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目的探讨经导管肝动脉化疗栓塞(transcatheter hepatic arterial chemoembolization,TACE)联合植入125I粒子靶向内照射治疗肝脏恶性肿瘤的近中期疗效。方法本组24例中原发性肝癌18例、胆管细胞癌3例、大肠癌术后肝转移癌3例,共29个病灶。采取先进行1~3次TACE治疗,待病灶初步得到控制后在CT或彩色多普勒超声导向下植入125I粒子,粒子植入之前采用治疗计划系统(treatment planning system,TPS)模拟布源或遵循Halarism的125I经验公式(mCi=Da×5),求出术中所需125I粒子的总活度及算出治疗粒子的数量。将粒子重点植入到肿瘤实质内碘油缺损区域及肿瘤边缘。结果随访6~23个月,半年生存率为100%,未出现严重的并发症。治疗后6个月肝内病灶肿瘤影像学评价,24例患者中,完全缓解(CR)4例,部分缓解(PR)13例,有效反应率(CR+PR)71%,稳定(NC)4例,进展(PD)3例。结论 TACE联合植入125I粒子靶向内照射治疗肝脏恶性肿瘤是安全、微创、有效的方法。
Objective To investigate the short-term and long-term effects of transcatheter hepatic arterial chemoembolization (TACE) combined with 125I targeted internal irradiation in the treatment of hepatic malignancies. Methods The group of 24 cases of primary liver cancer in 18 cases, cholangiocarcinoma in 3 cases, 3 cases of colorectal cancer liver metastases, a total of 29 lesions. TACE was first performed 1 to 3 times. After the lesion was initially controlled, 125I seeds were implanted under CT or color Doppler ultrasound. The treatment planning system (TPS) was used to simulate cloth source or Following Halarism’s empirical formula of 125 I (mCi = Da × 5), the total activity of 125 I particles required for the procedure and the number of therapeutic particles were calculated. Will focus on particles implanted in the tumor within the lipiodol deficiency and tumor margins. Results The follow-up of 6 to 23 months, half-year survival rate was 100%, no serious complications. Among 24 patients, 4 were complete remission (CR), 13 were partial remission (PR), 71% were effective response rate (CR + PR), and 4 were stable Cases, progress (PD) in 3 cases. Conclusion The combination of TACE and 125I targeted internal irradiation for the treatment of hepatic malignancies is a safe, minimally invasive and effective method.