^125I放射粒子治疗脑胶质瘤60例报告

目的探讨^125I放射粒子植入治疗脑胶质瘤的操作方法和疗效。方法回顾分析60例经CT、MRI平扫或增强扫描确诊的脑胶质瘤,包括原发性脑胶质瘤20例,脑胶质瘤术后复发23例,脑胶质瘤外放疗后复发17例。治疗前行CT引导下经皮穿刺快速病理证实,根据术前计划确定的粒子数目、空间分布、肿瘤匹配周边剂量（matched peripheral dose,MPD）、计划靶体积（PTV）等,在CT引导下经皮穿刺组织间植入^125I放射粒子4～46颗,^125I放射粒子的放射性活度为26、30、33 Mbp/颗,放射性总活度为132～1196 Mbp,粒子间距为0.5～1.0 cm。MPD为80～110 Gy。穿刺点为1～2处,每处穿刺点调整进针方向2～5次。术后即刻行CT扫描并进行质量验证。定期CT随访。结果按照WHO疗效评价标准,1、2、6个月有效率分别为48.3%（29/60）、55.0%（33/60）、67.3%（37/55）、70.0%（35/50）,脑水肿减轻率分别为55.0%（33/60）、65.0% （39/60）、76.4%（42/60）、78.0%（39/60）,1、2年有效率分别为63.8%（30/47）、55.2%（16/29）。全组中位生存时间18个月,其中1～2级脑胶质瘤中位生存时间为28个月,3～4级脑胶质瘤中位生存时间为16个月。1年生存率为78.3%（47/60）,其中1～2级脑胶质瘤1年生存率为90.0%（27/30）,3～4级脑胶质瘤1年生存率为66.7%（20/30）;2年生存率48.3% （29/60）,其中1～2级生存率为80.0%（24/30）,3～4级生存率为16.7%（5/30）。并发症包括针道少量出血4例,粒子移位3例,局部脑坏死6例,未出现与治疗相关的死亡病例。结论CT引导下经皮穿刺组织间植入^125I放射粒子治疗脑胶质瘤可提高局部控制率,减轻脑水肿,提高生存率,症状不同程度缓解。

Implantation of 125I seeds for Brain Glioma: Report of 60 Cases

Objective To investigate the technique and effect of CT-guided implantation of ^125I seeds for patients with brain glioma. Methods A total of 60 cases of brain glioma, that had been diagnosed by CT, MRI, or enhanced MRI, were enrolled in this study. Among the patients, 20 were primary cases, and 40 were recurrent cases after surgical treatment （23） or radiotherapy （17）. Before implanting the ^125I seeds, we pathologically comfirmed the diagnosis by using CT-guided percutaneous puncture. According to the pathological results, we determined the number and distribution of ^125I seeds, matched peripheral dose （MPD）, and PTV; and then implanted the seeds （4 to 46 seeds per patient） under the guidance of CT. The radioactivity per seed was set at 26, 30, or 33 Mbp, thus the total radioactivity ranged from 132 to 1196 Mbp. The distance between the seeds was O. 5 to 1.0 cm. And the MPD ranged from 80 to 119 Gy. In each patient, percutaneous puncture was performed at one or two sites, and the direction of the needle was changed for 2 to 5 times at each punctural site. The outcomes of the implantation was confirmed by CT scan immediately after the procedure. The patients were followed up by using CT. Results The criteria of curative effect recommended by WHO was adopted. According to these criteria, the effective rate of the procedure was 48. 3% （29/60） , 55.0% （33/60） , 67.3% （37/55） , and 70.0% （35/50） in 1 , 2, 3, and 6 months after the operation, and the rate of hydrocephalus relief was 55.0% （33/60） , 65.0% （39/60） , 76.4% （42/55） , and 78.0% （39/50） respectively. The patients achieved 1- and 2-years rates of 63.8% （30/47） and 55.2% （16/29） during the follow-up. The median survival time was 18 months in this series （28 months in the patients with I an II grades glioma, and 16 months for III to IV grades）. The total 1- and 2-year survival rate was 78.3% （47/60） and 48.3% （29/60） in our patients, among which I and II grades glioma cases achieved 90.0% ?