中华核医学与分子影像杂志
中華覈醫學與分子影像雜誌
중화핵의학여분자영상잡지
Chinese Journal of Nuclear Medicine and Molecular Imaging
2013年
3期
195-198
,共4页
骆红蕾%喻晓娟%李进%陈小飞%何敬东
駱紅蕾%喻曉娟%李進%陳小飛%何敬東
락홍뢰%유효연%리진%진소비%하경동
癌,非小细胞肺%碘放射性同位素%近距离放射疗法
癌,非小細胞肺%碘放射性同位素%近距離放射療法
암,비소세포폐%전방사성동위소%근거리방사요법
Carcinoma,non-small cell lung%Iodine radioisotopes%Brachytherapy
目的 探讨125I粒子植入联合化疗治疗同期放化疗后局部复发的Ⅲ期NSCLC的临床疗效.方法 2006年1月至2009年1月同期放化疗后局部复发的Ⅲ期NSCLC患者34例,按随机数字表法分为2组,其中对照组(17例)给予多西他赛60 mg/m2+顺铂75 mg/m2(DP方案),治疗组(17例)行125I粒子植入+ DP方案.用放射性粒子TPS制定125I粒子治疗计划.在CT引导下经皮穿刺植入125I粒子,处方剂量为90 ～ 110 Gy,术后即刻验证肿瘤匹配周边剂量(mPD),覆盖90％靶区的剂量(D90).随访至疾病进展.研究经医院伦理委员会批准,患者均签署知情同意书.局部病变控制时间、疾病无进展时间(PFS)分析采用log-rank法,Fisher确切概率法比较2组肿瘤CR率和近期有效率.结果 125I粒子植入术后mPD为93.9～130.4 Gy,中位剂量116.7 Gy；D9o为103.6 ～148.2 Gy,中位剂量130.6 Gy.治疗组局部控制时间为4,7 ～24.0(中位时间11.6;95％ CI:8.7 ～ 14.6)个月,其中2例随访24个月局部病灶无进展；PFS为10.5 (4.7 ～ 24.0；95％ CI:7.4 ～ 13.6)个月,近期有效率为64.7％ (11/17),肿瘤CR率41.2％ (7/17),PR率23.5％ (4/17),SD率23.5％ (4/17),PD率11.8％(2/17).对照组局部控制时间4.5 ～11.4(中位时间为7.5；95％ CI:6.7 ～8.3)个月,PFS为6.5(4.5～10.5；95％ CI:5.7 ～8.3)个月,近期有效率为41.2％ (7/17),CR率5.9％ (1/17),PR率35.3％ (6/17),SD率35.3％ (6/17),PD率23.5％ (4/17).2组近期有效率差异无统计学意义(P=0.30),局部控制时间(x2=8.40,P＜0.01)、PFS(x2=6.27,P＜0.05)、肿瘤CR率(P=0.04)差异均有统计学意义.结论 125I粒子植入联合化疗对治疗放化疗后局部复发的Ⅲ期NSCLC有效、安全,其疗效优于单纯化疗.
目的 探討125I粒子植入聯閤化療治療同期放化療後跼部複髮的Ⅲ期NSCLC的臨床療效.方法 2006年1月至2009年1月同期放化療後跼部複髮的Ⅲ期NSCLC患者34例,按隨機數字錶法分為2組,其中對照組(17例)給予多西他賽60 mg/m2+順鉑75 mg/m2(DP方案),治療組(17例)行125I粒子植入+ DP方案.用放射性粒子TPS製定125I粒子治療計劃.在CT引導下經皮穿刺植入125I粒子,處方劑量為90 ～ 110 Gy,術後即刻驗證腫瘤匹配週邊劑量(mPD),覆蓋90％靶區的劑量(D90).隨訪至疾病進展.研究經醫院倫理委員會批準,患者均籤署知情同意書.跼部病變控製時間、疾病無進展時間(PFS)分析採用log-rank法,Fisher確切概率法比較2組腫瘤CR率和近期有效率.結果 125I粒子植入術後mPD為93.9～130.4 Gy,中位劑量116.7 Gy；D9o為103.6 ～148.2 Gy,中位劑量130.6 Gy.治療組跼部控製時間為4,7 ～24.0(中位時間11.6;95％ CI:8.7 ～ 14.6)箇月,其中2例隨訪24箇月跼部病竈無進展；PFS為10.5 (4.7 ～ 24.0；95％ CI:7.4 ～ 13.6)箇月,近期有效率為64.7％ (11/17),腫瘤CR率41.2％ (7/17),PR率23.5％ (4/17),SD率23.5％ (4/17),PD率11.8％(2/17).對照組跼部控製時間4.5 ～11.4(中位時間為7.5；95％ CI:6.7 ～8.3)箇月,PFS為6.5(4.5～10.5；95％ CI:5.7 ～8.3)箇月,近期有效率為41.2％ (7/17),CR率5.9％ (1/17),PR率35.3％ (6/17),SD率35.3％ (6/17),PD率23.5％ (4/17).2組近期有效率差異無統計學意義(P=0.30),跼部控製時間(x2=8.40,P＜0.01)、PFS(x2=6.27,P＜0.05)、腫瘤CR率(P=0.04)差異均有統計學意義.結論 125I粒子植入聯閤化療對治療放化療後跼部複髮的Ⅲ期NSCLC有效、安全,其療效優于單純化療.
목적 탐토125I입자식입연합화료치료동기방화료후국부복발적Ⅲ기NSCLC적림상료효.방법 2006년1월지2009년1월동기방화료후국부복발적Ⅲ기NSCLC환자34례,안수궤수자표법분위2조,기중대조조(17례)급여다서타새60 mg/m2+순박75 mg/m2(DP방안),치료조(17례)행125I입자식입+ DP방안.용방사성입자TPS제정125I입자치료계화.재CT인도하경피천자식입125I입자,처방제량위90 ～ 110 Gy,술후즉각험증종류필배주변제량(mPD),복개90％파구적제량(D90).수방지질병진전.연구경의원윤리위원회비준,환자균첨서지정동의서.국부병변공제시간、질병무진전시간(PFS)분석채용log-rank법,Fisher학절개솔법비교2조종류CR솔화근기유효솔.결과 125I입자식입술후mPD위93.9～130.4 Gy,중위제량116.7 Gy；D9o위103.6 ～148.2 Gy,중위제량130.6 Gy.치료조국부공제시간위4,7 ～24.0(중위시간11.6;95％ CI:8.7 ～ 14.6)개월,기중2례수방24개월국부병조무진전；PFS위10.5 (4.7 ～ 24.0；95％ CI:7.4 ～ 13.6)개월,근기유효솔위64.7％ (11/17),종류CR솔41.2％ (7/17),PR솔23.5％ (4/17),SD솔23.5％ (4/17),PD솔11.8％(2/17).대조조국부공제시간4.5 ～11.4(중위시간위7.5；95％ CI:6.7 ～8.3)개월,PFS위6.5(4.5～10.5；95％ CI:5.7 ～8.3)개월,근기유효솔위41.2％ (7/17),CR솔5.9％ (1/17),PR솔35.3％ (6/17),SD솔35.3％ (6/17),PD솔23.5％ (4/17).2조근기유효솔차이무통계학의의(P=0.30),국부공제시간(x2=8.40,P＜0.01)、PFS(x2=6.27,P＜0.05)、종류CR솔(P=0.04)차이균유통계학의의.결론 125I입자식입연합화료대치료방화료후국부복발적Ⅲ기NSCLC유효、안전,기료효우우단순화료.
Objective To investigate the associated effect of 125I implantation plus chemotherapy in local recurrent stage Ⅲ NSCLC patients.Methods From January 2006 to January 2009,34 patients documented with local recurrent stage Ⅲ NSCLC were divided into two groups by random number table.The treatment group was treated with 125I permanent implantation combined with DP regimen (docetaxel 60 mg/m2 + cisplatinum 75 mg/m2),while the control group received only DP chemotherapy.According to the TPS,the treatment group received CT-guided percutaneous implantation of 125 I seeds with a particle activity of 2.22 ×107-2.59 × 107 Bq.The prescribed dose was in the range of 90-110 Gy and the postoperatively matched peripheral dose (mPD) and D9o were verified by TPS.The control group received a DP chemotherapy regime for 4 cycles after the procedure.This study was approved by the ethics committee,and all patients signed informed consents.The follow up time was up to disease progression.Kaplan-Meier survival analysis was used to describe the local lesion control (LLC) time and progression free survival (PFS).Log-rank test was used in the comparison of the survival rates between the two groups.Fisher's exact test was used to analyze the differences of CR rate and recent efficiency between two groups.Results In the treatment group,postoperative mPD was 93.9-130.4 (M 116.7) Gy,and D90 was 103.6-148.2 (M 130.6) Gy.The LLC time was 4.7 to 24.0 months with a median of 11.6 (95％ CI:8.7-14.6) months.In two cases,there was no recurrence during the follow-up time of 24 months.PFS was 4.7 to 24.0 months with a median of 10.5 (95％ CI:7.4-13.6) months.The recent effective rate of the treatment group was 64.7％ (11/17).CR,PR,SD and PD were 41.2％ (7/17),23.5％ (4/17),23.5％ (4/17) and 11.8％ (2/17),respectively.In the control group,the LLC time was 4.5 to 11.4 months with a median of 7.5 (95 ％ CI:6.7-8.3) months,and the median of PFS was 6.5 (4.5-10.5) (95％ CI:5.7-8.3) months.The response rate,CR,PR,SD and PD were 41.2％ (7/17),5.9％ (1/17),35.3％ (6/17),35.3 ％ (6/17) and 23.5％ (4/17),respectively.There was no statistical significance of the recent effective rate between the treatment group and control group (P =0.30),but the LLC time (x2 =8.40,P ＜ 0.01),the median of PFS time (x2 =6.27,P ＜ 0.05) and CR (P =0.04) of the treatment group were all significantly higher than those of the control group.Concltusion The implantation of 125I seeds combined with chemotherapy for recurring stage Ⅲ NSCLC patients is safe and effective,and its efficacy is superior to the second line chemotherapy alone.
