CT引导下放射性~(125)I粒子组织间植入治疗肺癌

目的探讨CT引导下放射性125I粒子组织间植入治疗肺癌的技术可行性和近期疗效。方法2003年3月~2007年9月,对16例肺癌(12例肺转移癌,4例肺癌术后复发)行CT引导下放射性125I粒子植入治疗。局部麻醉。术前计算机治疗计划系统行三维治疗计划,确定粒子数目、空间分布和粒子针数目。既往放疗肿瘤匹配周边剂量为90~110Gy,未行放疗为140~160Gy。计划靶体积包括临床靶体积加1cm外周。每颗粒子活度为0.40~0.70mCi。中位植入粒子38颗(15~145颗),术后即刻行CT扫描进行质量验证。3例术后1周加三维适形放疗,总剂量45~50Gy。结果中位随访14个月(6~47个月)。无治疗相关严重并发症发生。1年和2年局部控制率分别为93.8%(15/16)和93.8%(15/16)。中位生存时间14个月(6~24个月),1年和2年生存率分别为62.5%(10/16)和37.5%(6/16)。6例死于全身转移,3例死于恶液质和1例死于脑出血。结论CT引导下放射性125I植入治疗复发或转移性肺癌安全,微创,并发症发生率低,疗效肯定,粒子治疗后配合外放疗和全身化疗,有望进一步提高疗效。

CT-guided Interstitial Implantation of 125 I Seed for Lung Cancer

Objective To investigate the feasibility and short-term efficacy of CT-guided interstitial implantation of 125I seeds for lung cancer. Methods Under local anesthesia, 16 patients with lung cancer were treated with CT-guided interstitial implantation of 125I seeds. The TPS was used to calculate the number of seeds, the space distribution, and the number of needles. The MPD of 125I seed implantation were 90-110 Gy for patients who had ever received external radiotherapy and 140-160 Gy for those who had never received external irradiation. The PTV included CTV plus 1 cm margin. The activity of each seed was 0.40-0.70 mCi. A median of 38 (range, 15-145) 125I seeds were implanted, and CT scan were performed after the operation to evaluate the quality of the operation. Three of the patients received 3D-CRT external beam radiation therapy at a total dose of 45-50 Gy. Results The patients were followed up for a median of 14 months (6-47 months), during which none of them had serious operation-related complications. All patients could well tolerated seed implantation. The 1-and 2-year local control rates were 93.8% (15/16) and 93.8% (15/16), respectively. The median survival time was 14 months (6-24 months),and the 1-and 2-year survival rates were 62.5% (10/16) and 37.5% (6/16), respectively. Among the patients, 6 cases died of systemic metastasis, 3 died of cachexia, and 1 died of cerebral hemorrhage. Conclusions CT-guided interstitial implantation of 125I seeds is a safe and minimally invasive method for lung cancer with a low rate of complications and good outcomes. The efficacy of the treatment might be improved by combining with external radiotherapy and systemic chemotherapy.