CT导引下125I粒子植入治疗外照射后复发的恶性肿瘤

目的 评价外照射后复发的恶性肿瘤行CT导引下瘤体内^125I粒子植入治疗的可行性、安全性及疗效。资料与方法 2001年12月至2004年12月，14例外照射后局部复发的恶性肿瘤行CT导引下瘤体内^125I粒子植入，其中原发肿瘤8例，转移瘤6例（11个病灶），病灶的平均直径为3．25cm。依据粒子植入术前CT图像应用计算机治疗计划系统制定粒子植入计划，按治疗计划在CT导引下穿刺植入^125I粒子。植入^125I粒子数为9．48粒（中位数为28粒）。植入术后立即CT扫描及术后2～6个月CT扫描观察粒子在瘤体内的分布、有无并发症发生及疗效。结果 14例粒子植入均顺利完成，瘤体内粒子分布满意，其中1例植入术后有2粒粒子脱落到体外，未见急性并发症和治疗相关的放射损伤。4例疼痛患者粒子植入术后疼痛均有明显减轻。14例19个病灶粒子植入后完全缓解（CR）5个，部分缓解（PR）9个，无变化（NC）4个，进展（PD）1个，近期总有效率73．7％。结论 对于外照射后复发的恶性肿瘤CT导引下瘤体内^125I粒子植入近距离放射治疗是一种安全、可行的治疗方法，近期肿瘤局部控制率满意，远期疗效有待大组病例进一步观察。

CT-guided Percutaneous Permanent Iodine-125 Implantation for Recurrent Malignant Tumor After External Beam Radiation

Objective To evaluate the feasibility, safety and efficacy of CT guided permanent iodine-125 implantation in patients with local recurrent malignant tumor after external beam radiation.Materials and Methods 14 patients with recurrent malignant tumor after external beam radiation were treated with CT-guided iodine-125 permanent implantation brachytherapy, of which 8 cases were primary unresectable carcinoma and remaining 6 cases were metastases. The mean lesion diameter of perimplant was 3.25 cm. Based on the CT imaging before the implantation, a computer based treatment planning system was used to determine the optimal seed distribution. Subsequently CT-guided needle placement and seed implantation were carried out. The number of seeds implanted in lesion was 9 to 44 (median 28). Postimplant CT scans were performed immediately and seed distribution, complication and curative effect were evaluated 2 to 6 months after the implantation in all cases.Results CT-guided iodine 125 permanent implantation was accomplished smoothly in all cases, seeds were placed properly and accurately. 2 seeds migration were occurred in 1 case, no acute complications and injury related to the radiotherapy were observed. Pain relief was obtained in 4 cases (100%) presenting with pain. Among 19 lesions in 14 cases, 5 cases were completely relieved (CR), partly relieved in 9 cases (PR), no change in 4 cases (NC) and progressed in 1 cases (PD). Recent effective rate was 73.7%. Conclusion CT-guided iodine-125 permanent implantation is a feasible, effective, safe for locally recurrent malignant tumor after external beam radiation. The local control is promising, long term effective need series of patients to evaluate.