碘125粒子植入治疗与立体定向放射治疗肠癌术后反复复发肺转移瘤的临床效果比较

目的：比较碘125粒子植入治疗与立体定向放射治疗肠癌术后肺转移瘤的临床疗效和耐受性，分析影响生存预后的因素。 方法：回顾性分析36例肠癌术后肺转移患者，依据治疗方式的不同分为碘125粒子植入组（A组，20例）与立体定向放射治疗组（B组，16例）。分析并比较两组的局部控制率、生存期及术后并发症。采用Kaplan-Meier法计算累积生存率，采用Cox模型分析生存预后的影响因素。 结果：A组的中位生存时间为15个月，与B组的13个月比较差异无统计学意义（Log-Rank χ²=1.131, P=0.440），两组第1、3、6、12个月的局部控制率均达到80%以上，差异无统计学意义（P=0.897）。A组肺转移瘤的反复治疗次数多于B组，差异有统计学意义[（2.35±0.58）次vs.（1.69±0.48）次，t=3.729，P=0.001]；治疗后随访，B组放射性肺炎和放射性肺纤维化的损伤程度较A组严重，差异有统计学意义。放射性肺炎分级较高为预后的独立危险因素（HR=2.213，95%CI：1.013~4.834，P=0.046）。 结论：与立体定向放射治疗相比，碘125粒子植入治疗可以短时间内反复应用，肺组织的放射性反应轻微，治疗肺转移瘤安全、高效，临床应用限制较小。

Comparison on 125I seed brachytherapy and stereotactic body radiation therapy in treatment of recurrent pulmonary metastases of colorectal carcinoma

Objective:To evaluate the efficacy of ¹²⁵I seed implantation and stereotactic body radiation therapy (SBRT) in the treatment of lung metastases postoperative resection of colorectal cancer, to compare the tolerance of lung tissue to both radiotherapy, and to analyze the factors that affect the prognosis. Methods:Thirty-six colorectal cancer patients with postoperative lung metastases were divided into two groups according to the treatment, ¹²⁵I seed implantation group (group A, n=20) and SBRT group (group B, n=16) . Patients were followed up, and the local control rate, survival rate, and postoperative complications were analyzed retrospectively. Kaplan-Meier method was used for analysis of survival rate. Cox proportional hazards model was used to identify the independent predictors of poor prognosis and to analyze the prognostic factors. Results:Survival rate had no significant difference between groups A and B (median live time of 15 months and 13 months, respectively; Log-Rank χ²=1.131, P=0.440) . Local control rates after 1, 3, 6 and 12 months of treatment were all >80%, with no significant difference between the two groups (P=0.897) . The incidence of radiation-induced lung injury in group B was higher than that in group A, with significant differences between the two groups in the number of recurrent treatments [ (2.35±0.58) times vs. (1.69±0.48) times, t=3.729, P=0.001], the incidence of radiation pneumonia (P<0.001) and radiation-induced pulmonary fibrosis (P=0.004) . Multivariate regression analysis showed that radiation pneumonitis was an independent predictor of poor prognosis (HR=2.213, 95%CI: 1.013-4.834, P=0.046) . Conclusions:Compared with SBRT, ¹²⁵I seeds brachytherapy can be repeated within a short time, and causes milder lung tissue damage. The treatment of pulmonary metastasis is safe and effective, and the clinical application is less limited.