CT引导下125I粒子永久植入治疗难治性恶性肿瘤

目的]评价在CT引导下经皮穿刺125Ⅰ粒子组织间植入治疗临床难治性恶性肿瘤的安全性、疗效.方法]14例难治性恶性肿瘤15个病灶,瘤体直径5.0cm～10.0cm,平均7.0cm.根据粒子植入术前14d内CT图像,采用治疗计划系统(treatment plan system,TPS)制定粒子植入计划,按计划在CT引导下经皮穿刺准确植入125I粒子.植入后即刻及术后1～8个月CT复查观察粒子在瘤体内的分布、有无并发症发生及疗效.结果]14例粒子植入均顺利完成,11例粒子分布满意,3例粒子分布欠均匀,2例分别于术后4周和8周对肿瘤冷区进行粒子补充,另1例患者拒绝再次植入术.单个瘤体内植入粒子数为9～85粒(平均47粒).14例患者15个病灶,完全缓解(CR)2个;部分缓解(PR)12个;无变化(SD)0个;进展(PD)1个.总有效率93.3%(14/15).除1例阴道癌术后盆腔转移患者粒子植入术后联合静脉化疗出现重度骨髓抑制,其余13例未见急性并发症和治疗相关的放射损伤.结论]CT引导下经皮穿刺125I粒子组织间植入治疗常规放化疗无效的恶性肿瘤是一种安全、有效的治疗手段.

CT Guided Interstitial 125I Seed Implantation Treatment for Refractory Malignant Tumor

To evaluate the safety and efficacy of percutaneous CT guided interstitial 125I seed implantation treatment for refractory malignant tumor. Fifteen lesions (diameter 5.0cm~10.0cm,mean 7.0cm) in 14 refractory malignant tumor patients underwent percutaneous CT guided intratumoral 125I seed implantation. Treatment plan system (TPS) was adopted based computed tomography imaging 14 days before the procedure. The distribution of 125I seed, complications and efficacy were observed imediately postoperation and 1~18 months after the procedure. The procedure of intratumoral 125I seed implantation in 15 malignant tumors was successful. Seeds distribution in 12 malignant tumors in 11 patients was satisfaction while the distribution of 125I seed in other 3 cases were not uniformity, and the latter 2 of 3 cases were carried out 125I seed implantation in the tumor cool area. However, the other one case refused to repeat the procedure. Nine to eight-five particles (mean 47) of 125I seeds were implanted into a single tumor. The clinical CR and PR were achieved in 2 and 12 lesions respectively, with overall response rate 93.3% (14/15). The serious marrow suppression occurred in one case of vagina carcinoma with pelvic metastasis. No acute complications and treatment related radiation damages occurred in 13 cases.Conclusions] The CT guided percutaneous CT guided intratumoral 125I seed implantation treatment for refractory malignancies is a safe and effective method.