~(125)I粒子植入治疗宫颈癌放疗后复发腹膜后淋巴结转移10例
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摘要
目的探讨CT引导下放射性~(125)I粒子植入治疗宫颈癌放疗后复发腹膜后淋巴结转移初步疗效。方法选取2011年11月至2015年10月宫颈癌放疗后复发腹膜后淋巴结转移10例患者,12个病灶,垂直径1.7 cm×1.0 cm~6.5 cm×5.0 cm,其中直径<5.0 cm、≥5.0 cm的淋巴结分别为6个(50%)、6个(50%)。应用近距离治疗计划系统(TPS)制定治疗计划,CT引导下植入~(125)I粒子,活度0.3~0.7 m Ci,术后验证D90(90%靶体积所接受的最小剂量):36~110 Gy(中位59 Gy)。术后观察病灶大小变化、疼痛缓解情况及并发症。结果 10例患者随访时间4.3~16.1个月,中位随访时间9.7个月,2个月局部控制率100%、有效率58.3%,2、6、12个月生存率分别为100%、66.7%、58.3%,中位生存时间12.1个月。1例患者术后5个月死于消化道出血,6例死于肿瘤转移,3例患者生存并未见粒子植入部位复发,未见其他部位大出血、肠道感染、骨髓抑制等粒子相关严重并发症。结论 CT引导下~(125)I粒子植入治疗宫颈癌放疗后复发腹膜后淋巴结转移取得了较满意的近期疗效,是一种安全可行的方法。
Objective To evaluate the safety and efficacy of CT- guided radioactive~(125)I seed implantation in treating retroperitoneal lymph node metastasis due to recurrent cervical cancer after radiotherapy. Methods A total of 10 patients with retroperitoneal lymph node metastasis(12 lesions in total)due to recurrent cervical cancer after radiotherapy, who were treated with CT- guided~(125)I seed implantation during the periodfrom November 2011 to October 2015, were included in this study. The diameters, that were perpendicular to each other, of the involved lymph nodesranged from 1.7 cm ×1 cm to 6.5 cm ×5 cm, the diameter of 6 involved lymph nodes(50%) was <5.0 cm and the diameter of other 6 involved lymph nodes(50%) was ≥5.0 cm.With the help of treatment planning system for brachytherapy, the source distribution was formulated. Under CT guidance, the~(125)I seedswith the activity of 0.3-0.7 m Ci were implanted. Postoperative validation showed that D90(90% minimum prescription dose received by the target volume) was 36- 110 Gy(median 59 Gy). After the treatment, the changes in lesion size, pain relief and complications were recorded. Results The 10 patients were followed up for 4.3-16.1 months, the median follow- up time was 9.7 months. The 2- month local control rate and the 2- month effective rate were 100% and 58.3%, respectively. The 2- month, 6- month and12- month survival rates were 100%, 66.7% and 58.3%,respectively. The median survival time was 12.1 months. One patient(10%) died of gastrointestinal bleeding at five months after treatment, six patients(60%)died of distant metastases, three patients(30%) survived withno evidence of local recurrence. No major complications such as massive hemorrhage, intestinal infection, bone marrow suppression or other~(125)I seed-related complications occurred. Conclusion For the treatment of retroperitoneal lymph node metastasis due to recurrent cervical cancer after radiotherapy, CT- guided radioactive~(125)I seed implantation has satisfactory short- term curative effect, and this technique is safe and feasible.(J Intervent Radiol, 2017, 26: 137-141)
Objective To evaluate the safety and efficacy of CT- guided radioactive~(125)I seed implantation in treating retroperitoneal lymph node metastasis due to recurrent cervical cancer after radiotherapy. Methods A total of 10 patients with retroperitoneal lymph node metastasis(12 lesions in total)due to recurrent cervical cancer after radiotherapy, who were treated with CT- guided~(125)I seed implantation during the periodfrom November 2011 to October 2015, were included in this study. The diameters, that were perpendicular to each other, of the involved lymph nodesranged from 1.7 cm ×1 cm to 6.5 cm ×5 cm, the diameter of 6 involved lymph nodes(50%) was <5.0 cm and the diameter of other 6 involved lymph nodes(50%) was ≥5.0 cm.With the help of treatment planning system for brachytherapy, the source distribution was formulated. Under CT guidance, the~(125)I seedswith the activity of 0.3-0.7 m Ci were implanted. Postoperative validation showed that D90(90% minimum prescription dose received by the target volume) was 36- 110 Gy(median 59 Gy). After the treatment, the changes in lesion size, pain relief and complications were recorded. Results The 10 patients were followed up for 4.3-16.1 months, the median follow- up time was 9.7 months. The 2- month local control rate and the 2- month effective rate were 100% and 58.3%, respectively. The 2- month, 6- month and12- month survival rates were 100%, 66.7% and 58.3%,respectively. The median survival time was 12.1 months. One patient(10%) died of gastrointestinal bleeding at five months after treatment, six patients(60%)died of distant metastases, three patients(30%) survived withno evidence of local recurrence. No major complications such as massive hemorrhage, intestinal infection, bone marrow suppression or other~(125)I seed-related complications occurred. Conclusion For the treatment of retroperitoneal lymph node metastasis due to recurrent cervical cancer after radiotherapy, CT- guided radioactive~(125)I seed implantation has satisfactory short- term curative effect, and this technique is safe and feasible.(J Intervent Radiol, 2017, 26: 137-141)
引文
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[8]张丹丹,吴小华.妇科恶性肿瘤腹主动脉旁淋巴结转移与临床处理[J].妇产与遗传·电子版,2012,2:16-19.
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[12]王娟,孙美玲,张宏涛,等.外放疗后复发颈部淋巴结转移癌17例125I粒子植入治疗的初步疗效[J].介入放射学杂志,2014,23:784-787.
[13]Huang H,Liu J,Li Y,et al.Metastasis to deep obturator and para-aortic lymph nodes in 649 patients with cervical carcinoma[J].Eur J Surg Oncol,2011,37:978-983.
[14]韩志红,田小飞,韩星梅,等.中晚期宫颈癌腹主动脉旁淋巴结转移治疗的临床研究[J].现代肿瘤学,2015,23:692-694.
[15]马洪明,邹珩,李红,等.125I粒子植入治疗癌性疼痛临床观察[J].中国现代医学杂志,2013,23:62-64.
[2]魏光绪,彭太华,史传,等.宫颈癌根治术联合腹主动脉旁淋巴结切除在ⅠB2-ⅡA2期宫颈癌中的应用[J].山东医药,2015,55:33-34.
[3]袁利梅,赵德英,邱惠,等.影响宫颈癌患者预后的临床病理因素分析[J].山东医药,2014,54:21-23.
[4]Yessaian A,Magistris A,Burger RA,et al.Radical hysterectomy followed by tailored postoperative therapy in the treatment of stage IB2 cervical cancer:feasibility and indications for adjuvant therapy[J].Gynecol Oncol,2004,94:61-66.
[5]Yao L,Jiang Y,Jiang P,et al.CT-guided permanent125I seed interstitial brachytherapy for recurrent retroperitoneal lymph node metastases after external beam radiotherapy[J].Brachytherapy,2015,14:662-669.
[6]Wang Z,Lu J,Gong J,et al.CT-Guided radioactive125I Seed implantation therapy of symptomatic retroperitoneal lymph node metastases[J].Cardiovasc Intervent Radiol,2014,37:125-131.
[7]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.
[8]张丹丹,吴小华.妇科恶性肿瘤腹主动脉旁淋巴结转移与临床处理[J].妇产与遗传·电子版,2012,2:16-19.
[9]Lai HC.Management of recurrent cervical cancer[J].Chang Gung Med J,2004,27:711-717.
[10]Karchevsky M,Babb JS,Schweitzer ME.Can diffusion-weighted imaging be used to differentiate benign from pathologic fractures?A meta-analysis[J].Skeletal Radiol,2008,37:791-795.
[11]Ng BH,Rozita A,Adlinda A,et al.Extended field radiotherapy with or without chemotherapy in patients with cervical cancer and positive para-aortic lymph nodes:a single institution retrospective review[J].Asian Pac J Cancer Prev,2015,16:3827-3833.
[12]王娟,孙美玲,张宏涛,等.外放疗后复发颈部淋巴结转移癌17例125I粒子植入治疗的初步疗效[J].介入放射学杂志,2014,23:784-787.
[13]Huang H,Liu J,Li Y,et al.Metastasis to deep obturator and para-aortic lymph nodes in 649 patients with cervical carcinoma[J].Eur J Surg Oncol,2011,37:978-983.
[14]韩志红,田小飞,韩星梅,等.中晚期宫颈癌腹主动脉旁淋巴结转移治疗的临床研究[J].现代肿瘤学,2015,23:692-694.
[15]马洪明,邹珩,李红,等.125I粒子植入治疗癌性疼痛临床观察[J].中国现代医学杂志,2013,23:62-64.