CT导向下125I粒子植入治疗晚期肿瘤转移淋巴结的近期疗效

背景与目的:淋巴结转移是影响恶性肿瘤分期、治疗和预后的重要因素,恶性肿瘤经过综合治疗后残留淋巴结或新出现的转移淋巴结,往往治疗比较困难.本研究旨在评价CT导向下125I粒子植入治疗晚期肿瘤转移淋巴结的临床价值.方法:回顾性分析2003年11月至2007年4月中山大学肿瘤防治中心收治的47例经病理确诊为恶性肿瘤并接受经CT导向下125I粒子植入治疗的患者临床资料.转移淋巴结共计57枚,直径1.0～5.5 cm;其中直径＜2 cm 20枚(35.1%),≥2 cm、＜3 cm 21枚(36.8%).≥3 cm、＜4 cm 10枚(17.5%),≥4 cm 6枚(10.5%).采用计算机立体定位计划系统(treatment plan system,TPS)计算布源,在CT导向下将(2.2～3.3)×107 Mq活度的125I粒子相隔1.0×1.5 cm平面播植.手术结束后1～3个月复查CT或PET-CT.结果:治疗前17例有疼痛症状的患者中13例于术后5～14 d内疼痛缓解.有效率76.5%.47例患者中淋巴结完全缓解38例(80.9%),部分缓解4例(8.5%),无变化3例(6.4%),进展2例(4.3%),总有效率89.4%.主要的并发症为少量出血7例(14.9%).结论:CT导向下125I粒子植入治疗恶性肿瘤转移淋巴结近期效果好,安全性高,创伤小,并发症发生率低.

Short-term efficacy of ct-guided radioactive seed 125I implantation on residual or relapsing metastatic lymph nodes in advanced tumor patients after multi-modality treatment

BACKGROUND & OBJECTIVE: Lymph node metastasis is an important factor affecting tumor staging, treatment and prognosis. Residual or newly developed metastatic lymph nodes after combined therapy will bring difficulty in further treatment for cancer patients. This study was to investigate the clinical value of CT-guided radioactive seed 125I implantation in treating metastatic lymph nodes. METHODS: From Nov. 2003 to Apr. 2007, 47 patients with pathologically confirmed malignant tumors received CT-guided radioactive seed 125I implantation to treat a total of 57 metastatic lymph nodes. The diameter of these metastatic lymph nodes ranged from 1.0 to 5.5 cm: 20 (35.1%) of them with diameter of < 2.0 cm, 21 (36.8%) with diameter of 2.0-2.9 cm, 10 (17.5%) with diameter of 3.0-3.9 cm, 6 (10.5%) with diameter of > or = 4.0 cm. Treatment planning system was used to design the distribution of seed 125I. Under CT guidance, 125I seeds of (2.2-3.3) x 10(7) Mq were implanted into the metastatic lymph nodes at a distance of 1.0-1.5 cm. CT or PET-CT re-examination was performed at 1-3 months after seed 125I implantation. RESULTS: Seventeen patients had pain caused by metastatic lymph nodes and 13 of them had the pain relieved at 5-14 days after 125I implantation, with a response rate of 76.5%. Of the 47 patients, 38 (80.9%) achieved complete remission (CR), 4 (6.4%) achieved partial remission (PR), 3 (4.3%) had no change (NC), 2 (4.3%) had progressive disease (PD); the overall response rate was 89.4%. The major complication was slight hemorrhage developed in 7 patients (14.9%). CONCLUSION: CT-guided radioactive seed 125I implantation is effective and safety in treating metastatic lymph nodes, with minimal damage and few complications.