CT引导下放射性粒子植入治疗恶性纤维组织细胞瘤肺转移瘤临床疗效研究
Clinical efficacy of 125I radioactive seed implantation in postoperative lung metastases of malignant fibrous histiocytoma
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摘要:目的 研究CT引导下经皮穿刺植入放射性125I粒子治疗恶性纤维组织细胞瘤术后肺转移瘤的临床疗效。方法 选取自2006年1月至2011年8月在天津医科大学附属第二医院接受治疗的恶性纤维组织细胞瘤术后经病理明确诊断出现肺转移瘤的患者10例, 对转移病灶行CT引导下经皮穿刺肿瘤内放射性125I粒子植入治疗。术后6个月复查胸部CT, 与粒子植入前比较肿瘤变化, 按照国际标准判定疗效。随访自2006年6月至2012年6月。结果 全部患者顺利完成粒子植入治疗, 靶区接受的平均照射剂量为(207.4±43.1)Gy, D100(99.7±10.6)Gy, D90(127.5±16.1)Gy。植入术后6个月随访, 有效率80.0%。截至2012年6月, 10例患者中2例生存, 8例死亡, 死亡患者术后平均生存时间14.6±3.5个月, 中位生存期13个月。术中6例患者出现气胸, 其中3例行胸腔闭式引流术, 3例行胸腔穿刺抽气; 6例患者出现肺内针道出血, 不伴咳血, 无进行性血胸, 止血处理后症状消失, 1个月后复查出血吸收。结论 放射性粒子对于恶性纤维组织细胞瘤术后肺部转移病灶短期局部效果明显, 可以作为一种有效的局部治疗手段。Abstract:Objective To investigate the clinical efficacy of CT-guided percutaneous 125I radioactive seed implantation in treating postoperative lung metastases of malignant fibrous histiocytoma(MFH).Methods From June 2006 to August 2011, 10 patients with pathologically confirmed lung metastases after MFH surgery received CT-guided percutaneous 125I radioactive seed implantation.After a six-month implantation, the chest CT scan was reviewed and the changes were evaluated according to international standards.The patients were followed up from June 2006 to June 2012.Results All operations were successfully completed.The average dose delivered to the nidus was(207.4±43.1) Gy, D100(99.7±10.6)Gy, D90(127.5±16.1) Gy.Two patients were alive and eight were dead until June 2012.Patient survival was 14.6 months ± 3.5 months, and the median survival time was 13 months.The overall response rate was 80.0%.Six pneumothorax cases in all operations were identified, three of which were treated by closed drainage of pleural cavity, and the remaining three by thoracocentesis(three cases).We administered hemostatic therapy to six cases of pulmonary hemorrhage.Conclusion CT-guided 125I radioactive seed implantation exhibits short-term clinical efficacy in treating postoperative lung metastases of MFH.
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