125I粒子组织间植入近距离治疗恶性肿瘤

摘要

Twenty inpatients suffered from malignant tumors with twenty-four lesions were treated with 125Ⅰ permanent brachytherapy seed in Peking University Shenzhen Hospital, and the feasibility, curative effect and adverse effect of the treatment were observed. Before 125I seeds implantation, the three-dimensional treatment planning was preconcerted. There were two methods to implant 125Ⅰ seeds. One was to insert the seeds in the location of residual focus and metastatic lesions of the tumors directly in ordinary operations or through laparoscopy under general anesthesia. The other was to implant the seeds into the tumors through percutaneous needles by the guidance of CT scanning or color doppler ultrasonography under local anesthesia. The implantations for all of the 20 patients (24 lesions) were performed successfully. During and one week after the implantation, the distributions of the planted seeds were approximately the same as the scheduled three-dimensional treatment planning, and no seed migration was found. Adverse reactions during and after the operation were slight and recovered after correlative treatments. Clinical symptoms were palliated and serum tumor marker decreased to a different extent among most patients. The complete remission (CR) rate is 20.00％ ( 4/20 patients ),the partial remission(PR) rate is 35.00％( 7/20 patients),the stable disease (SD) rate is 30.00 ％ ( 6/20 patients ), the progressive disease (PD) rate is 15.00％ (3/20 patients), and the overall response rate (CR+PR) is 53.33％ ( 8 patients). 125Ⅰ seeds implantation for targeted therapy is convenient, safe and effective on malignant tumor, and is well worth advanced application.%采用125I粒子植入法对20例恶性肿瘤患者的24个病灶进行治疗,以评价125I粒子组织间植入恶性肿瘤的可行性及不良反应.术前制定肿瘤组织间三维立体定向放射治疗计划,在全麻剖腹直视下、全麻腹腔镜下或局麻CT、局麻彩色多普勒导向下经皮穿刺将125I粒子植入恶性肿瘤病灶内.20例患者125I粒子植入均顺利完成,术中及术后1周观察粒子在病灶内的分布基本与计划相符合,未观察到粒子迁移;术中及术后不良反应较为轻微且易于处理;多数患者临床症状得到不同程度的缓解,血清肿瘤标志物水平呈现不同程度的下降;病情完全缓解(CR)20.00%(4/20例),部分缓解(PR)35.00%(7/20例),稳定(SD)30.00%(6/20例),进展(PD)15.00%(3/20例),总有效率(CR+PR)55.00%(11/20例).以上结果表明,125I粒子组织问植入近距离内放射治疗恶性肿瘤施术方便、安全有效,具有较高的临床价值,值得进一步推广及深入研究.