记忆合金支架捆绑碘-125粒子治疗食管癌的临床应用

目的:探讨附有碘-125粒子的医用记忆合金食管支架置入对晚期食管恶性狭窄的疗效．方法:45例晚期食管癌按患者是否愿意接受碘-125粒子支架而将其分为A、B两组,A组为普通自膨式支架,B组为附有碘-125粒子的自膨式食管支架进行治疗．术后随访并发症及生存期．结果:45例患者支架全部顺利置放,支架置入成功率100％,患者吞咽困难均得到明显缓解． A组患者生存时间90-300 d,平均171±56 d．B 组患者生存时间120-450 d,平均316±116 d．两者比较有统计学意义(t=-3．385,P<0．05)．两组均未出现严重并发症．结论:附有碘-125粒子的自膨式食管支架能明显缓解吞咽困难症状,明显提高患者生活质量及生存期,且无严重并发症发生．     

术中125I粒子植入联合术后化学治疗中晚期食管鳞癌

目的 探讨术中125I粒子植入联合术后化学治疗治疗胸段中晚期食管鳞癌(ESCC)的安全性及疗效.方法 前瞻性队列研究,入组时间为2000年1月至2005年12月.根据ESCC术前CT分期标准,南京医科大学附属南京第一医院肿瘤外科和盐城市肿瘤医院胸外科298例Ⅱ～Ⅲ期胸段ESCC患者通过计算机随机数字法分为术中125I粒子植入联合术后化学治疗组(A组,98例)、术后放射化学治疗组(B组,100例)及单纯根治术组(C组,100例).三组均行食管癌根治术.再根据术后pTNM分期标准,最终实际入组Ⅱb～Ⅲ期胸段ESCC患者233例,三组分别为78例、75例、80例.依据治疗计划系统(TPS)所确定的剂量,A组于术中直视下植入125I粒子.选用0.5 mCi的125I粒子10～22粒,总活度在5～11 mCi,肿瘤匹配周边剂量60～70 Gy,术后通过影像学手段(CT、X线片)行粒子验证和质量评估.观察患者术后并发症,通过CT监测肿瘤影像学、局部复发情况,随访术后1、3、5、10年生存率.结果 A组术后粒子验证无移位、脱落,质量评估满意.A、B、C组局部复发率分别为11.5%、13.3%、38.8%,比较差异有统计学意义(P＜0.05).3组并发症比较差异无统计学意义(P＞0.05).3组1年生存率对比差异无统计学意义(P＞0.05),A、B、C组3、5、10年总体及无进展生存率分别为64.8%,37.7%,25.1%;63.3%,36.9%,24.9%;43.6%,25.0%,12.6%)及63.5%,37.4%,15.1%;62.5%,36.6%,14.4%;42.5%,25.6%,6.2%;3组比较差异均有统计学意义(P＜0.05).结论 术中125I粒子植入联合术后化疗与术后放化疗治疗中晚期食管鳞癌疗效相当,是简单、安全、有效的方法,可降低局部复发率、延长患者生存期.

Abstract：

Objective To evaluate the safety and efficacy of 125I radioactive seeds implantation combined with postoperative chemotherapy as a treatment option for thoracic advanced esophageal squamous cell carcinoma(ESCC). Methods A prospective cohort study was carried out between 2000and 2005. According to preoperative CT staging criteria,298 patients in phase Ⅱ-Ⅲ of ESCC, who had were admitted to Oncology Center Surgery of Nanjing First Hospital Affiliated to Nanjing Medical University and Thoracic Surgery of YanCheng Oncology Hospital, were randomly divided into three groups: intraoperative 125I seeds implantation combined with postoperative chemotherapy (group A, 98cases), postoperative chemoradiotherapy (group B, 100 cases) and surgery alone (group C, 100cases). All patients received radical resection of esophageal cancer. According to pTNM staging criteria after operation, 233 patients in phase Ⅱb-Ⅲ of ESCC were finally enrolled in the study (78 in group A, 75 in group B, and 80 in group C). With 0. 5 m Ci of single seed, total activity of 5-11 mCi and matched peripheral dose in 60-70 Gy, 10-22 125I seeds were implanted into the target of patients in group A under direct vision in accordance with treatment planning system. The validation and quality assessment of radioactive seeds were demonstrated according to CT scan or X-ray imaging. The postoperative complications were observed. The local recurrence of the cancer was demonstrated using CT scan. The survival rate of patients was followed up for 1-,3-,5- and 10 years. Results The satisfied quality assessment of 125I seeds was observed. There was no displacement or loss of seed. The local recurrence in group A, B and C was 11. 5%, 13. 3% and 38. 8%, respectively, with statistical significance (P ＜ 0. 05). There was no significant difference among three groups with respect to complications and 1-year survival (P＞0. 05). However, the overall survival rate 3-, 5- and 10-years was 64.8%,37. 7% and 25. 1% in group A respectively; 63.3%, 36.9% and 24.9% in group Brespectively; 43. 6i%, 25.0%, and 12.6% in group C, respectively (all P＜0. 05). The 3-,5- and 10-year progression free survival rates were 63.5 %, 37.4 % and 15.1% in group A respectively; 62.5 %,36.6% and 14. 4% in group B respectively; 42.5%, 25.6% and 6.2% in group C respectively (all P＜0. 05). Conclusions It is a safe, effective and simple method for intraoperative 125I seeds implantation combined with postoperative chemotherapy in treatment of advanced ESCC, which may reduce the local recurrence and improve survival rates in patients with ESCC.     

超声引导下放射性粒子植入治疗肝细胞癌患者短期疗效研究

目的 探讨采用放射性125 I粒子植入治疗肝细胞癌(HCC)患者的近期疗效及其影响因素.方法 2017年7月～2021年8月我院收治的HCC患者84例,在超声引导下行放射性125 I粒子植入治疗,粒子活度为0.6～0.8 mCi,肿瘤匹配周边剂量(MPD)为110～160 Gy,术后2个月复查CT或MRI并参考RECI...     

125I粒子组织间植入治疗胰腺癌的实验研究

目的 探讨125I粒子组织间植入治疗胰腺癌的有效性.方法 Balb/c裸鼠腋下接种人胰腺癌SW1990细胞.按植入剂量不同将成瘤后裸鼠分为对照组和50 Gy、100 Gy、150 Gy、200 Gy组,每4 d测量肿瘤体积,21 d后处死裸鼠,称瘤重,计算肿瘤抑制率,常规病理检查,TUNEL法检测凋亡细胞.结果 对照组、50 Gy组、100 Gy组、150 Gy组及200 Gy组抑瘤率分别为0、(42.8±16.2)%、(55.1±22.3)%、(72.8±12.8)%及(75.6±8.6)%;以粒子为中心的肿瘤坏死面积分别为(6.3±2.1)%、(20.8±3.2)%、(36.3±3.1)%、(64.1±2.8)% 及(82.6±3.8)%;相对凋亡指数分别为1、2.07±0.57、2.75±0.33、4.64±0.45及7.04±0.34,各治疗组均显著高于对照组(P＜0.05).结论 125I粒子组织间植入可显著抑制肿瘤生长,放射粒子具有直接杀死肿瘤细胞和诱导凋亡双重作用.     

内镜下肝外胆管癌及壶腹癌125I粒子置入腔内持续照射方法研究

目的探讨晚期肝外胆管癌及壶腹癌采用^125Ⅰ粒子置入治疗的方法和价值。方法12例经B超、CT、磁共振检查确诊或拟诊为肝外胆管癌及壶腹癌的患者，采用十二指肠镜行ERCP检查，并取活检行病理检查，确定恶性肿瘤的病变长度，行病变段胆管扩张后置入金属支架，引流胆汁。于支架置入7-14d后采用相应的自制粒子载体将^125Ⅰ粒子置入，行腔内持续近距离放射治疗。术后随访6-32个月，进行B超及内镜复查。结果12例患者均顺利完成操作，无手术并发症。术后随访，超声及内镜结果与术前无明显变化，12例均存活，2例已存活32个月。结论内镜下肝外胆管癌及壶腹癌^125Ⅰ粒子腔内持续照射，是治疗晚期恶性肿瘤的安全有效的方法。     

^125Ⅰ粒子组织间植入治疗胰腺癌的实验研究

目的探讨125I粒子组织间植入治疗胰腺癌的有效性。方法Balb/c裸鼠腋下接种人胰腺癌SW1990细胞。按植入剂量不同将成瘤后裸鼠分为对照组和50Gy、100Gy、150Gy、200Gy组,每4d测量肿瘤体积,21d后处死裸鼠,称瘤重,计算肿瘤抑制率,常规病理检查,TUNEL法检测凋亡细胞。结果对照组、50Gy组、100Gy组、150Gy组及200Gy组抑瘤率分别为0、(42.8±16.2)%、(55.1±22.3)%、(72.8±12.8)%及(75.6±8.6)%;以粒子为中心的肿瘤坏死面积分别为(6.3±2.1)%、(20.8±3.2)%、(36.3±3.1)%、(64.1±2.8)%及(82.6±3.8)%;相对凋亡指数分别为1、2.07±0.57、2.75±0.33、4.64±0.45及7.04±0.34,各治疗组均显著高于对照组(P<0.05)。结论125I粒子组织间植入可显著抑制肿瘤生长,放射粒子具有直接杀死肿瘤细胞和诱导凋亡双重作用。     

CT导引下~(125)I粒子植入治疗无法切除肝细胞癌的临床疗效

目的对CT导引下125I粒子植入治疗无法切除肝细胞癌的临床疗效进行评价。方法对该院2008年4月至2012年4月收治的309例无法切除的肝细胞癌患者实施CT导引下125I粒子植入治疗,平均植入粒子数27.4个(18⁴3个)。术后随访患者的临床指标、实验室检查、生存时间,根据实体瘤的疗效评价标准(RECIST)进行目标病灶临床疗效评价。结果随访分析显示125I粒子植入治疗的总有效率为60.5%。术后中位AFP值显著下降(P<0.05)。所有患者的中位生存时间为13个月,1年存活率为51.8%,2年存活率为31.4%。结论125I粒子植入治疗肝细胞癌具有疗效可靠、安全性高、不良反应小的特点,可以显著提高患者的中位生存时间。单独或联合TACE治疗可能是中晚期肝细胞癌患者的一种极其有效的治疗选择。     

门静脉支架及经动脉药物治疗栓塞联合或未联合血管内植入碘-125粒子条治疗肝癌合并门静脉主干癌栓的比较

目的 比较门静脉支架及经动脉药物治疗栓塞(TACE)联合或未联合血管内植入碘-125(125I)粒子条治疗原发性肝癌伴门静脉主干癌栓的疗效.方法 对106例(男94例,女12例,平均年龄53.23岁)在我院接受TACE治疗的原发性肝癌合并门静脉主干癌栓患者的资料进行回顾性分析,其中56例(A组)在门静脉内植入支架及125I粒子条,余50例(B组)仅在门静脉内植入支架.分别对两组患者的生存期、支架通畅率及相关不良事件进行分析.对治疗前后各测量值的改变采用配对样本t检验,计数资料采用x2检验,用Kaplan-Meier法分析生存时间及支架通畅期.结果 门静脉内植入支架及125I粒子条的技术成功率为100％,无严重相关不良事件发生.两组患者中位生存期分别为335 d(A组)及146 d(B组),P=0.001(P＜0.05)及HR=2.244;两组患者支架的中位通畅期分别为400d (A组)及190d(B组),P=0.005(P＜0.05)及HR=2.479.结论 门静脉支架及TACE联合血管内植入125I粒子条能显著延长原发性肝癌伴门静脉主干癌栓患者的生存期.     

经消化内镜植入碘-125粒子对消化道癌肿行组织间放疗的护理

癌肿的碘-125组织间放疗是近年来悄然开展的一种新方法。我院自2001年11月首创了经消化道内镜用自制植入器进行消化道癌肿的碘-125粒子组织间植入术，现将术后护理要点介绍如下。     

~(125)I放射性粒子植入治疗不可切除胰腺癌的研究进展

近年来~(125)放射性粒子植入治疗不可切除胰腺癌迅猛发展,临床实践表明,它在缓解患者疼痛,局部控制肿瘤进展,延长患者生存时间等方面具有良好效果。介绍了~(125)放射性粒子的物理、生物学特性及治疗优缺点,以及~(125)放射性粒子植入治疗不可切除胰腺癌的治疗方法、手术安全性、临床治疗效果等。认为作为一种切实有效的治疗方案,有条件的医疗单位应积极推广应用。     

Clinical value of ~(125)I radioactive seed implantation plus transcatheter arterial chemoembolization combined with radiofrequency ablation in treating patient with sub-capsular hepatocellular carcinoma

<正>Objective To analyze the clinical efficacy and safety of ~(125)I radioactive seed implantation in the treatment of sub-capsular hepatocellular carcinoma (sub-HCC) with sequential radiofrequency ablation and transcatheter arterial chemoembolization (TACE). Methods The clinical data of 76 cases with advanced HCC with sub-capsular nodules including 68 males and 8 females,with an average age of (58±9) years,ranging from 33 to 78 years,     

放射性~(125)I粒子治疗食管鳞癌的安全性及疗效

目的:探讨125I粒子在体内外对人ESCC的疗效和作用机制以及植入治疗胸段中晚期食管鳞癌(ESCC)的安全性及疗效.方法:细胞及动物实验:125I粒子植入体外培养的人食管鳞癌Eca-109细胞,分A组不加粒子(对照组);B组0.2mCi(低剂量组);C组0.4mCi(中剂量组);D组0.8mCi(高剂量组).分析细胞克隆形成率、细胞凋亡指数和细胞周期分布情况;建立裸鼠皮下移植性食管癌模型后,对照组(A组,不做任何处理)、假手术组(B组,穿刺瘤体1次,但不植入粒子)、低剂量组(C组,0.2mCi)、中剂量组(D组,0.4mCi)和高剂量组(E组,0.8mCi),计算各组抑瘤率.临床试验:前瞻性研究,入组时间为2000-2004年.根据ESCC术前CT分期标准,298例Ⅱ-Ⅲ期胸段ESCC患者随机分为术中联合125I粒子植入组及单纯手术组.依据TPS所确定的剂量,A组术中直视下植入125I粒子.选用0.5mCi的125I粒子20-40粒,总活度在10-30mCi,肿瘤匹配周边剂量60-70Gy,术后行粒子验证和质量评估.观察患者术后并发症、监测局部复发情况、评价患者疗效.结果:细胞克隆形成率B、C、D组均低于A组...     

CT-guided implantation of radioactive 125I seed in advanced non-small-cell lung cancer after failure of first-line chemotherapy

Purpose

We investigated implanting computed tomography (CT)-guided ¹²⁵I seed to treat locally advanced non-small-cell lung cancer (NSCLC) after chemotherapy failure.

Methods

From January 2005 to July 2010, we recruited 69 patients with locally advanced NSCLC who had each had first-line chemotherapy four to six times but had progressive disease; 34 received ¹²⁵I seed implantation with second-line chemotherapy (Group A) and 35 received second-line chemotherapy only (Group B).

Results

Mean follow-up was 32 months (range 5–56 months). Overall 2-year local control rate for existing lung lesions was Group A: 39.9 %; Group B: 12.5 % (P < 0.05). The 1-, 3-year, and median overall survival was 68.7 and 20.8 % at 17.4 months in Group A; and 45.1 and 18.7 % at 11.3 months in Group B, respectively (P > 0.05). Local 3-, 24-month, and median progression-free survival was Group A: 100 and 79.1 % at 11 months; Group B: 76.5 and 18.7 % at 7.3 months, respectively. The groups did not significantly differ in treatment toxicity. Chest pain remission was Group A: 82.1 % (23/28); Group B: 30.8 % (8/26) (P < 0.05). Group A showed no radiation-related pneumonia, esophagitis, bronchial fistulae, or life-threatening morbidity.

Conclusion

CT-guided radioactive seed ¹²⁵I implantation procedure is safe and well tolerated in treating locally advanced NSCLC, with few complications. It has good local control rate and can relieve symptoms without increasing side effects.     

I125粒子植入在胰腺恶性肿瘤治疗中的疗效分析

目的:分析姑息性手术联合I125粒子植入和化疗对晚期胰腺癌患者的疗效.方法:回顾性分析我科2004.2008年收治的晚期胰腺癌患者149例,按治疗方法分为2组,姑息手术+I125粒子植入+化疗62例(A组),姑息手术+化疗87例(B组).比较2组患者客观有效率(OTR)、临床受益率(CBR)、中位生存期以及并发症发生率.结果:与B组相比,Am患者临床受益率,中位生存期差异有统计学差异(χ2=7.361,10.090,P<0.05),而客观有效率与并发症发生率差异无统计学差异(P>0.05).结论:姑息性手术联合I125粒子植入和术后化疗治疗晚期胰腺癌患者,是一种安全有效的治疗方法.     

125I粒子植入或3DCRT联合TACE治疗晚期原发性肝癌患者临床疗效对比研究*

目的 研究¹²⁵I粒子植入或者三维适形放射治疗(3DCRT)联合肝动脉化疗栓塞(TACE)治疗肝细胞癌(HCC)患者的临床疗效。方法 采用随机数字表法将92例HCC患者分为观察组和对照组,每组46例。在观察组,采用¹²⁵I粒子植入联合TACE治疗,对照组患者接受3DCRT联合TACE治疗。检测血清甲胎蛋白(AFP)、甲胎蛋白异质体(AFP-L3)和高尔基体蛋白73(GP73)。结果 治疗后第4周时,观察组和对照组疾病控制率分别为62.5%和57.5%(P>0.05)],观察组和对照组1 a生存率分别为52.5%和45.0%(P>0.05)];治疗前和治疗后1月,两组血清AFP、AFP-L3和GP73水平比较,差异均无统计学意义(P>0.05);在治疗期间,两组白细胞降低、贫血、血小板降低和胃肠道反应发生率比较,差异均无统计学意义(P>0.05),观察组放射性肝损伤严重程度较对照组显著减轻,差异有统计学意义(P<0.05)。结论 采用TACE治疗晚期肝癌患者短期有效,与¹²⁵I粒子植入或3DCRT联合治疗可提高疗效,但联合¹²⁵I粒子植入可能副反应更轻。     

~(125)I放射性粒子植入治疗肝转移癌的近期疗效

目的:分析应用125I放射性粒子植入近距离放疗治疗肝转移癌的近期疗效.方法:24例肝转移癌患者共32个病灶,因不宜或不同意外科手术切除而行粒子植入治疗,病灶直径4.5-12.8cm,平均7.8cm.术后复查随访统计有效率、局部控制率和生存率以及副反应等情况.结果:32个病灶中肿瘤完全缓解(CR)7个,部分缓解(PR)16个,无缓解(NR)5个,肿瘤进展(PD)4个;有效率CR+PR为71.9%.术后随访时间为7-22mo,平均16mo,局部控制率为65.6%,总生存率为70.1%,未发现严重并发症.结论:对于手术禁忌或不接受手术的肝转移癌患者,125I放射性粒子植入近距离放疗可以获得较好的近期疗效.     

To evaluate the efficacy and safety of 125I seed implantation in SCLC as second line therapy

This study aimed to evaluate the efficacy and safety of iodine 125 (¹²⁵I) radioactive seed implantation for small cell lung cancer at the limited stage of relapse as second line therapy. We collected 6 patients with recurred limited stage small cell lung cancer, who got pathological diagnosis after a bronchoscopic biopsy and then received standard first line treatment, combined chemotherapy and radiotherapy, including prophylactic cranial irradiation. These recurred small cell lung cancer patients got ¹²⁵I seed implantation treatment as second line therapy, if the treatment not good responsive or the disease got rapid progress, we used the second line chemotherapy as salvage treatment. Clinical data of these patients were collected and short-term effects were observed. The follow-up period lasted for 42 months. All the patients tolerated the procedure of ¹²⁵I radioactive seed implantation very well. We followed up the patients to 42 months. Five patients got complete remission and 1 patient got partial remission at 1 month after implantation. The objective response rate was 100%. The median survival time was 26 months. And median progression-free survival was 12 months after ¹²⁵I treatment. And about the complications, 1 patient suffered from the light aerothorax, 1 patient had a little hemoptysis. Our study showed that ¹²⁵I seed implantation as second line regimen in small cell lung cancer that recurred locally after first line treatment was effective and safe. That could improve the overall survival and progression-free survival only comparing to the second line chemotherapy. Therefore ¹²⁵I seed implantation as brachytherapy protocol is a promising method and can be applied as second line treatment to control the locally recurred small cell lung cancer.