125I粒子与缓释化疗粒子联合应用靶向治疗复发性直肠癌

目的 探讨应用放、化疗粒子联合植入法综合治疗复发性直肠癌的可行性、安全性及短期疗效。方法 自2001年12月至2005年12月,应用放、化疗粒子联合植入法综合治疗复发性直肠癌26例,均为直肠癌Mile＇s术后盆腔复发病人。在治疗计划指导下,交替植入氟尿嘧啶缓释化疗粒子和放射性125I粒子。放射性粒子的肿瘤匹配周边剂量（matched peripheral dose,MPD）为90～130Gy。平均每例使用^125Ⅰ粒子12粒,氟尿嘧啶600 mg。结果 26例病人手术均顺利完成,未发生出血、感染等并发症,经盆腔摄片证实放射性粒子的位置无变化。疼痛缓解率为88.9%（16/18）,平均疼痛缓解时间为5～10 d。于术后3～6个月CT复查肿瘤变化,提示瘤体不同程度缩小,其中2例完全缓解,19例部分缓解,4例稳定,局部控制率为81%。随访6～42个月,中位生存期为29个月,最长1例随访时间为术后42个月,现仍存活。1例术后6个月死于全身广泛转移。结论 放射性125I粒子和氟尿嘧啶缓释化疗粒子联合应用局部植入技术具有安全、微创及并发症发生率低的特点,是综合治疗复发性直肠癌较有效的手段之一。

Radiochemotherapy with interstitial implantation of 125I seeds and 5-FU slow-released seeds for recurrent colorectal adenocarcinoma

ObjectiveTo investigate the feasibility, security, and short-term efficacy of combined treatment of interstitial implantation of ~ 125 I seeds and 5-FU slow-released seeds for recurrent colorectal adenocarcinoma. Methods From December 2001 to December 2005, 26 cases of recurrent colorectal adenocarcinoma underwent Mile's procedure were treated with the radiochemotherapy.We implanted alternately ~ 125 I seeds and 5-FU slow-released seeds following the treatment planning system.The matched peripheral dose (MPD) of ~ 125 I seed implantation was 90-130 Gy. Twelve granules of ~ 125 I seeds and 600 mg of 5-FU were administered in every patient on average. Results No operation-related complication was occurred during the implantations for all the cases. No displacement of ~ 125 I seed was found by pelvic X-ray examination.Lenitive rate of the pain was 88.9% (16/18).The relief has lasted for 5-10 days on average. CT scanning showed that the size of tumor reduced in various degree at 3-6 months after the implantation.The complete recovery rate was 7.7% (2/26), the partial recovery rate was 73.1% (19/26).The PD was 15.4% (4/26).The median survival time was 29 months estimated by following these cases for 6-42 months. One case died of bone and lung metastases at 6 months after the implantation. ConclusionCombined radiochemotherapy with interstitial implantation of ~ 125 I seeds and 5-FU slow-released seeds was a safe and effective microinvasive treatment for recurrent colorectal carcinoma.