| 吉喆,霍彬,邢超,等.125I粒子植入治疗早期非小细胞肺癌的临床效果和预后分析[J].中华放射医学与防护杂志,2021,41(1):31-36.Ji Zhe,Huo Bin,Xing Chao,et al.125I seed implantation for early stage non-small cell lung cancer—analysis of clinical efficacy and prognosis factors[J].Chin J Radiol Med Prot,2021,41(1):31-36 |
| 125I粒子植入治疗早期非小细胞肺癌的临床效果和预后分析 |
| 125I seed implantation for early stage non-small cell lung cancer—analysis of clinical efficacy and prognosis factors |
| 投稿时间：2020-05-16 修订日期：2020-05-16 |
| DOI：10.3760/cma.j.issn.0254-5098.2021.01.007 |
| 中文关键词: 非小细胞肺癌 放射性粒子植入 疗效 预后因素 |
| 英文关键词:Non-small cell lung cancer Radioactive seed implantation Efficacy Prognostic factors |
| 基金项目: |
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| 摘要点击次数: 3290 |
| 全文下载次数: 1910 |
| 中文摘要: |
| 目的 分析放射性125I粒子植入治疗无法手术的早期非小细胞肺癌的疗效及安全性，为实际临床工作及相关研究的开展提供数据参考。方法 回顾性分析自2010年12月至2018年12月于多个治疗中心接受CT引导下放射性125I粒子植入治疗的39例早期非小细胞肺癌（NSCLC）患者的数据。粒子植入流程包括术前计划设计、CT引导下穿刺、粒子植入、术后评估剂量验证。分析粒子植入治疗的疗效及相关并发症。疗效评价采用实体瘤评价标准（RECIST）v1.1，不良反应评价采用不良事件常用术语评定标准（CTCAE）v4.0。结果 患者平均年龄70岁（51~85岁），中位病灶直径2.7 cm（1.1~6.0 cm），使用粒子活度中位0.6~0.8 mCi（1 Ci=3.7×1010 Bq）。术后验证所示中位剂量D90 159.9 Gy（110.4~278.8 Gy）。中位随访时间29个月（3~97个月），患者总体的1、3、5年局部控制率分别为89.5%、79%、79%。1、3、5年生存率分别为100%、74.8%、49.9%。局部复发和远处转移为最主要的失败原因，各占7例（17.9%）。气胸发生率达56.4%（22例），其中有9例（23.1%）需要有创闭式引流。只观察到1例2级放射性肺炎（2.6%），未观察到皮肤、食管炎、脊髓炎等其他不良反应。单因素分析显示，KPS评分80~90、病理类型为腺癌、T分期为T1~2、术后D90>180 Gy的患者有更高的局部控制率（χ2=12.706，3.995，6.077，6.202，P<0.05）。术后D90高的患者有更高的生存率（χ2=6.907，P<0.05）。结论 放射性125I粒子植入治疗无法手术的早期NSCLC安全性及效果良好，可作为治疗选择之一。气胸是125I粒子植入手术最主要的操作并发症。肺腺癌、剂量高预示着较好的局部控制率。 |
| 英文摘要: |
| Objective To analyze the efficacy and safety of radioactive 125I seed implantation in the treatment of unresectable early-stage non-small cell lung cancer (NSCLC), in order to provide data for clinical practice and relevant research.Methods A retrospective study was conducted on the data of 39 patients with early-stage NSCLC who received CT-guided radioactive 125I seed implantation from Dec 2010 to Dec 2018 in multiple hospitals.The seed implantation process consisted of preoperative planning and design, CT-guided puncture, seed implantation, and postoperative evaluation and dose verification.The efficacy and complications of the treatment were analyzed.The clinical efficacy was evaluated by adopting the Response Evaluation Criteria in Solid Tumors (RECIST) (v1.1) and the adverse reactions were evaluated using the Common Terminology Criteria for Adverse Events (CTCAE v4.0). Results All the patients were 70 years old on average (51-85). The median lesion diameter was 2.7 cm (1.1-6.0 cm), the median seed activity was 0.7 mCi (0.6-0.8 mCi), while the median follow-up duration was 29 months (3-97 months). Meanwhile, the 1-, 3-, and 5-year overall local control rates were 89.5%, 79%, and 79%, respectively, and the 1-, 3-, and 5-year overall survival rates were 100%, 74.8%, and 49.9%, respectively.Local recurrence and distant metastasis were the main causes of failure, accounting for 17.9% (7 cases) each.The incidence of pneumothorax was 56.4% (22 cases), among which nine cases (23.1%) required invasive closed thoracic drainage.Only 1 case of grade-2 radiation pneumonia (2.6%) was observed, with no other adverse reactions such as dermatoses, esophagitis, or myelitis being discovered.As indicated by univariate analysis, the patients with KPS scores of 80-90, pathological type of adenocarcinoma, T stage of T1-2, and D90>180 Gy exhibited better local control (χ2=6.202, P<0.05). Meanwhile, high D90 was also associated with a higher survival rate (χ2=6.907, P<0.05). Conclusions Radioactive 125I seed implantation is a safe and effective treatment for unresectable early-stage NSCLC.In cases where external beam radiotherapy is not available, radioactive 125I seed implantation can be considered as one of the treatment options.Pneumothorax is the most common complication of radioactive 125I seed implantation, and adenocarcinoma (pathological type) and higher values of D90 are predictors of better local control. |
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