^125I放射性粒子植入联合三维适形放疗治疗局部非小细胞肺癌的疗效

目的：探讨^125I放射性粒子（^125I粒子）植入联合三维适形放疗治疗非小细胞肺癌的放射剂量、安全性和近期疗效。方法：对经病理学确诊的16例非小细胞肺癌病人（均为周围型,腺癌9例,鳞癌7例）予外照射（8MV的X线常规放疗）治疗,60-66Gy/（30-33）次。1-2个月左右复查胸部CT,观察肿瘤退缩情况,并开始应用^125I粒子。术前经三维立体定向^125I粒子植入放射治疗计划系统（TPS）制定治疗计划,根据TPS结果计算所需^125I粒子数和布源方法。在CT引导下经皮穿刺组织间植入^125I粒子,内照射剂量为90-120Gy。术后应用TPS进行剂量验证。结果：^125I粒子植入术后每3个月左右复查胸部CT,肺部肿瘤完全消退者4例,部分退缩者12例。16例病人接受植入术中发生少量气胸者2例;4例出现咳血痰,给予止咳和止血药物后1-2d症状消失。结论：^125I粒子植入联合外照射治疗非小细胞肺癌是一种有效的方法,且肺放射性损伤程度低,值得进一步研究。

Efficacy of ^125I radioactive seed implantation combined with three-dimensional conformal radiation therapy for localized non-small cell lung cancer

Objective：To explore the radiation dose,safety and primary efficacy of 125I radioactive seeds implantation and three-dimensional conformal radiation therapy for non-small cell lung cancer.Methods：All 16 patients with pathologically confirmed non-small cell lung cancer（all cases were peripheral,9 cases adenocarcinoma,7 cases squamous cell carcinoma） were accepted the external exposure（8MV X-ray three-dimensional conformal radiation therapy） treatment,60-66Gy/（30-33） times.After 1-2 months,all patients were reexamined by chest CT,observing the tumor regression,and to start using 125I.Before the trentment,with three-dimensional stereotactic 125I seed implantation radiation treatment planning system（TPS） to design treatment plans,and calculated the number of particles of 125I and the distribution method of source.With the guideline of CT,percutaneous implantation of 125I particles,the radiation dose was 90-120Gy.After application,verified the dose with TPS again.Results：After implantation,all patients were examined by chest CT every 3 months,lung tumor disappeared completely in 4 patients,12 cases partly disappearaed.Long-term survival was in the follow-up.Only 2 cases occurred small amount pneumothorax,4 patients developed bloody sputum,and after 1-2 days the symptom disappeared.Conclusion：The method of 125I implantation combined with three-dimensional conformal radiation therapy for non-small cell lung cancer is an effective way,and the incidence of radiation injury of the lung was low.