复发转移胸壁肿瘤CT引导125I粒子治疗疗效初探

目的 初步探讨CT引导¹²⁵I粒子植入治疗复发或转移胸壁肿瘤的可行性和疗效。
方法 回顾分析2004-2012年间23例复发或转移胸壁恶性肿瘤患者接受CT引导¹²⁵I粒子植入治疗资料。术前计算机治疗计划系统行三维治疗计划,确定粒子数目、空间分布,术后即刻CT扫描剂量验证。90%靶体积接受的剂量为100~160 Gy (中位数130 Gy),¹²⁵I粒子活度为(1.85~2.89)×10⁷ Bq (中位数2.63×10⁷ Bq)。植入粒子8~269颗(中位数53颗)。局部控制率和生存率计算采用Kaplan-Meier法。
结果 随访率100%,随访时间满3、5年者分别为11、8例。23例患者中4例完全缓解、12例部分缓解。1、3、5年局部控制率分别为82%、62%、62%,肿瘤特异生存率分别为61%、45%、45%,总生存率分别为58%、58%、39%。疗后1例患者出现轻中度臂丛神经损伤,6例出现1、2级皮肤损伤。
结论 初步结果显示CT引导¹²⁵I粒子植入治疗复发或转移胸壁肿瘤安全有效。

Therapeutic effect of 125I seed implantation under computed tomography guidance in treatment of recurrent or metastatic chest wall tumor:a preliminary study

Objective To preliminarily evaluate the feasibility and therapeutic effect of ¹²⁵I seed implantation under computed tomography (CT) guidance in the treatment of recurrent or metastatic chest wall tumor. Methods A retrospective analysis was performed on the clinical data of 23 patients with recurrent or metastatic malignant chest wall tumor who underwent ¹²⁵I seed implantation under CT guidance from July 2004 to October 2012. A computerized treatment planning system was used for three-dimensional treatment planning before operation to determine the number and spatial distribution of ¹²⁵I seeds. CT scan dosimetry was performed immediately after operation. The dose received by 90% of the target volume was 100—160 Gy (median:130 Gy). The activity of ¹²⁵I seeds was (1.85—2.89)×10⁷ Bq (median:2.63×10⁷ Bq). The total number of seeds implanted was 8—269(median:53). The local control rate and survival rate were calculated by the Kaplan-Meier method. Results The follow-up rate was 100%. Two patients were followed up for at least 3 years, and 2 for at least 5 years. Of the 23 patients, 4 had a complete remission, and 12 had a partial remission. The 1-, 3-, and 5-year local control rates were 82%, 62%, and 62%, respectively;the 1-, 3-, and 5-year tumor-specific survival rates were 61%, 45%, and 45%, respectively;the 1-, 3-, and 5-year overall survival rates were 58%, 58%, and 39%, respectively. After treatment, mild or moderate brachial plexus injury was seen in one patient, and grade 1 or 2 skin injury was seen in 6 patients. Conclusions ¹²⁵I seed implantation under CT guidance is safe and effective in the treatment of recurrent or metastatic chest wall tumor, according to the preliminary study