CT导引下125I粒子植入治疗胰腺癌

目的评价CT导向下125I粒子植入治疗胰腺癌的临床价值.方法回顾性分析2003年6月至2004年5月中山大学肿瘤防治中心26例经CT导向下125I粒子植入治疗胰腺癌患者的临床资料,重点总结此手术的经验和技巧.本组26例中,男21 例,女5例,年龄47～73 岁.中位年龄为60岁±13岁.病灶平均直径为6.1(1.0～8.5) cm.其中腹痛较剧者15例,黄疸10例.全部病例经CT、 MRI检查(14例)或病理穿刺活检(12例)后临床诊断为胰腺癌.病理分期(TNM, pTNM)Ⅱ期3例,Ⅲ期20例, Ⅳ期3 例.采用计算机立体定位计划系统(treatment plan system,TPS)计算布源,在CT导向下将125I粒子植入胰腺瘤灶内,采用(2.2～3.3)×107 Mq活度的125I粒子相隔1.0～1.5 cm平面播植.125I在1.7 cm内具有杀灭肿瘤的作用.结果 9例患者疼痛完全缓解,2例部分缓解,4例无效,平均术后3～7 d疼痛缓解.4例死于局部进展,2例死于远处转移,全组中位生存时间11个月.2个月后CT复查,完全缓解(CR)2例;部分缓解(PR)13例;无变化(NC)5例;进展(PD)6例.总有效率(CR+PR) 57.7%.2个月随访过程中发现3粒粒子(2例患者)迁徙至肝脏内;白细胞轻度下降1例.未见胰瘘、胰腺炎、肠出血、腹腔内脓肿等严重并发症.结论 CT导向下放射性粒子植入治疗胰腺癌创伤小,并发症发生率低,生活质量改善明显,近期效果好,具有很好的姑息止痛疗效,是一种治疗中晚期胰腺癌的简单、安全、有效的方法.

CT guided radioactive seed 125I implantation in treatment of pancreatic cancer

OBJECTIVE: To investigate the clinical value of CT guided radioactive seed (125)I implantation in treatment of pancreatic cancer. METHODS: Twenty-six patients with pancreatic cancer 6.1 cm in size on average, 21 males and 5 females, aged 60 +/- 13 (47 - 73), underwent CT guided radioactive seed (125)I implantation. Of the 26 patients 15 had the symptom of severer abdominal pain and 10 had jaundice. Three of them were in the TNM (pTNM) stage II, 30 in the stage III, and 3 in the stage IV. Treatment plan system was used to design the distribution of the seed (125)I needed. Under CT guidance, the (125)I seeds of (2.2 - 3.3) Mq were implanted into the pancreatic cancer at a distance of 1.0 - 1.5 cm. A follow-up for 3 - 12 months was conducted. RESULTS: Complete relief (CR) of the symptoms was seen in 9 patients, partial relief (PR) in 2 patients, and no change (NC) in 4 cases with an effective rate of 73.4%. The abdominal pain was relieved 3 - 7 days after the implantation. CT performed 2 months after implantation showed CR in 2 cases, PR in 13 cases, NC in 5 cases, and progression in 5 cases with an overall effective rate of 57.7%. Four patients died of local progression and 2 patients died of distant metastasis. Migration of the seeds into the liver was seen in 3 patients and slight decrease of white blood cells was seen in 1 patient during the 2-month follow-up. No severe complications, such as pancreatic leakage, acute pancreatitis, intestinal hemorrhage, etc, were found. CONCLUSION: Safe and with minimal damage and few complications, CT guided radioactive seed (125)I implantation is effective in treatment of pancreatic cancer.