热疗联合125I粒子治疗复发性直肠癌的近期疗效评价

目的：通过比较复发性直肠癌患者治疗前、后影像学和血清中癌胚抗原（CEA）以及术后随访结果，评价热疗联合¹²⁵I放射性粒子治疗直肠癌的有效性。方法：手术且放疗后行CT引导下¹²⁵I放射性粒子植入术（20例手术治疗患者，1例患者无法耐受热疗退出），术前应用放射性粒子治疗计划系统（TPS）制定粒子植入计划，粒子间距为1.0 cm，植入后立即复查CT，再行剂量验证，植入粒子数量为12~58颗，每颗粒子放射性活度为0.5 mCi，肿瘤周边匹配剂量为90~140 Gy。射频热疗，每次60 min，维持温度43℃，每周2次，连续3周。治疗后随访3个月，通过影像学结果和血清中CEA水平变化评价有效率，并评估尿频、尿痛、血尿和直肠出血等并发症。结果：与治疗前比较，随访6个月后影像学结果显示肿瘤缩小；患者治疗后血清中CEA水平由治疗前（30.25±8.32） mg·L^-1降低到（11.89±5.22） mg·L^-1（t=13.158，P < 0.01）；局部有效率94.7%（18/19），疼痛缓解率为94.4%（17/18）；治疗前NRS评分中位数为6（4，7）分，治疗后NRS评分中位数为1（0，3）分，治疗前后比较差异有统计学意义（P < 0.01）。随访期间患者未出现尿频、尿痛、血尿和直肠出血等并发症。结论：热疗联合¹²⁵I放射性粒子植入对复发性直肠癌具有较好的临床效果，是复发性直肠癌有效的综合治疗手段。

Observation on short-term efficacy of thermal-therapy combined with 125I particles in treatment of recurrent rectal cancer

Objective:To evaluate the clinical efficacy of thermal-therapy combined with 125 I radioactive particles by comparing the results of preoperative and postoperative images,serum carcino-embryonic antigen (CEA) and following-up after treatment of the patients with recurrent rectal cancer.Methods:Nineteen rectal cancer patients with postoperative recurrence after radiotherapy were treated with 125I implantation guided by CT (20 cases were treated with operation,but 1 patient was exited who couldn't tolerate the thermal-therapy).Radioactive particle treatment planning system (TPS) was used to make the plan before the particle implantation,and the distance of the particle was 1.0 cm;all patients received CT scanning and were quantificationally evaluatated after implantation;the number of seeded particles was about 12-58,the radioactivity of the 125I particle was 0.5 mCi,and the matching dose surrounding the tumor was 90-140 Gy.All patients were treated with microwave thermal-therapy after particle implantation,60 min per time,lasting the temprature at 43℃,twice per week,for three weeks.And the patients were followed up after treatment for 3 months,the efficacy was evaluated by image and CEA results,and the urinary frequency,dysuria,hematuria and rectal bleeding were evaluated.Results:Compred with before treatment,after following up for 6 months,the image results showed that the tumor volume was reduced,and the blood CEA level of all patients were decreased from (30.25±8.32) mg · L-1 to (11.89±5.22) mg · L-1 (t=13.158,P＜0.01);the local efficacy was 94.7％ (18/19),and the pain relief rate was 94.4％ (17/18);the NRS median was 6 (4,7) before treatment,and it was 1 (0,3) after treatment,there was significant difference (P＜0.001).There were no frequent urination,urinary pain,hematuria,rectal bleeding and other complications in all patients.Conclusion:Thermal-therapy combined with 125I radioactive particle implantation has good curative effects on the recurrent rectum cancer,and is effective means for recurrent rectum cancer treatment.