CAJ | 학술논문

目的探讨CT引导下放射性125碘(Ⅰ)放射性粒子组织间植入对复发性卵巢癌治疗的可行性、近期疗效及并发症.方法 2009年10月至2010年11月,收集中山大学肿瘤医院影像与微创介入中心18 F-FDG PET/CT诊断的12例复发卵巢癌患者共25处病灶,其中21处病灶采用放射性粒子组织间植入治疗,1例患者3处肝、1处脾转移病灶采用CT引导下微波消融治疗.9例患者粒子植入术后进行了2～6疗程化疗.在采用粒子植入治疗的21处病灶中长径＞2 cm的11处,≤2 cm的10处；根据PET/CT图像显示的病灶高代谢范围,应用放射性粒子治疗计划系统(TPS)或Memorial Sloan-Ketterin列解图法(nomogram)制定粒子植入计划；靶区匹配周边剂量(MPD)为145 Gy,植入粒子数9 ～ 45颗,中位数20.5颗.应用18F-FDG PET/CT或CT判断放射性粒子治疗效果.结果术后随访时间9～ 19个月,中位随访时间15个月,除1例患者因肿瘤侵犯双侧输尿管引起肾功能衰竭导致死亡外,其余患者随访期内均存活.在21处粒子植入治疗的病灶中,10处肿瘤病灶完全缓解(CR),6处部分缓解(PR),5处局部进展(PD),有效率76.2％.经Fisher确切概率法统计分析,长径≤2 cm病灶局部控制效果好于长径＞2 cm的病灶(P=0.035).微波消融治疗肝、脾共4处病灶,经18F-FDG PET/CT检查肿瘤活性完全消失.1例患者术中穿刺时损伤坐骨神经,出现了右下肢麻木、疼痛,半年后症状逐渐消失；本组患者未出现肠瘘、直肠炎等放射性损伤并发症.结论 CT引导下125Ⅰ放射性粒子组织间植入可用于复发性卵巢癌治疗,其近期疗效好、并发症少.125Ⅰ粒子植入治疗与化疗结合,具有巩固和提高局部复发性卵巢癌的疗效作用.
목적 탐토CT인도하방사성125전(Ⅰ)방사성입자조직간식입대복발성란소암치료적가행성、근기료효급병발증.방법 2009년10월지2010년11월,수집중산대학종류의원영상여미창개입중심18 F-FDG PET/CT진단적12례복발란소암환자공25처병조,기중21처병조채용방사성입자조직간식입치료,1례환자3처간、1처비전이병조채용CT인도하미파소융치료.9례환자입자식입술후진행료2～6료정화료.재채용입자식입치료적21처병조중장경＞2 cm적11처,≤2 cm적10처；근거PET/CT도상현시적병조고대사범위,응용방사성입자치료계화계통(TPS)혹Memorial Sloan-Ketterin렬해도법(nomogram)제정입자식입계화；파구필배주변제량(MPD)위145 Gy,식입입자수9 ～ 45과,중위수20.5과.응용18F-FDG PET/CT혹CT판단방사성입자치료효과.결과 술후수방시간9～ 19개월,중위수방시간15개월,제1례환자인종류침범쌍측수뇨관인기신공능쇠갈도치사망외,기여환자수방기내균존활.재21처입자식입치료적병조중,10처종류병조완전완해(CR),6처부분완해(PR),5처국부진전(PD),유효솔76.2％.경Fisher학절개솔법통계분석,장경≤2 cm병조국부공제효과호우장경＞2 cm적병조(P=0.035).미파소융치료간、비공4처병조,경18F-FDG PET/CT검사종류활성완전소실.1례환자술중천자시손상좌골신경,출현료우하지마목、동통,반년후증상축점소실；본조환자미출현장루、직장염등방사성손상병발증.결론 CT인도하125Ⅰ방사성입자조직간식입가용우복발성란소암치료,기근기료효호、병발증소.125Ⅰ입자식입치료여화료결합,구유공고화제고국부복발성란소암적료효작용.
Objective To explore the feasibility,short-term efficacies and complications of computed tomography (CT)-guided 125Ⅰ interstitial implant therapy for recurrent ovarian cancer.Methods From October 2009 to November 2010,a total of 25 lesions for 12 patients were diagnosed as recurrent ovarian cancer by positron emission tomography/computed tomography (PET/CT).Among 25 lesions,21 underwent 125Ⅰ seed implantation.And 4 lesions of liver and spleen in one patient were treated with microwave ablation.Nine patients underwent 2-6 cycles of chemotherapy after seeding.There were 11 lesions with diameter ＞ 2 cm and 10 ≤2 cm.According to the area of physiologic 18FDG uptake in lesions,the treatment plans were formulated by computerized treatment planning system (TPS) and Memorial Sloan-Ketterin nomograph.The matched peripheral dose (MPD) was 145 Gy in target mass.A median of 20.5 seeds per patient (range:9-45) were implanted.The efficacies were evaluated by CT and 18F-FDG PET/CT findings.Results One patient died of renal failure while the other patients survived during a median followup of 15 mouths (range:9-19).Ten lesions showed complete remission,6 partial remission and 5 progressive disease.The effective rate was 76.2％ (16/21).Compared with those ＞ 2 cm,the lesions ≤2 cm in diameter had a better local control rate by Fisher's exact test (P =0.035).The hepatic and renallesions treated by microwave ablation showed inactivation on PET/CT.Only one patient suffered from sciatic nerve injury caused by punctuation and numbness and pain of right lower extremity were persistent.There was no onset of the complications of radiation injury,such as intestinal fistula and proctitis.Conclusion The CT-guided 125Ⅰ interstitial implant therapy for recurrent ovarian cancer yields excellent short-term efficacies with fewer complications.The combined modality of 125I interstitial implant and chemotherapy may further improve the patient outcomes.