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目的:探讨和评估放射性125I粒子植入治疗肺癌外照射(适形放疗,伽玛刀)后局部残存病灶的疗效。方法:依据TPS计划系统预先计算出18例肺癌患者外照射后局部残存病灶处所需植入的粒子数目,活度和处方剂量;在手术植入过程中再次通过TPS计划系统做粒子植入剂量验证报告,同时分析危及器官心包、食道、脊髓等组织的受量,以达到与治疗计划相符的处方剂量;粒子植入后2个月再行TPS剂量验证,评估实际肿瘤包块粒子治疗的剂量。结果:18例患者瘤体最小周边剂量(mPD)为80-120Gy,靶区90%体积的吸收剂量(D90)为103.6-137.6Gy;肿瘤距离心包,脊髓组织最近的在1-2cm处,吸收剂量迅速衰减到20%到5%左右,为24和6Gy;18例患者2个月内瘤体达到CR+PR者17例(94%),瘤体缩小明显,无明显变化(NC)1例(6%)。并发症:气胸6例,喀血0例,18例患者未发现放射性损伤。结论:放射性125I粒子植入治疗可有效控制外照射后肺癌局部残存病灶,是一种安全,有效的方法。
Objective: To investigate and evaluate the efficacy of radioactive 125I seed implantation in the treatment of local residual lesions after lung cancer external irradiation (conformal radiotherapy, gamma knife). Methods: According to the TPS planning system, the number of particles, the activity and the prescription dose of the local residual lesions in 18 cases of lung cancer patients after external irradiation were calculated in advance. In the course of surgical implantation, the particle implantation dose Verify the report, at the same time analyze the endanger the organ pericardium, esophagus, spinal cord and other organizations by the amount of the dose in line with the treatment plan to achieve the prescription dose; TPS dose verification 2 months after particle implantation to assess the actual tumor mass particle dose . Results: The minimum peripheral dose (mPD) of 18 patients was 80-120 Gy and the dose of 90% of the target volume (D90) was 103.6-137.6 Gy. The tumor was nearest to the pericardium and spinal cord at 1-2 cm, The dose rapidly decayed to 20% to 5% at 24 and 6 Gy. Twenty-seven patients (94%) achieved CR + PR within 2 months. The tumor was significantly reduced and there was no significant change (NC) (6%). Complications: 6 cases of pneumothorax, 0 cases of hematuria, 18 cases of patients found no radioactive injury. CONCLUSION: Radioactive 125I seed implantation is a safe and effective method to control the local residual lesions of lung cancer after external irradiation.