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摘要:
目的 探讨125I放射性粒子植入治疗纵隔淋巴结转移的安全性和疗效观察。 方法 回顾性分析陕西省肿瘤医院2014年6月至2018年6月53例采用CT引导下125I粒子植入治疗纵隔淋巴结转移患者，采用术前放射治疗计划系统（treatment planning system，TPS）进行计划并术后验证，记录术中、术后并发症情况，观察生存质量改善情况，治疗后1、3、6个月，1、2年复查胸部CT随访，评估局部病灶控制情况，随访中位生存期及总生存期，并对生存预后及死亡原因等进行分析。 结果 53例纵隔淋巴结转移瘤患者均顺利完成125I放射性粒子植入术，中位生存期为254天，1年生存率为48.67%，疗效评价完全缓解率（complete response，CR）+部分缓解率（partial response，PR）为83.02%（44/53）；Cox模型多因素分析，生存预后与ECOG评分、植入时远处转移、植入后同期化疗、二次粒子植入等相关因素有关（P < 0.05）；术中、术后气胸和咯血的并发症发生率分别为20.75%（11/53）、13.21%（7/53），无一例患者死亡；植入后在咳嗽、气短、疼痛、声音嘶哑、呛咳和上腔静脉综合征等症状方面有60.00%~82.61%的缓解率。 结论 CT引导下125I粒子植入治疗纵隔淋巴结转移，具有手术创伤小、疗效显著、安全性好和可行性高等优点，具有重要应用价值，值得临床进一步推广应用。 Abstract:Objective To investigate the safety and efficacy of 125I radioactive seed implantation in the treatment of mediastinal lymph node metastasis. Methods Records of 53 patients enrolled in Shaanxi Provincial Tumor Hospital from June 2014 to June 2018 with mediastinal lymph node metastasis treated by computed tomography (CT)-guided 125I seed implantation were analyzed retrospectively. The preoperative treatment planning system was validated after the surgery. Intraoperative and post-operative complications were recorded. The improvement in quality of life was observed. Chest CT follow-up was conducted 1 month, 3 months, 6 months, 1 year, and 2 years after treatment. The local focus control was evaluated. The median survival and total survival were recorded, and the survival prognosis and causes of death were analyzed. Results The median survival time was 254 days (8.5 months), one-year survival rate was 48.67%, and complete and partial response rate was 83.02% (44/53). Multivariate Cox model analysis showed that the survival prognosis was related to the Eastern Cooperative Oncology Group (ECOG) score, distant metastasis at the time of implantation, concurrent chemotherapy after implantation, and secondary seed implantation (P < 0.05). The rates of developing pneumothorax and hemoptysis during and after the surgery were 20.75% (11/55) and 13.20% (7/55), respectively. No patients died. After implantation, the remission rate of cough, shortness of breath, pain, hoarseness, and superior vena cava syndrome was 60.00%-82.61%. Conclusions CT-guided 125I seed implantation in the treatment of mediastinal lymph node metastasis has the advantages of minimal trauma, remarkable curative effect, safety, and feasibility. It has important application value and is worthy of further clinical application. -
Key words:
- mediastinal lymph node metastasis /
- brachytherapy /
- 125I particles
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图 1 纵隔4、6、7区纵隔粒子植入病例影像
▶A，B：纵隔4区淋巴结植入时与植入后18个月对比；C，D：纵隔6区淋巴结植入前及植入后4年对比；E~ G：纵隔7区淋巴结植入时与植入后6个月对比；H：TPS计划DVH图
表 1 53例患者的临床资料特征
表 2 粒子的剂量学资料
表 3 植入后的疗效评估 （%）
表 4 55例患者生存预后的相关因素分析
表 5 在观察终点时局部控制情况 （%）
表 6 死亡因素分析 （%）
表 7 生存质量的改善情况 （%）
表 8 粒子植入后相关并发症 （%）
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