~（125）I粒子植入治疗晚期非小细胞肺癌近期疗效观察
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摘要
目的:观察125I粒子瘤内植入治疗晚期肺癌的近期疗效,探讨该方法治疗肺癌的临床价值。方法:对22例经病理证实的原发IIIB及IV期非小细胞肺癌患者,CT定位下行肺内病灶放射性粒子植入术。术后1~6个月进行临床随访,术后第2、3个月后全部行CT复查。结果:1、KPS评分:提高7例,稳定14例,下降1例。2、根据肺癌近期有效率的评定标准,125I粒子瘤内植入有效率(CR+PR)为73.9%(17/23)。3、肿瘤在5cm以下者有效控制率为93.3%,≤3者有效控制率为100%。4、所有病例未出现放射性肺炎、粒子丢失等严重并发症。结论:1、CT导向经皮穿刺瘤内植入125I粒子对晚期肺癌有较好的近期治疗效果,该方法能够提高患者的KPS评分(P<0.05)能够有效缩小肿瘤体积(P<0.05)。2、肿瘤大小与疗效有关,肿瘤越小,局部控制率越高。3、肺癌125I粒子瘤内植入治疗仍是一种局部治疗方法,有其局限性,对减少肿瘤远处转移的作用及远期疗效有待进一步研究。
Objective: The purpose of this study is to investigate the short-term efficacy and explore the clinical value of 125I radioactive seeds implantation for treatment of advanced non-small cell lung cancer. methods: 22 cases of primary advanced non-small cell lung cancer (ⅢB andⅣstage) patients approved by pathology, and the 125I radioactive seeds implanted in their tumors in lung by CT-guided all. There is a 1 ~ 6 month clinical follow-up after operation regularly and reviewed by CT twice after two and three month all. Result:1. The evaluation of KPS as follows: 7 cases improved and 14 are stable, only one descend. 2.The effective rate (CR+PR) is 73.9%(17/23).3. The effective control rate of lesions less than 5cm is 93.3%, and lesions not more than 3cm is 100%. Conclusion:1.Therapy of the implanting 125I seeds guided by CT for pulmonary carcinoma presents a better clinical short-term therapeutic efficacy to the advanced non-small cell lung cancer, this method could improve the Karnofsky score and. reduce the tumor’s volume effectively. 2.The size of lesion is related to the therapeutic efficacy, the smaller lesion is,the better therapeutic efficacy is. 3. The implant of 125I seeds is just a local therapy, whether or not to decrease the incidence of distant metastasis and improve prospective efficacy is not yet assessed.
Objective: The purpose of this study is to investigate the short-term efficacy and explore the clinical value of 125I radioactive seeds implantation for treatment of advanced non-small cell lung cancer. methods: 22 cases of primary advanced non-small cell lung cancer (ⅢB andⅣstage) patients approved by pathology, and the 125I radioactive seeds implanted in their tumors in lung by CT-guided all. There is a 1 ~ 6 month clinical follow-up after operation regularly and reviewed by CT twice after two and three month all. Result:1. The evaluation of KPS as follows: 7 cases improved and 14 are stable, only one descend. 2.The effective rate (CR+PR) is 73.9%(17/23).3. The effective control rate of lesions less than 5cm is 93.3%, and lesions not more than 3cm is 100%. Conclusion:1.Therapy of the implanting 125I seeds guided by CT for pulmonary carcinoma presents a better clinical short-term therapeutic efficacy to the advanced non-small cell lung cancer, this method could improve the Karnofsky score and. reduce the tumor’s volume effectively. 2.The size of lesion is related to the therapeutic efficacy, the smaller lesion is,the better therapeutic efficacy is. 3. The implant of 125I seeds is just a local therapy, whether or not to decrease the incidence of distant metastasis and improve prospective efficacy is not yet assessed.
引文
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[20] Siebert FA, Kohr P, Kovacs G. Comparison of CT and radiograpbased post-implant dosimetry for transperineal 125I prostate brachytherapy using single seeds and a commercial treatment-planning software. Strahlenther Onkol,2006,182(2):96-101.
[21] Taussky D,Yeung I,Williams T,et al. Rectal-wall dose dependence on postlian timing after permanent-seed prostate prostate brachytheraphy. Int J Radiat Oncol Bio Phys,2006,65,65(2):358-363.
[22] Kaskowitz L, Graham MV, Emami B,et al.Radiation theraphy along for stageⅠnon-small cell lung cancer.Int J radiat Oncol Biol phys,1993,27(3):517-523.
[23] Li DF,Cui Q,Wang Q,et al.Application of 125I brachytherapy combined Artificial joint prosthesis in malignant osteo- and soft-tisse sarcoma. Cancer Biother Radiopharm. 2006,21(2):167-172.
[24] Yu Y, Anderson LL, Li ZF, et al. Permanent prostate seed implant brachytherapy: report of the American Association of Physicests in Medicine Task Group No.64.Med Phys, 1999,26:2054 2076.
[25]柴树德,郑广钧,毛玉权,等.CT引导下经皮穿刺种植放射性125I粒子治疗晚期肺癌[J].中华放射肿瘤学杂志,2004,13(4):291-293.
[26]宁雪坚,范先基,姚波,等.吉西他滨联合125I放射性粒子植入治疗老年非小细胞肺癌[J].中国肿瘤临床与康复,2005,12(1):83-84.
[27]法逸华.125I粒子近距离照射在肿瘤治疗中的应用.国外医学·放射医学核医学分册,2003,27(3):115-117.
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[29]胡效坤,王明友,杨志国,等.CT导引下经皮穿刺组织间植入125I放射微粒子治疗中心型肺癌的应用研究[J].中华放射学杂志,2004,38(9):910-915.
[30]王俊杰,唐劲天,黎功.放射性粒子近距离治疗肿瘤[M].北京:北京医科大学出版社, 2001. 1-20,170-175。
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[2]孙燕.肺癌流行病学与肺癌预防[J].中国肺癌杂志,2000,3(6):404-405.
[3] Parkin DM,Bary F,Ferlay J,Pisani P.Global cancer statistics,2002.CA Cancer J Clin, 2005,55:74-1088
[4]李龙芸.继续深入开展肺癌的基础与临床研究[J].中华内科杂志,2000,39 (11):725-727.
[5]李连弟,鲁凤珠,张思维,等.中国恶性肿瘤死亡率20年变化趋势和近期预测分析[J].中国肿瘤杂志,1997,19:3.
[6] Peto R,DarbyS,DeoH,等.1950年以来英国的吸烟、戒烟和肺癌状况:全国统计和两项病例对照研究的综合报告[J].英国医学杂志中文版,2000,3(4):169.
[7]李雅莉,杨德昌.肺癌的诊断及其进展.国外医学呼吸系统分册, 2005,25(2):124-126.
[8] Dabrowski A, Ciechanski A, Wallner G, et al, Squamous cell oeesophageal cancer in patient after surgical treatment of achalasia. Pol MerKur Lekarski,2004,17:629- 631.
[9]张旭,岳世昌,赵翌.手术加I-125粒子植入治疗肺癌的初步评价[J].实用医学杂志,2005,21(4):375-376.
[10] CadyB,Jenkins RL,Steele GD Jr, etal. Surgical margin in hepatic resection for colorectal metastasis: a critical and improvable determinant of outcome[J]. Ann Surg,1998,227:566.
[11] Spigel DR,Greco FA. Chemotherapy in metastatic and locally advanced non-small cell lung cancer[J].Semin Surg Oncol,2003,21(2):98-110.
[12] Belani CP. Optimizing chemotherapy for advanced non-small cell:focus on docetaxel[J]. Lung Cancer,2005,50(Suppl2):3-8.
[13]张福君,吴沛宏,赵明,等.CT导向下125I粒子植入治疗胰腺癌[J].中华医学杂志,2006,86:223-227.
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