| 霍彬,霍小东,王磊,曹强,王金焕,王丽丽,臧立,王海涛,柴树德,王俊杰.CT联合模板引导放射性粒子植入治疗不可手术的早期非小细胞肺癌[J].中华放射医学与防护杂志,2017,37(7):500-504 |
| CT联合模板引导放射性粒子植入治疗不可手术的早期非小细胞肺癌 |
| CT and template-guided radioactive seed implantation for inoperable early stage non-small cell lung cancer |
| 投稿时间：2017-04-05 |
| DOI：10.3760/cma.j.issn.0254-5098.2017.07.005 |
| 中文关键词: 模板 CT引导 近距离放射治疗 放射性粒子植入 非小细胞肺癌 |
| 英文关键词:Template CT guided Brachytherapy Radioactive seeds implantation Non small cell lung cancer(NSCLC) |
| 基金项目:国家自然科学基金（81572543）；天津市自然科学基金（15JCYBJC28400） |
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| 中文摘要: |
| 目的 探讨CT联合模板引导放射性粒子植入治疗不可手术的早期非小细胞肺癌（NSCLC）的疗效和不良反应。方法 回顾性分析2010年12月到2016年10月间在天津医科大学第二医院接受CT引导下放射性粒子治疗的21例不可手术的T1-2N0M0早期非小细胞肺癌患者。所有患者术前取得组织学病理，选用粒子活度18.5~29.6 MBq，处方剂量120~160 Gy，均在1次手术内完成粒子植入，术前及术后经TPS制定计划和质量验证。随访评价肿瘤局部控制率、总生存时间、无进展生存期、剂量验证满意率及不良反应。结果 中位随访时间为25.1个月（范围4.4~72.7个月）。1、2、3年的原发肿瘤局部控制率分别为100%、95.2%、95.2%。所有患者的中位总生存期为48个月，中位无进展生存期为43.4个月。1、2、3年生存率分别为100%、91.7%、72.9%。3年无进展生存率为70.2%。术后质量验证满意率为100%。与治疗相关的不良事件包括：气胸、支气管出血、胸膜出血、咳嗽、肺部纤维化及粒子移位。其中7例患者发生1级不良事件（33.3%）；4例患者发生2级不良事件（19%）。无3级或更高级别不良事件发生。结论 CT联合模板引导放射性粒子植入治疗T1-2N0M0的NSCLC肿瘤局部控制率较高，治疗相关不良反应较少，可作为不可手术的早期非小细胞肺癌治疗的一种选择。 |
| 英文摘要: |
| Objective To investigate the efficacy and side effects of radioactive seed implantation in the treatment of non-surgical early stage non-small cell lung cancer (NSCLC) based on CT guidance combined with template. Methods Twenty-one patients with inoperable T1-2N0M0 NSCLC who underwent CT-guided radioactive seed implantation therapy were retrospectively analyzed from December 2010 to October 2016 in the Second Hospital of Tianjin Medical University. All patients were diagnosed by histopathology. All seeds, with the activity of 18.5-29.6 MBq and prescription dose of 120-160 Gy, were completed in an operation of the radioactive seed implantation. The preoperative and postoperative TPS treatment plans and quality verification were corducted. In addition, the local control rate of tumors, overall survival (OS), progression free survival time (PFS), satisfaction rate of dose validation and adverse reactions were evaluated. Results The median follow-up was 25.1 months (range 4.4-72.7 months). The local control rate of primary tumor in 1-, 2- and 3-year was 100%, 95.2% and 95.2%, respectively. Of all patients, the median OS was 48 months with the median PFS 43.4 months. In particular, the 1-, 2- and 3-year survival rate was 100%, 91.7% and 72.9%, respectively. Moreover, the rate of 3-year PFS was 70.2% and the satisfactory rate of postoperative quality verification was 100%. The treatment-related adverse events included pneumothorax, bronchial hemorrhage, pleural effusion, cough, pulmonary fibrosis and seed shifts. In all, 7 (33.3%) patients had grade 1 adverse events and 4 (19%) patients with grade 2, but no grade 3 adverse event. Conclusions CT and template-guided radioactive seed implantation in NSCLC with T1-2N0M0 has a high tumor local control rate and low treatment-related adverse reactions, suggesting that it might provide an alternative way for the treatment of inoperable early stage NSCLC. |
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