| 焦德超,韩新巍,王俊杰,张建好,王艳丽,水少锋,任建庄,李宗明,张全会,牛荣仿.125Ⅰ放射性粒子链腔内近距离放疗输尿管癌的初步经验[J].中华放射医学与防护杂志,2017,37(7):508-513 |
| 125Ⅰ放射性粒子链腔内近距离放疗输尿管癌的初步经验 |
| Preliminary experience of 125Ⅰ seed strands cavity brachytherapy for ureteral carcinoma |
| 投稿时间：2017-03-14 |
| DOI：10.3760/cma.j.issn.0254-5098.2017.07.007 |
| 中文关键词: 125Ⅰ粒子链 近距离放疗 输尿管癌 |
| 英文关键词:125Ⅰ seed strands Brachytherapy Ureteral carcinoma |
| 基金项目:国家高新研发项目（863项目）（2015AA020301） |
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| 中文摘要: |
| 目的 初步评价放射性 125Ⅰ粒子链腔内近距离放疗输尿管癌的安全性和有效性。方法 10例输尿管癌患者采用C臂 CT联合数字血管造影（DSA）引导进行肾造瘘，并在输尿管闭塞/狭窄段置入 125Ⅰ粒子链行腔内近距离放疗。评价技术成功率、并发症、肿瘤局部控制率、输尿管通畅情况和生存时间，比较治疗前后Karnofsky评分、肾积水Girignon分级和疼痛评分，对比术前术后剂量学参数。结果 所有患者均顺利完成肾造瘘及粒子链植入，技术成功率100%，操作时间（12.3±3.8）min，无输尿管穿孔、感染、严重出血等情况发生。粒子链近距离放疗后2~3个月，局部病灶评价CR 4 例，PR 6例，局部控制率（CR+PR）100%。输尿管通畅率50%（5/10）。患者术后Karnofsky评分，肾积水Girignon分级，疼痛评分均较术前明显改善（Z=-2.72、-2.88、-2.83，P<0.01）。平均随访（14.6±6.5）（5~25）个月，3例随访期间病情进展，7例病情稳定；9例患者存活，1例因多器官衰竭死亡。术前术后D90%、mPD、V100%、V150%、V200%、CI、EI、HI比较，差异均无统计学意义（P>0.05）。结论 肾造瘘联合放射性粒子链腔内近距治疗输尿管癌安全有效，无严重并发症，是无法接受外科根治术患者有效替代方案。 |
| 英文摘要: |
| Objective To evaluate the safety and efficacy of 125Ⅰ seed strands cavity brachytherapy for ureteral carcinoma. Methods To tally 10 patients with ureteral carcinoma underwent C-arm CT and DSA guided percutaneous nephrostomy with 125Ⅰ seed strands cavity brachytherapy. The technical success rate, complications, tumor local control rate, ureteral patency andsurvival time, and compared the Karnofsky scores, Girignon grade, pain score before and after treatment were evaluated.The dose related parameters were compared between pre-and post-treatment. Results 125Ⅰ seed strands implantation was successfully completed in all patients with technical success rate of 100%. The mean procedure time was (12.3±3.8) min. No severe complications such as ureteral perforation, infection, severe bleeding occurred. Local tumor response was CR in 4 cases and PR in 6 cases, showing local control efficiency (CR+PR) 100% after 2-3 months. Ureteral patency rate was 50% (5/10). Postprocedure Karnofsky scores, Girignon grades, and pain scores were significantly improved (Z=-2.72, -2.88, -2.83, P<0.01). The average follow-up time was (14.6±6.5) months (5-25 months), tumor progression was observed in 3 cases, stable disease in 7 cases. Nine cases were alive and one died due to multiple organ failure. The differences of D90%, mPD, V100%, V150%, V200%, CI, EI, HI between the pre-and post-treatment were not statistically significant (P>0.05). Conclusions 125Ⅰ seed strands cavity brachytherapy for ureteral carcinoma is an effective and safe procedure without serious complications, and an effective alternative treatment for patients who are unable to undergoor refuse surgery. |
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