摘要
目的评估CT引导下放射性^(125)I粒子植入治疗寡转移非小细胞肺癌(NSCLC)患者的安全性及有效性.方法回顾性分析2011年2月至2020年5月期间在两所医院确诊寡转移NSCLC患者的临床资料.共计纳入寡转移NSCLC患者106例,病灶336处,均经病理学证实,靶向驱动基因检测突变为阴性,无法或拒绝外科手术切除,无法耐受或拒绝常规外照射放疗,并且转移灶少于5个,无严重凝血功能障碍以及Karnofsky评分≥70,接受CT引导下放射性^(125)I粒子植入治疗.术前1周内行CT检查,应用治疗计划系统(TPS)勾画出肿瘤靶区轮廓,确定粒子的数量、空间排布方式及植入针数目.所有病灶均接受CT引导下^(125)I粒子植入治疗.术后每2个月随访1次,评价指标包括疾病控制率、总生存时间、生活质量、治疗相关不良反应.结果所有病灶均成功接受CT引导下^(125)I粒子植入治疗.治疗后2个月,完全缓解3例,部分缓解38例,病灶稳定40例,疾病进展25例,总体疾病控制率76.4%,术后4、6个月总体疾病控制率分别为72.0%、71.1%.治疗后2个月,KPS评分升高14例,稳定79例,减低13例,KPS评分未降低者所占比例为87.7%,术后4、6个月KPS评分未降低者所占比例分别为72.0%、61.8%.中位随访时间为390(150~1210)d.随访终止时,死亡105例,1年、2年总生存率分别为37.8%、2.6%,中位生存时间为333 d.没有出现治疗相关的死亡患者.粒子植入术后出现1级骨髓抑制患者8例(7.5%);1级恶心、呕吐患者4例(3.8%);1级乏力患者6例(5.7%);12例(11.3%)患者出现气胸,其中6例(5.7%)患者肺组织受压程度超过30%,经胸腔引流治疗后得以恢复;另6例气胸患者无明显症状,未予处理,1周后复查CT示气胸吸收.6例患者术后出现少量痰中带血,未予以处理,自行缓解.结论CT引导下放射性^(125)I粒子植入治疗寡转移的非小细胞肺癌是安全、可行的,对于寡转移NSCLC是一种挽救性的治疗措施.
Objective To evaluate the efficacy and safety of CT-guided ^(125)I seed implantation in treating oligometastatic non-small cell lung cancer(NSCLC).Methods The clinical data of 106 patients with oligometastatic NSCLC,whose diagnosis was confirmed in two hospitals during the period from February 2011 to May 2020,were retrospectively analyzed.A total of 336 pathologically-proved NSCLC lesions with negative target-driven gene detection mutation were detected in the 106 patients.The patients couldn’t or refused to receive surgical resection,or couldn’t tolerate or refused to receive conventional external irradiation therapy,besides,the patients had less than 5 metastatic lesions,had no severe coagulation dysfunction and had a Karnofsky Performance Status(KPS)score≥70 points.CT-guided ^(125)I seed implantation was adopted in the 106 patients.Within one week before treatment,the following preparations,including CT scan,drawing of the outline of tumor target with treatment planning system(TPS),determination of the number of ^(125)I seeds to be used,the spatial arrangement patterns of ^(125)I seeds to be implanted and the number of puncturing needles to be used,were accomplished.CT-guided ^(125)Iseed implantation was carried out for all the 336 lesions.Postoperative follow-up check was conducted once every 2 months.The evaluation indexes included disease control rate,overall survival time,quality of life,and treatment-related complications.Results Successful CT-guided ^(125)I seed implantation was accomplished for all lesions.Two months after treatment,complete remission was achieved in 3 patients,partial remission in 38 patients,stable disease in 40 patients and progression disease in 25 patients.The overall disease control rate was 76.4%.The postoperative 4-month and 6-month overall disease control rates were 72.0%and 71.1%respectively.Two months after treatment,increase of KPS score was observed in 14 patients,stable KPS score in 79 patients and decrease of KPS score in 13 patients;in 87.7%of all patients the KPS
作者
高福磊
黄祥忠
王浩
王勇
朱光宇
陈荔
郭金和
GAO Fulei;HUANG Xiangzhong;WANG Hao;WANG Yong;ZHU Guangyu;CHEN Li;GUO Jinhe(Department of Interventional Radiology,Affiliated Jiangyin Hospital,Medical College of Southeast University,Jiangyin,Jiangsu Province 214400,China)
出处
《介入放射学杂志》
CSCD
北大核心
2021年第12期1250-1255,共6页
Journal of Interventional Radiology
基金
国家自然科学基金(81971716)。
关键词
非小细胞肺癌
寡转移
放射性
I粒子
近距离放疗
non-small cell lung cancer
oligometastasis
125I seed implantation
brachytherapy
