~(125)I粒子植入治疗复发性骨肉瘤8例
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摘要
目的评价CT引导下~(125)I粒子植入治疗8例复发性骨肉瘤患者的初步结果。方法收集2008年11月至2017年6月在河北省人民医院就诊的8例复发性骨肉瘤患者的临床资料。肿瘤最大径4.3～8.6 cm,处方剂量90～140 Gy,单颗粒子活度(0.3～0.8) mCi。应用WHO实体肿瘤疗效评价标准评估疗效,数字评分法(NRS)评判疼痛症状改善情况。结果放射性粒子植入术后6个月,实际临床获益率:完全缓解(CR)1例;部分缓解(PR)3例、疾病稳定(SD)3例,疾病进展(PD)1例,总有效率为7/8。粒子植入术后疼痛缓解率:疼痛缓解6例。放射性粒子植入术中及术后无一例并发症。结论放射性粒子植入治疗复发性骨肉瘤患者安全、有效、微创,临床应用价值较高。
Objective To evaluate the preliminary results of CT-guided ~(125)I seed implantation in treating 8 patients with recurrent osteosarcoma. Methods The clinical data of 8 patients with recurrent osteosarcoma, who were admitted to Hebei Provincial People's Hospital, China, during the period from November 2008 to June 2017 to receive treatment, were collected. The age of patients ranged from 40 to 71 years. The maximum diameter of tumors was 4.3-8.6 cm. The prescribed dose was 90-140 Gy and the single seed activity was(0.3-0.8) mCi. World Health Organization(WHO) criterion for evaluating the efficacy of solid tumors was used to assess the curative effect, and numerical rating scale(NRS) was adopted to evaluate the improvement of pain degree. Results Six months after ~(125)I seed implantation, complete remission(CR)was obtained in one patient, partial remission(PR) in 3 patients, stable disease(SD) in 3 patients and progress disease(SD) in one patient; the total clinical benefit rate(CR+PR+SD) was 87.5%(7/8). Obvious pain relief was achieved in 6 patients. During and after ~(125)I seed implantation procedure no complications occurred.Conclusion For the treatment of recurrent osteosarcomas, radioactive~(125)I seed implantation is safe, effective and minimally-invasive. This therapy has high clinical application value.
Objective To evaluate the preliminary results of CT-guided ~(125)I seed implantation in treating 8 patients with recurrent osteosarcoma. Methods The clinical data of 8 patients with recurrent osteosarcoma, who were admitted to Hebei Provincial People's Hospital, China, during the period from November 2008 to June 2017 to receive treatment, were collected. The age of patients ranged from 40 to 71 years. The maximum diameter of tumors was 4.3-8.6 cm. The prescribed dose was 90-140 Gy and the single seed activity was(0.3-0.8) mCi. World Health Organization(WHO) criterion for evaluating the efficacy of solid tumors was used to assess the curative effect, and numerical rating scale(NRS) was adopted to evaluate the improvement of pain degree. Results Six months after ~(125)I seed implantation, complete remission(CR)was obtained in one patient, partial remission(PR) in 3 patients, stable disease(SD) in 3 patients and progress disease(SD) in one patient; the total clinical benefit rate(CR+PR+SD) was 87.5%(7/8). Obvious pain relief was achieved in 6 patients. During and after ~(125)I seed implantation procedure no complications occurred.Conclusion For the treatment of recurrent osteosarcomas, radioactive~(125)I seed implantation is safe, effective and minimally-invasive. This therapy has high clinical application value.
引文
[1]Ritter J,Bielack SS.Osteosarcoma[J].Ann Oncol,2010,21(Suppl 7):302-325.
[2]Durnali A,Alkis N,Cangur S,et al.Prognostic factors for teenage and adult patients with high-grade osteosarcoma:an analysis of 240 patients[J].Med Oncol,2013,30:624.
[3]Sadoghi P,Leithner A,Clar H,et al.The threat of misdiagnosis of primary osteosarcoma over the age of 60:a series of seven cases and review of the literature[J].Arch Orthop Trauma Surg,2010,130:1251-1256.
[4]王玲,王燕,冯琛,等.骨肉瘤免疫治疗的研究进展[J].中华老年骨科与康复电子杂志,2017,3:381-384.
[5]仇志强,廖琦.骨肉瘤治疗的研究进展[J].中国修复重建外科杂志,2010,24:1469-1475.
[6]万艳.头颈部复发癌125I粒子植入治疗的临床初步研究[D].石家庄:河北医科大学,2011.
[7]陆健,刘琳,陈志瑾,等.进展期非小细胞肺癌125I粒子植入前后CEA、CYFRA21-1变化与临床疗效评估[J].介入放射学杂志,2016,25:234-238.
[8]陆健,郑云峰,张欢,等.CT导引下植入125I粒子治疗19例晚期胰腺癌的疗效观察[J].介入放射学杂志,2010,19:550-553.
[9]王威,毕文志.骨肉瘤治疗现状与展望[J].解放军医学院学报,2013,34:198-200.
[10]Bacci G,Forni C,Longhi A,et al.Local recurrence and local control of non-metastatic osteosarcoma of the extremities:a 27-year experience in a single institution[J].J Surg Oncol,2007,96:118-123.
[11]Wu PK,Chen WM,Chen CF,et al.Primary osteogenic sarcoma with pulmonary metastasis:clinical results and prognostic factors in 91 patients[J].Jpn J Clin Oncol,2009,39:514-522.
[12]Schwarz R,Bruland O,Cassoni A,et al.The role of radiotherapy in osteosarcoma[J].Cancer Treat Res,2009,152:147-164.
[13]张建国,张杰,宋铁砾,等.放射性粒子组织间植入治疗口腔颌面部恶性肿瘤初探[J].中华口腔医学杂志,2006,41:464-466.
[14]王忠敏,黄钢,陈克敏,等.CT引导下125I粒子植入治疗复发性直肠癌的临床应用[J].介入放射学杂志,2009,18:681-684.
[15]王娟,吴娟,魏东,等.CT引导下125I粒子植入治疗腹膜后淋巴结转移癌18例的初步疗效[J].介入放射学杂志,2015,24:219-222.
[16]高斌,贺克武,李劲松,等.CT导引下125I粒子组织间置入治疗恶性骨肿瘤[J].临床放射学杂志,2008,27:1107-1110.
[17]朱丽红,王俊杰,袁慧书,等.转移及复发骨肿瘤的放射性粒子治疗[J].中华放射肿瘤学杂志,2006,15:407-410.
[18]陈玉峰,邱若光,宋爱芹,等.125I粒子组织间插植联合中药治疗恶性骨肿瘤及骨转移瘤[J].中国现代药物应用,2012,6:103-104.
[19]李鼎锋,崔秋,乐守玉,等.放射性粒子与人工关节复合假体应用于恶性骨及软组织肿瘤的临床观察[A].全国骨肿瘤治疗进展及并发症防范策略学术研讨会论文汇编[M].济南:山东大学齐鲁医院,2005年.
[20]Davis BJ,Horwitz EM,Lee WR,et al.American brachytherapy society consensus guidelines for transrectal ultrasound-guided permanent prostate brachytherapy[J].Brachytherapy,2012,11:6-19.
[21]Devlin PM,Cormack RA,Holloway CL,et al.Brachytherapy applications and techniques[M].New York:Demos Medical Publishing,2015.
[2]Durnali A,Alkis N,Cangur S,et al.Prognostic factors for teenage and adult patients with high-grade osteosarcoma:an analysis of 240 patients[J].Med Oncol,2013,30:624.
[3]Sadoghi P,Leithner A,Clar H,et al.The threat of misdiagnosis of primary osteosarcoma over the age of 60:a series of seven cases and review of the literature[J].Arch Orthop Trauma Surg,2010,130:1251-1256.
[4]王玲,王燕,冯琛,等.骨肉瘤免疫治疗的研究进展[J].中华老年骨科与康复电子杂志,2017,3:381-384.
[5]仇志强,廖琦.骨肉瘤治疗的研究进展[J].中国修复重建外科杂志,2010,24:1469-1475.
[6]万艳.头颈部复发癌125I粒子植入治疗的临床初步研究[D].石家庄:河北医科大学,2011.
[7]陆健,刘琳,陈志瑾,等.进展期非小细胞肺癌125I粒子植入前后CEA、CYFRA21-1变化与临床疗效评估[J].介入放射学杂志,2016,25:234-238.
[8]陆健,郑云峰,张欢,等.CT导引下植入125I粒子治疗19例晚期胰腺癌的疗效观察[J].介入放射学杂志,2010,19:550-553.
[9]王威,毕文志.骨肉瘤治疗现状与展望[J].解放军医学院学报,2013,34:198-200.
[10]Bacci G,Forni C,Longhi A,et al.Local recurrence and local control of non-metastatic osteosarcoma of the extremities:a 27-year experience in a single institution[J].J Surg Oncol,2007,96:118-123.
[11]Wu PK,Chen WM,Chen CF,et al.Primary osteogenic sarcoma with pulmonary metastasis:clinical results and prognostic factors in 91 patients[J].Jpn J Clin Oncol,2009,39:514-522.
[12]Schwarz R,Bruland O,Cassoni A,et al.The role of radiotherapy in osteosarcoma[J].Cancer Treat Res,2009,152:147-164.
[13]张建国,张杰,宋铁砾,等.放射性粒子组织间植入治疗口腔颌面部恶性肿瘤初探[J].中华口腔医学杂志,2006,41:464-466.
[14]王忠敏,黄钢,陈克敏,等.CT引导下125I粒子植入治疗复发性直肠癌的临床应用[J].介入放射学杂志,2009,18:681-684.
[15]王娟,吴娟,魏东,等.CT引导下125I粒子植入治疗腹膜后淋巴结转移癌18例的初步疗效[J].介入放射学杂志,2015,24:219-222.
[16]高斌,贺克武,李劲松,等.CT导引下125I粒子组织间置入治疗恶性骨肿瘤[J].临床放射学杂志,2008,27:1107-1110.
[17]朱丽红,王俊杰,袁慧书,等.转移及复发骨肿瘤的放射性粒子治疗[J].中华放射肿瘤学杂志,2006,15:407-410.
[18]陈玉峰,邱若光,宋爱芹,等.125I粒子组织间插植联合中药治疗恶性骨肿瘤及骨转移瘤[J].中国现代药物应用,2012,6:103-104.
[19]李鼎锋,崔秋,乐守玉,等.放射性粒子与人工关节复合假体应用于恶性骨及软组织肿瘤的临床观察[A].全国骨肿瘤治疗进展及并发症防范策略学术研讨会论文汇编[M].济南:山东大学齐鲁医院,2005年.
[20]Davis BJ,Horwitz EM,Lee WR,et al.American brachytherapy society consensus guidelines for transrectal ultrasound-guided permanent prostate brachytherapy[J].Brachytherapy,2012,11:6-19.
[21]Devlin PM,Cormack RA,Holloway CL,et al.Brachytherapy applications and techniques[M].New York:Demos Medical Publishing,2015.