碘-125粒子条腔内近程放射治疗局部进展期胰腺导管腺癌伴梗阻性黄疸的初步临床研究

 目的 探索碘-125粒子条腔内近程放射治疗局部进展期胰腺导管腺癌伴梗阻性黄疸的安全性及可行性。方法 对2010年1月至2015年2月复旦大学附属中山医院介入科收治的17例局部进展期(4例为T4N0M0,13例为T4N1M0)胰腺导管腺癌伴梗阻性黄疸患者行碘-125粒子条腔内近程放射治疗的临床资料进行回顾性分析。用配对t检验分析患者术前、术后肝功能变化。碘-125粒子条放射剂量由碘-125粒子条放射区域分布计算软件(0.1版,复旦大学影像研究所)根据美国医学物理协会TG43U1近程放射公式计算。用Kaplan-Meier曲线分析无梗阻生存期和累计生存期。术后并发症根据美国国立癌症研究所通用毒性标准4.0版评估。结果 碘-125粒子条累计剂量(r=5 mm,240天)为164.19～170.05 Gy,平均为167.38Gy。平均、中位无梗阻生存期分别为(9.62±1.47)个月(95%CI:6.73～12.50)和(7.26±1.71)个月(95%CI:3.90～10.62),平均、中位总生存期分别为(9.89±1.59)个月(95%CI:6.78～13.00)和(7.26±1.71)个月(95%CI:3.90～10.62)。患者术前、术后总胆红素和直接胆红素差异具有统计学意义。研究中2例患者发生3级术后并发症,1例患者发生4级并发症。1例患者出现支架再狭窄(5.9%)。结论 碘-125粒子条腔内近程放射治疗是局部进展期胰腺导管腺癌伴梗阻性黄疸的一种安全可行的治疗方法。

Intraluminal brachytherapy using iodine-125 seed strand for locally advanced pancreatic ductal adenocarcinoma with obstructive jaundice:a retrospective clinical study

Objective To investigate the safety and feasibility of intraluminal brachytherapy using iodine-125 seed strand for locally advanced pancreatic ductal adenocarcinoma with obstructive jaundice. Methods Clinical data of 17 consecutive patients, from January 2010 to February 2015, diagnosed with pancreatic ductal adenocarcinoma (4 cases of T4N0M0 and 13 of T4N1M0) with obstructive jaundice and received intraluminal brachytherapy using iodine-125 seed strand were collected and analyzed retrospectively. Liver function was evaluated using paired-samples t test. The iodine-125 seed strand radiation doses were calculated using iodine-125 radiation field distribution calculation software (version 0.1, Institute of Radiation Medicine, Fudan University, Shanghai, China) based on the American Association of Physicists in Medicine TG43U1 brachytherapy formula. Obstruction free survival and overall survival were calculated using the Kaplan-Meier method. Complications were assessed according to the CTCAE 4.0 criteria. Results The estimated mean accumulating dose (r=5 mm, 240 days) was 167.2 Gy, from 164.19 Gy to 170.05 Gy. The mean and median obstruction free survival time were (9.62±1.47) months (95%CI: 6.73-12.50) and (7.26±1.71) months (95%CI: 3.90-10.62). The mean and median overall survival time were (9.89±1.59) months (95%CI: 6.78-13.00) and (7.26±1.71) months (95%CI: 3.90-10.62), retrospectively. Total bilirubin and conjugated bilirubin decreased significantly after the therapy. Two patients had adverse event of Grade 3, one of Grade 4. Stent dysfunction occurred in 1/17 (5.9%) patients. Conclusions Intraluminal brachytherapy using iodine-125 seed strand might be considered as a safe treatment option for the locally advanced pancreatic duct adenocarcinoma complicated by obstructive jaundice.