| 姜伟娟,王俊杰,林蕾,姜玉良,田素青,孙海涛,江萍.图像引导放射性125I粒子植入治疗复发性软组织肉瘤疗效以及临床预后因素分析[J].中华放射医学与防护杂志,2018,38(6):429-433 |
| 图像引导放射性125I粒子植入治疗复发性软组织肉瘤疗效以及临床预后因素分析 |
| Efficacy and clinical prognostic factors of image-guided 125I seed implantation for locally recurrent soft tissue sarcoma |
| 投稿时间：2018-01-12 |
| DOI：10.3760/cma.j.issn.0254-5098.2018.06.006 |
| 中文关键词: 软组织肉瘤 复发 125I粒子 预后 |
| 英文关键词:Recurrence Soft tissue sarcoma 125I seed implantation Prognosis |
| 基金项目:福建省科技厅引导性项目（2016Y0044）；福建省医学创新项目（2016-CX-19） |
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| 中文摘要: |
| 目的 观察图像引导下放射性125I粒子植入治疗复发性软组织肉瘤的疗效和不良反应，分析临床因素与预后之间关系。方法 回顾分析2002年9月—2015年12月北京大学第三医院图像引导下采用放射性125I粒子植入治疗的60例局部复发软组织肉瘤资料。入组患者KPS≥60分、拒绝或不能耐受再次手术、拒绝或不能耐受放疗、预计总生存时间>3个月的软组织肉瘤多重治疗后复发，行CT或超声引导性放射性125I粒子植入治疗。本组患者中位粒子活度为25.9×106 Bq（11.1×106~29.6×106 Bq），植入粒子中位数为58颗（3~133），中位D90为120 Gy（36.50~460.97 Gy）。评价患者总生存（OS）时间和局部无进展生存（LPFS）时间及其与临床因素的关系。Kaplan-Meier计算OS率和LPFS率。Log-rank检验和Cox回归进行单因素和多因素分析。结果 中位随访时间18.75个月（1~146个月）。中位OS时间18.5个月（95%CI 13.1~23.9），1、3、5年OS率分别为63.3%、33.0%、29.5%。1、3、5年LPFS率分别为72.5%、63.7%、59.7%。疼痛缓解率为100%（6/6）。8.3%（5/60）患者出现4级皮肤反应，无致死性并发症发生。单因素分析显示，肿瘤最大径 < 7 cm、既往应用化疗、KPS评分、是否伴有全身转移、肿瘤体积 < 45 cm3、D90 > 110 Gy是影响OS的预后因素；肿瘤最大径 < 5 cm、KPS评分、体积 < 40 cm3、D90 > 95 Gy是影响LPFS的预后因素。多因素分析显示既往化疗和伴有全身多发转移是影响总生存的预后因素。结论 图像引导下125I粒子植入治疗复发性软组织肉瘤，局部控制好，是一种安全、有效的挽救治疗手段。肿瘤大小、D90是影响OS和LPFS的主要因素。 |
| 英文摘要: |
| Objective To evaluate the outcomes and prognostic factors of image-guided 125I seed implantation for locally recurrent soft tissue sarcoma(RSTS). Methods A total of 60 patients with RSTS who received image-guided 125I seed implantation in Peking University Third Hospital, from September 2002 to December 2015, were retrospectively analyzed. The enrollment criteria:KPS > 60 points, refused or could not tolerate surgery or radiotherapy, the expecting survival time > 3 months, relapsed after multiple treatment of soft tissue sarcoma, and underwent CT or ultrasound guided 125I seed implantation treatment. In all, the median activity of seeds was 25.9×106 Bq (range, 11.1×106-29.6×106 Bq), median number of implanted seeds was 58 (range, 3-133), and the median D90 was 120 Gy (range, 36.50-460.97 Gy). The local progression-free survival (LPFS) and overall survival (OS) were calculated using the Kaplan-Meier method. The log-rank test and Cox regression model were used for the univariate and multivariate analyses. Results The median follow-up was 18.75 months (range,1-146). The median OS was 18.5 months (95% CI 13.1-23.9). The 1-, 3-and 5-year OS rate were 63.3%, 33.0% and 29.5%, respectively. The 1-, 3-and 5-year LPFS rate were 72.5%, 63.7% and 59.7%, respectively. The general rate of pain relieving was 100% (6/6). 8.3% (5/60) presented grade Ⅳ skin toxicity. No fatal complications ocurred. The univariate analysis suggested that tumor size, tumor volume, KPS score, D90 were prognostic factors of OS and LPFS. The multivariate analysis demonstrated that previous chemotherapy history and distant metastases were independent prognostic factors of survival. Conclusions Image-guided 125I seed implantation for recurrent soft tissue sarcoma is a safe treatment option with high efficacy and low morbidity. Tumor size and D90 were the prognostic factors of OS and LPFS. |
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