摘要
目的探讨^125I粒子植入联合化疗治疗同期放化疗后局部复发的Ⅲ期NSCLC的临床疗效。方法2006年1月至2009年1月同期放化疗后局部复发的Ⅲ期NSCLC患者34例，按随机数字表法分为2组，其中对照组（17例）给予多西他赛60mg／m^2＋顺铂75mg／m^2（DP方案），治疗组（17例）行^125I粒子植入＋DP方案。用放射性粒子TPS制定^125I粒子治疗计划。在CT引导下经皮穿刺植入^125I粒子，处方剂量为90～110Gy，术后即刻验证肿瘤匹配周边剂量（mPD），覆盖90％靶区的剂量（D90）。随访至疾病进展。研究经医院伦理委员会批准，患者均签署知情同意书。局部病变控制时间、疾病无进展时间（PFS）分析采用log—rank法，Fisher确切概率法比较2组肿瘤CR率和近期有效率。结果^125I粒子植入术后mPD为93．9～130．4Gy，中位剂量116．7Gy；％为103．6～148．2Gy，中位剂量130．6Gy。治疗组局部控制时问为4．7～24．0（中位时间11．6；95％CI：8．7～14．6）个月，其中2例随访24个月局部病灶无进展；PFS为10．5（4．7—24．0；95％CI：7．4—13．6）个月，近期有效率为64．7％（11／17），肿瘤CR率41．2％（7／17），PR率23．5％（4／17），SD率23．5％（4／17），PD率11．8％（2717）。对照组局部控制时间4．5～11．4（中位时间为7．5；95％CI：6．7～8．3）个月，PFS为6．5（4．5～10．5；95％CI：5．7—8．3）个月，近期有效率为41．2％（7／17），CR率5．9％（1／17），PR率35．3％（6／17），SD率35．3％（6／17），PD率23．5％（4／17）。2组近期有效率差异无统计学意义（P=0．30），局部控制时间（，=8．40，P〈0．01）、PFS（X^2=6．27，P〈0．05）、肿瘤CR率（P=0．04）差异均有统计学意义。结论^125I粒子植入联合化疗对治疗放化疗后局部复发的Ⅲ期NSCLC有效、安全，其疗效优于单纯化疗。
Objective To investigate the associated effect of ^125I implantation plus chemotherapy in local recurrent stage Ⅲ NSCLC patients. Methods From January 2006 to January 2009, 34 patients documented with local recurrent stage Ⅲ NSCLC were divided into two groups by random number table. The treatment group was treated with ^125I permanent implantation combined with DP regimen （docetaxel 60 mg/m^2 ＋ cisplatinum 75 mg/m^2 ）, while the control group received only DP chemotherapy. According to the TPS, the treatment group received CT-guided percutaneous implantation of ^125I seeds with a particle activity of 2.22 × 107 -2. 59 × 10^7 Bq. The prescribed dose was in the range of 90 -110 Gy and the postoperatively matched peripheral dose （mPD） and Dg0 were verified by TPS. The control group received a DP chemotherapy regime for 4 cycles after the procedure. This study was approved by the ethics committee, and all patients signed informed consents. The follow up time was up to disease progression. Kaplan-Meier survival analysis was used to describe the local lesion control （LLC） time and progression free survival （PFS）. Log-rank test was used in the comparison of the survival rates between the two groups. Fisher＇s exact test was used to analyze the differences of CR rate and recent efficiency between two groups. Results In the treatment grouo, postoperative mPD was 93.9 - 130.4 （M 116.7） Gy, and D90was 103.6 - 148.2 （M 130.6） Gy. The LLC time was 4. 7 to 24.0 months with a median of 11.6 （95% CI：8.7 -14.6） months. In two eases, there was no recurrence during the follow-up time of 24 months. PFS was 4.7 to 24.0 months with a median of 10.5 （95% CI： 7.4 - 13.6） months. The recent effective rate of the treatment group was 64.7% （11/17）. CR, PR, SD and PD were 41.2% （7/17） , 23.5% （4/17）, 23.5% （4/17） and 11.8% （2/17）, respectively. In the control group, the LLC time was 4.5 to 11.4 months with a median of 7.5 （95% CI： 6.7 - 8.3 ） months, and the median of PFS was 6.5 （4.5 - 10.5 ） （95% CI： 5.7 - 8.3 ） months. The response rate, CR, PR, SDandPDwere41.2%（7/17）, 5.9%（1/17）, 35.3%（6/17）, 35.3%（6/17） and 23.5%（4/17）, respectively. There was no statistical significance of the recent effective rate between the treatment group and control group （P = 0.30）, but the LLC time （X^2 = 8.40, P 〈 0.01 ）, the median of PFS time （X2 = 6. 27, P 〈 0.05 ） and CR （ P = 0.04 ） of the treatment group were all significantly higher than those of the control group. Conclusion The implantation of lz5I seeds combined with chemotherapy for recurring stage Ⅲ NSCLC patients is safe and effective, and its efficacy is superior to the second line chemotherapy alone.
出处
《中华核医学与分子影像杂志》
CSCD
北大核心
2013年第3期195-198,共4页
Chinese Journal of Nuclear Medicine and Molecular Imaging
