有统计学意义(P均<0.05);两组患者随访期间均未出现严重并发症。结论：含洛铂方案TACE联合¹²⁵I粒子植入术治疗不能手术的中晚期肝癌的疗效确切,与单纯含洛铂方案TACE治疗相比优势明显,能更有效的控制肿瘤转移,提高生存率,值得在临床推广应用。     

Treatment of primary unresectable carcinoma of the pancreas with I-125 implantation

Between January 1 1974 and October 31 1987, 98 patients with biopsy proven unresectable adenocarcinoma of the pancreas were treated with I-125 implants during laparotomy. Presenting symptoms were pain (57 patients), jaundice (45 patients), and weight loss (34 patients). All patients underwent laparotomy and surgical staging. Thirty patients had T1NoMo disease, 47 patients had T2-3NoMo disease, and 21 patients had significant regional lymph node involvement (T1-3N1Mo). The surgical procedure performed was biopsy only (16 patients), gastric bypass (36 patients), biliary bypass (49 patients), and partial or total pancreatectomy with incomplete resection (5 patients). The total activity and the number of seeds used were determined from the Memorial Sloan Kettering Cancer Center (MSKCC) nomogram. Stereoshift localization X ray films were taken 3-6 days after operation. The mean activity, minimal peripheral dose (MPD), and volume of the implants were 35 mCi, 13,660 cGy, and 53 cm3, respectively. In addition, 27 patients received postoperative external irradiation and 27 patients received chemotherapy. Postoperative complications were observed in 19 patients. These included post-operative death (1 patient), biliary fistula (4), intraabdominal abscess (4), GI bleeding (3), gastric or small bowel obstruction (6), sepsis (5), and deep vein thrombophlebitis (4). Pain relief was obtained in 37/57 patients (65%) presenting with pain. A multivariate analysis showed that four factors significantly affected survival: T stage, N stage, administration of chemotherapy, and more than 30% reduction in the size of the implant on follow-up films. The median survival for the entire group was 7 months. A subgroup of patients with T1No stage disease who received chemotherapy survived 18.5 months. The indications for I-125 seed implantation in unresectable carcinoma of the pancreas are discussed.     

冷消融联合放射性碘粒子植入治疗不可切除的肺癌

背景与目的大多肺癌患者发现时已届晚期,失去手术机会。因而探索新的能替代手术的治疗措施,对改善该类患者的预后具有重要意义。本研究观察疗氩氦刀冷消融联合125I粒子植入治疗肺癌疗效和副作用,评估其有效性和安全性。方法不可切除的肺癌患者140例,行CT引导下经皮穿刺氩氦刀冷消融联合125I粒子植入治疗,跟踪随访1年,术后定期CT检查,观察疗效、并发症、生存时间。结果140例患者均顺利完成冷消融与125I粒子植入治疗,接受1年随访。按照实体瘤评价标准,术后6月时完全缓解(CR)为16.8%、部分缓解(PR)为70.1%、稳定(SD)为7.4%、进展(PD)为5.7%;术后半年、1年生存率分别为94.3%、65.7%;部分患者术后1月症状即有所改善,KPS评分从平均66.9提高到76.3。结论氩氦刀靶向冷冻联合125I粒子植入治疗肺癌,疗效肯定,为不可切除的肺癌患者提供了一种新的治疗方案。     

附加放射性粒子植入的局部晚期肺癌外科治疗

Objective： To study the clinical efficacy and methods of permanent implantation of radioactive I-125 seed in surgery for local advanced non small lung cancer （LANSCLC）. Methods： From Apr. 2004 to Apr. 2006, the I-125 seeds were implanted into 30 patients with LANSCLC in surgery. The numbers of seeds were 10-40. The chemotherapy was performed in 10 to 14 days after operation. Results： There was no operative death, and the distribution of seeds and complications were reviewed by CT and X-ray after treatment. The distribution of seeds was satisfactory in all patients. The complete response rate （CR） was 56.6% and the part response （PR） was 26.6%. The overall response rate was 83.3% after 4-24 months of surgery. There was no one occurred radiation pneumonia. Prospective efficacy await further follow-up. Conclusion： Permanent implantation of 1-125 seed in surgery for LANSCLC, is a safe and effective method with mild complications.