CT引导下125I放射粒子植入治疗脑内肿瘤的应用研究

目的探讨CT引导下^125Ⅰ放射性密封籽源植入治疗脑部肿瘤的操作方法、安全性及疗效。方法回顾分析22例经CT平扫及增强扫描确诊的脑内肿瘤，包括脑胶质瘤5例，脑胶质瘤术后复发6例．单发脑转移瘤9例，脑膜瘤2例。治疗前行CT引导下经皮穿刺快速病理证实，待病理结果后即刻行CT引导下经皮穿刺组织间植入^125Ⅰ放射性密封籽源4～16粒，^125Ⅰ放射性密封籽源的放射性活度为26、30、33Mbq／颗，籽源放射性总活度为120～480Mbq，籽源间距为1～1．5cm。穿刺点均为1处．调整进针方向2～5次。结果22例中随访1月以上22例，2月以上21例，3月以上20例，6月18例。1月随访22例中，肿瘤直径缩小11例，无变化10例，增大1例；2月随访21例中，肿瘤直径缩小14例。无变化4例，增大3例；3月随访20例中，肿瘤直径缩小15例，无变化2例，增大3例；6月随访18例中．肿瘤直径缩小14例，无变化2例，增大2例。22例中治疗前有明显神经定位体征16例，各种症状21例。其中精神症状1例，随访中症状减轻19例。脑水肿减轻14例，无变化4例，加重0例。治疗4月后死亡1例。结论经皮穿刺组织间植入^125Ⅰ放射性密封籽源治疗脑内肿瘤可使瘤体明显缩小。水肿减轻，症状不同程度缓解，效果肯定。CT引导下植入准确，相对安全。

Application of 125I in the treatment of brain tumor under CT guidance

Objective To explore the method, safety and effect of brain tumor treatment by CT-guided percutaneous embedment of 125I. Methods 22 cases of brain tumor affirmatively diagnosed by planning and contrast-enhanced CT scan w ere retrospectively analyzed, including 5 cases of glioma, 6 glioma recurring af ter surgery, 9 metastasis, 2 meningioma. Right after all the cases had been conf irmed pathologically by CT-guided percutaneous puncturing, they were immediately treated by embedding 4~16 particles of 125I, with the radioactivity quantum 22, 26, 30 MBq per granule and the overall radioactivity quantum 120~480 Mbq. The d istance between particles was 1~1.5 cm. The number of puncture point was only on e and the number of puncture direction regulation was 2~5 times. Results 22 c ases were followed up for 1 month, 21 cases for 2 months, 20 cases for 3 months, and 18 cases for 6 months. Among the 22 cases for 1 month, the tumor was reduce d in 11 cases, unchanged in 10 cases, and increased in 1 case. Among the 21 case s for 2 months, the tumors were reduced by more than 50% in 14 cases, unchanged in 4 cases, and expanded in 3 cases. Among the 20 cases followed up for 3 months , the tumors were reduced in 15 cases, unchanged in 2 cases, and increased in 3 cases. Among 18 cases for 6 months, the tumors were reduced in 14 cases, unchang ed in 2 cases and increased in 2 cases. Among the 22 cases, 16 cases had obvious nerve orientation somatogeny, 21 cases displayed all sorts of symptoms and 1 ca se mental disorder before CT guided therapy. The symptoms were relieved in 19 c ases after treatment. The brain edema shrank in 14 cases, went unchanged in 2 ca ses and 1 died 4 months after treatment. Conclusion The size of brain tumor s were reduced obviously, and the brain edema and the symptoms were relieved aft er the treatment. CT-guided percutaneous embedment of 125I is safe and accurate in treating brain tumors.