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目的探讨CT引导下放射性125I粒子植入近距离治疗肺癌的短期疗效、不良反应和临床价值。方法 2012年10月至2013年7月,对32例病理组织学证实的肺癌(29例原发性肺癌,3例肺转移癌)行CT引导下放射性125I粒子植入近距离治疗。既往行放疗者肿瘤匹配周边剂量为90~110 Gy,未行放疗者为110~140 Gy。术前利用治疗计划系统(TPS)制定三维治疗计划,确定粒子数目、空间分布和粒子针数目。局部麻醉下手术,术后行质量验证,剂量不足需补种粒子或加用外照射,记录术中并发症。术后1、3、6个月定期复查CT,后每3~6个月随访并复查CT,每次复查观察并记录疗效、毒副作用及并发症,随访6~12个月。结果全部患者125I粒子均植入成功,无死亡。1、3、6、12个月总有效率分别为50.00%(16/32)、81.25%(26/32)、87.50%(28/32)和90.62%(29/32)。32例随访6~12个月,1年生存率为100%(32/32)。治疗过程中共出现并发症7例(21.88%),其中气胸3例(9.38%),咯血3例(9.38%),1例出现发热(3.12%),无治疗相关死亡。结论 CT引导下放射性125I粒子植入治疗原发或转移性肺癌安全,疗效肯定,创伤小,并发症发生率低。
Objective To investigate the short-term curative effect, adverse reactions and clinical value of CT-guided 125I seeds implantation in the brachytherapy of lung cancer. Methods From October 2012 to July 2013, 32 patients with pathologically confirmed lung cancer (29 primary lung cancer and 3 lung metastases) were treated with CT-guided radioactive 125I particles brachytherapy. In the previous radiotherapy, the tumor matched peripheral dose was 90-110 Gy, while those without radiotherapy were 110-140 Gy. Preoperative use of treatment planning system (TPS) to develop three-dimensional treatment plan to determine the number of particles, spatial distribution and particle number of needles. Local anesthesia surgery, postoperative quality verification, the lack of dose of seed replanting particles or add external irradiation, recording intraoperative complications. CT was retrospectively reviewed at 1, 3, and 6 months after operation. CT was followed up every 3 to 6 months, and CT was observed and recorded after each review. The curative effect, side effects and complications were recorded and followed up for 6 to 12 months. Results All patients with 125I particles were successfully implanted without death. The total effective rates at 1, 3, 6 and 12 months were 50.00% (16/32), 81.25% (26/32), 87.50% (28/32) and 90.62% (29/32), respectively. 32 cases were followed up for 6 to 12 months, the 1-year survival rate was 100% (32/32). There were 7 cases (21.88%) of complications during the treatment, including 3 cases of pneumothorax (9.38%), 3 cases of hemoptysis (9.38%), 1 case of fever (3.12%) and no treatment-related death. Conclusion Radioactive 125I seeds guided by CT are safe for the treatment of primary or metastatic lung cancer with definite curative effect, small trauma and low complication rate.