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目的评价CT引导下125Ⅰ粒子组织间植入治疗盆腔难治性恶性肿瘤的临床疗效,探讨粒子植入技术。方法23例盆腔恶性肿瘤,均为术后复发接受化疗和(或)根治量放疗肿瘤仍进展患者,瘤体最大径3.5～7.0 cm,平均4.5 cm。粒子植入术前1～3 d行模拟CT扫描,采用治疗计划系统(TPS)制定粒子植入计划,根据处方剂量求出术中所需125Ⅰ粒子的总活度并算出治疗粒子数量。在CT引导下经皮穿刺植入125Ⅰ粒子。其中6例患者粒子植入前或后接受髂内动脉灌注化疗。结果单个瘤体内首次植入粒子数为9～75粒,平均27粒。6例接受髂内动脉灌注化疗共14个疗程。粒子植入术后72 h～4周,下肢疼痛和(或)肛门、会阴周围疼痛坠胀不适,完全缓解5例,部分缓解11例,有效率69.6%(16/23)。术后随访2～34个月,中位随访21个月,部分缓解(PR)18例;无变化(SD)4例;进展(PD)1例,总有效率78.3%(18/23)。死亡3例,存活20例,最长生存时间34个月。结论CT引导下125Ⅰ粒子植入对盆腔难治性恶性肿瘤安全、有效。
Objective To evaluate the clinical effect of CT-guided implantation of 125 I seeds in the treatment of pelvic refractory malignant tumors and to explore the technique of particle implantation. Methods Twenty - three patients with pelvic malignant tumors, all of whom undergone chemotherapy and / or radical radiotherapy, continued to progress. The maximum diameter of tumors was 3.5-7.0 cm (4.5 cm in average). Particle implantation was performed 1 to 3 days before the CT scan was simulated. The treatment plan system (TPS) was used to establish the particle implantation plan. The total activity of the 125 I seeds needed during operation was calculated and the number of therapeutic particles was calculated. Percutaneous implantation of 125I particles guided by CT. 6 patients received intra-iliac arterial infusion chemotherapy before or after particle implantation. Results The number of implanted particles in a single tumor was 9 ~ 75, with an average of 27. 6 cases received internal iliac artery infusion chemotherapy a total of 14 courses. At 72 h to 4 weeks after implantation, the pain in the lower limbs and / or anus and discomfort of pain around the perineum were completely relieved in 5 and partially relieved in 11, with an effective rate of 69.6% (16/23). The patients were followed up for 2 to 34 months, with a median follow-up of 21 months. There were 18 cases of partial remission (PR), 4 cases of no change (SD) and 1 case of progression (PD). The total effective rate was 78.3% (18/23). 3 died, 20 survived, the longest survival time was 34 months. Conclusion CT-guided implantation of 125 I seeds pelvic refractory malignancies safe and effective.