摘要
目的探讨CT引导下^(125)Ⅰ粒子植入治疗髂血管旁淋巴结转移癌的可行性、疗效及并发症。方法回顾性分析12例接受CT引导下^(125)Ⅰ粒子植入治疗髂血管旁淋巴结转移癌患者共12个病灶,其中直径≤6 cm 7个,>6 cm 5个。采用计算机治疗计划系统计算布源,在CT引导下植入^(125)Ⅰ粒子,粒子活度0.4~0.7 m Ci,相隔0.5~1 cm平面插植。植入术后即行CT扫描,了解粒子分布情况及有无并发症。术后验证D90(90%靶体积接受的处方剂量)≥75 Gy的6例,<75 Gy的6例。手术结束后2个月复查CT,参考WHO实体肿瘤评价标准进行影像学评估。结果 12例患者均顺利完成手术,术后2个月疗效评价:完全缓解0例,部分缓解8例,无变化3例,进展1例,有效率为66.7%(8/12),2个月局部控制率为91.7%(11/12)。术前疼痛症状患者8例,术后1~14 d均明显缓解;术前下肢水肿3例于术后1~14 d明显缓解2例。术后随访3~39个月,中位随访时间11个月,1年5例患者存活生存率41.7%(5/12),未见大出血、感染、骨髓抑制、粒子移位等并发症。结论 CT引导下^(125)Ⅰ粒子植入治疗髂血管旁淋巴结转移癌安全可行,淋巴结小于6 cm,周边剂量大于75 Gy,疗效可能更好。
Objective To discuss the feasibility, efficacy and complications of CT- guided^125Ⅰ seed implantation for the treatment of lymph node metastasis nearby the iliac vessels. Methods The clinical data of twelve patients with para- iliac vessel lymph node metastasis, who had been treated with CT- guided^125Ⅰ seed implantation, were retrospectively analyzed. A total of 12 lesions were detected; the diameter ≤6 cm was seen in seven lesions, and the diameter 6 cm was seen in five lesions. Using computer treatment planning system, the source distribution was calculated. Under CT guidance^125Ⅰ seeds with the activity of 0.4-0.7 mci were implanted into the metastatic lymph nodes with a seed interval of 0.5-1.0 cm. CT scan was performed immediately after implantation to check the distribution of seeds as well as the possible complications. After the treatment, D90（90% prescription dose received by target volume） was ≥75 Gy in 6patients and 75 Gy in other 6 patients. Two months after the treatment CT reexamination was employed,and imaging evaluation was conducted according to WHO Response Evaluation Criteria in Solid Tumors.Results CT- guided^125Ⅰ seed implantation was successfully accomplished in all 12 patients. Two months after the treatment, the evaluation of the therapeutic effect showed that complete remission（CR） was obtained in 0patient, partial remission（PR） in 8 patients, stable disease in 3 patients and progress disease in one patient;and the total effect rate（CR＋PR） was 66.7%. The local control rate was 91.7%. In eight patients the pain that was caused by metastatic lymph nodes was significantly relieved within 1-14 days after^125Ⅰ implantation treatment. Before the treatment three patients had lower limb edema, and in two of them the lower limb edema was obviously relieved within 1-14 days after the treatment. All patients were followed up for 3-39 months, and the median follow- up time was 11 months. One- year survival rate was 41.7%. No severe complications such as massive hemorrhage, infection, myelosuppression or seed displacement occurred. Conclusion For the treatment of para- iliac vessel lymph node metastasis, CT- guided^125Ⅰ seed implantation is safe and feasible. Better curative effect may be achieved when the diameter of the metastatic lymph node is 6 cm and the peripheral radiation dose is 75 Gy.
出处
《介入放射学杂志》
CSCD
北大核心
2015年第12期1072-1076,共5页
Journal of Interventional Radiology
基金
河北省卫生厅项目(20130412)
关键词
近距离放射治疗
淋巴结转移
疗效
剂量
brachytherapy
lymph node metastasis
curative effect
dosimetry
