化疗联合125I粒子治疗不能手术的肺上沟癌的疗效分析

目的 探讨应用放射治疗计划系统（TPS）在CT引导下经皮穿刺种植放射性¹²⁵I粒子近距离联合化疗治疗肺上沟癌的疗效分析。方法 回顾性分析2002年12月至2010年12月本院收治的影像及病理证实为肺上沟癌的患者36例，其中鳞癌26例，腺癌10例。粒子植入后1周行化疗，具体方案为第1、8天静脉给予1 000 mg/m²吉西他滨，第1天静脉给予顺铂75 mg/m²，连续4个周期。¹²⁵I粒子在化疗间期植入，中位粒子数43，处方剂量（prescribed dose，PD）120 Gy，粒子中位活度0.7 mCi （2.59×10⁷ Bq），范围0.68~0.82 mCi （2.52×10⁷~3.03×10⁷ Bq）。患者中位随访时间48个月，观察生存率。结果 靶区瘤体周围处方剂量mPD （118.7±7.2）Gy，D₉₀（126±4.7）Gy，D₉₀> mPD。术后6个月胸部CT显示，完全缓解（CR）11例，占30.6%；部分缓解（PR）19例，占52.8%；疾病稳定（SD）5例，占13.9%；疾病进展（PD）1例，占2.8%；总有效率（CR＋PR）为83.4%，共30例。1、3、5年的局部控制率分别为92%、83%和67%，中位局部控制时间56.8个月。1、3、5年累计生存率分别为84.1%、56.7%和36.8%，中位生存期38个月。结论 化疗联合组织间近距离¹²⁵I粒子植入是一种微创有效的治疗肺上沟癌的方法。

Efficacy analysis of chemotherapy in combination with 125I seed implantation for treatment of inoperational pancoast tumor

Objective To explore the therapeutic effect of radioactive ¹²⁵I seeds combined with chemotherapy on the treatment of inoperative pancoast tumor by CT-guided percutaneous implantation of treatment planning system (TPS). Methods From December 2002 to December 2010, 36 patients with pancoast tumor were confirmed by imaging and pathology. Among them, 26 cases suffered from squamous cell carcinoma and 10 cases with adenocarcinoma. At 1 week after radioactive ¹²⁵I implantation, chemotherapy was administered as intravenous 1 000 mg/m² gemcitabine at 1 and 8 d and intravenous cisplatin 75 mg/m² at 1 d for 4 consecutive cycles. The prescribed dose (PD) was 120 Gy, and the median activity of the seeds was 0.7 mCi(2.59×10⁷ Bq)with the range of 0.68-0.82 mCi (2.52×10⁷-3.03×10⁷ Bq). The patients were followed-up and the median follow-up time was 48 months. The survival rate was observed. Results The mPD of the target tumor was (118.7±7.2) Gy, D₉₀ (126±4.7) Gy, D₉₀> mPD. The rate of CR (11 cases) was 63.6%, and the effective rate (CR+PR) was 83.4%. The follow-up last till December 1st, 2016. 1-,3-and 5-year local control rates were 92%, 83%, and 67%, respectively. 1-,3-and 5-year cumulative survival rate were 84.1%, 56.7%, and 36.8%, respectively. Median survival was 38 months. Conclusions Chemotherapy combined with tissue radioactive ¹²⁵I seed implantation is a minimally invasive and effective method for the treatment of pancoast tumor.