摘要
目的探讨超声支气管镜引导下经气管壁植入^(125)I放射性粒子治疗纵隔型肺癌及纵隔转移性肺癌的可行性、临床疗效及安全性。方法术前制定放射治疗计划,确定放射性粒子数量及针道。在超声支气管镜引导下,对34例失去手术机会的纵隔型肺癌及纵隔转移性肺癌患者实施^(125)I放射性粒子植入术;术后采用TPS验证放射性粒子剂量分布,观察术后症状缓解情况及并发症;术后2月、4月、6月随访胸部CT,同时评估患者KPS评分。结果所有病例均成功植入放射性粒子,术后验证D90在87-115 Gy之间,中位值为95 Gy。V90在95.4%-99.8%之间,中位值97.4%,周围正常靶区平均照射剂量明显低于正常组织耐受剂量。术后2例患者出现低热,所有患者未出现气胸、大咯血等严重并发症;术后2月、4月、6月随访,有效率分别为76.5%,85.3%,73.5%,术后半年随访KPS评分较术前明显增高,差异有统计学意义(z=-3.60,P=0.000 3)。结论超声支气管镜引导下植入^(125)I放射性粒子治疗肺癌具有可行性,近期效果明显,安全性高,值得临床推广。
Objective To investigate the feasibility,efficacy and safety of ultrasound bronchoscopy-guided transtracheal brachytherapy for mediastinal type lung cancer and lung cancer with mediastinal metastasis. Methods Ultrasound bronchoscopy-guided 125I seed interstitial implantation was performed in 34 patients with mediastinal type lung cancer and lung cancer with mediastinal metastasis. Treatment planning system（ TPS） was used to draw up a pre-operative implantation plan,and the dose distribution after implantation was also checked by TPS. The clinical symptoms and complications were observed. All patients were followed up for 6 months. At month 2,4and 6 after implantation,CT scans and KPS scores were performed. Results All patients were successfully implanted 125I seed. D90 was 87-115 Gy with the median dose of 95 Gy,and V90 was 95. 4%-99. 8% with the median of 97. 4%. The average irradiation dose of the normal target areas was significantly lower than the tolerance dose. Two cases showed fever,and no pneumothorax or massive hemoptysis occurred. The effective rate was 76. 5%,85. 3%,73. 5% at month 2,4 and 6 after implantation,respectively. The average postoperative KPS scores at 6 month was significantly higher than that before implantation（ z =-3. 60,P = 0. 000 3）. Conclusion Ultrasound bronchoscopy-guided transtracheal brachytherapy is safe,effective and feasible,and it is a promising palliative therapy method for mediastinal type lung cancer and lung cancer with mediastinal metastasis.
出处
《山西医科大学学报》
CAS
2017年第5期467-470,共4页
Journal of Shanxi Medical University
