192Ir三维近距离联合调强放疗在晚期肝外胆管癌的临床应用

目的探讨¹⁹²Ir三维近距离联合调强放射治疗在不可手术切除的晚期梗阻性肝外胆管癌患者的临床疗效及安全性。方法回顾性分析2014年1月1日至2018年1月1日河北省沧州中西医结合医院收治的18例不可手术切除的晚期恶性梗阻性肝外胆管癌患者,经病理证实且接受胆道支架植入,继而序贯调强放射治疗及¹⁹²Ir三维近距离放射治疗。收集患者的临床资料,包括性别、年龄、临床分期、近距离放射治疗剂量-体积参数等,评价临床疗效及不良反应、治疗前后的胆红素变化水平、局部控制率及生存率。结果所有患者均顺利完成治疗。¹⁹²Ir三维近距离联合调强放射治疗后1个月复查,18例患者中,部分缓解(PR)16例,稳定(SD)2例,其中14例患者在接受近距离放射治疗后肿瘤较调强放射治疗后缩小,4例肿瘤无明显变化。6个月局部控制率(LC)为94.4%(17/18)。1年和2年生存率分别为55.6%(10/18)和38.9%(7/18)。治疗后患者总胆红素、直接胆红素均降低,黄疸症状明显缓解。整个治疗过程中,患者不良反应为恶心、呕吐,发热,胆道感染等,但无3级及以上不良反应。结论¹⁹²Ir三维近距离放射治疗联合调强放射治疗在不可手术切除的晚期肝外胆管癌患者中,局部控制率良好,不良反应可耐受,但对长期生存的影响尚需大样本的对照研究。

Clinical application of 192Ir three-dimensional brachytherapy combined with intensity-modulated radiotherapy in advanced extrahepatic cholangiocarcinoma

Objective To explore the efficacy and safety of ¹⁹²Ir three-dimensional brachytherapy combined with intensity-modulated radiotherapy in patients with unresectable advanced obstructive extrahepatic cholangiocarcinoma.Methods A retrospective analysis of the efficacy and safety of 18 patients with unresectable advanced malignant obstructive extrahepatic cholangiocarcinoma admitted to the Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine in Hebei province from January 2014 to January 2018.All patients were pathologically confirmed and received biliary stent implantation, followed by sequential intensity-modulated radiotherapy and ¹⁹²Ir three-dimensional brachytherapy.The clinical data of all patients were collected, including gender, age, clinical stage, adverse reactions, brachytherapy dose-volume parameters, changes in bilirubin levels before and after treatment, evaluation of efficacy, local control rate and survival rate.Results All patients successfully completed the treatment.Re-examination was conducted one month after the combined treatment, of the 18 patients, 16 had partial remission (PR) and 2 were stable (SD). Among them, 14 patients had tumor shrinkage after brachytherapy compared with intensity-modulated radiotherapy, and 4 patients showed no significant change. The 6-month local control rate (LC) was 94.4% (17/18). The 1-year survival rate was 55.6% (10/18), and the 2-year survival rate was 38.9% (7/18). Statistical analysis showed that after combined treatment, total bilirubin and direct bilirubin were significantly reduced, and jaundice symptoms were significantly relieved.The adverse reactions of the patient were nausea, vomiting, fever, biliary tract infection, etc.There were no adverse reactions of grade 3 or above.Conclusions ¹⁹²Ir three-dimensional brachytherapy combined with intensity-modulated radiotherapy in patients with inoperable advanced extrahepatic cholangiocarcinoma has a good local control rate and tolerable adverse reactions, but the impact on long-term survival requires a large sample of controlled studies.