125I粒子组织间植入治疗局部晚期肺癌的对比研究

目的评价CT导向下^125I粒子植入治疗局部晚期肺癌的临床价值。方法CT导向下^125I粒子植入32例（A组）经一线化疗未控的局部晚期肺癌患者。32例患者病灶数48个,所有病灶与正常组织间有较清楚的边界,最大径4．5-7．5cm,平均5．5cm。全部病例均经病理证实。应用放射性^125I粒子源强为23．3-30．0MBq,肿瘤匹配周边剂量为100-150Gy。采用TPS计算布源,在cT导向下将^125I粒子植入瘤灶内。对照组为随机抽取一线化疗局部晚期肺癌病例30例（B组）。结果2个月后cT复查,A组局控率78．1％。一年生存率为65．0％,中位生存时间15个月。术中肺内会有少量渗出;4例出现气胸,肺压缩均在30％以内,经保守治疗好转;术后1周痰中带血15例。未见骨髓抑制等严重并发症。B组局控率43．3％。一年生存率为48．0％,中位生存时间11个月,骨髓抑制发生率46．3％。两者差异有统计学意义。结论放射性粒子植入治疗局部晚期肺癌临床疗效好,并发症发生率低,生活质量改善明显,近期效果好,是一种治疗局部晚期肺癌的简单、安全、有效的方法。

CT guided radioactive 125I seed implantation in treating localized advanced pulmonary carcinoma

OBJECTIVE: To investigate the clinical value of CT guided radioactive 125I seed implantation (CTRISI) in the treatment of localized advanced pulmonary carcinoma. METHODS: Thirty-two biopsy -confirmed localized advanced pulmonary carcinoma patients (Group A) with 48 lesions, 5.5 (4.5 -7.5) cm in diameter, clearly demarcated from the adjacent normal tissue, who failed to be improved in the first line chemotherapy, underwent CI-guided implantation of 125I seeds of 23.3 - 30.0 megabecquerel (MBq) into these lesions with the matched peripheral dose of 100-150 Gy. Thirty patients (Group B) treated by first line chemotherapy were randomly selected as the control group. RESULTS: CT follow-up two months later proved that the local control rate of Group A was 78.1%, significantly higher than that of Group B; the one year survival rate of Group A was 65.0%, significantly higher than that of Group B (48.0%); the median survival time of Group A was 15 months, significantly longer than that of Group B (11 months); no myelosuppression was found in Group, and the myelosuppression rate of Group B was 46.3%. In Group A small amount of effusion was observed, pneumothorax occurred in 4 cases with one of the lungs compressed by less than 30% that was improved after conservative treatment; one week after the procedure bloody sputum occurred in 15 cases. CONCLUSION: Improving the living quality obviously and with good short-term effects and few complications, CTGRISI procedure is safe and well-tolerated in treating localized advanced pulmonary carcinoma in Chinese patients.