| 霍彬,霍小东,王磊,等.125I粒子植入治疗中心型肺癌合并肺不张的可行性研究[J].中华放射医学与防护杂志,2021,41(1):37-41.Huo Bin,Huo Xiaodong,Wang Lei,et al.Feasibility of 125I seed implantation in the treatment of central lung cancer complicated with atelectasis[J].Chin J Radiol Med Prot,2021,41(1):37-41 |
| 125I粒子植入治疗中心型肺癌合并肺不张的可行性研究 |
| Feasibility of 125I seed implantation in the treatment of central lung cancer complicated with atelectasis |
| 投稿时间：2020-05-27 修订日期：2020-05-27 |
| DOI：10.3760/cma.j.issn.0254-5098.2021.01.008 |
| 中文关键词: 肺癌 支气管镜引导 CT引导 放射性粒子 肺不张 |
| 英文关键词:Lung cancer Bronchoscopy-guided CT-guided 125I seed Atelectasis |
| 基金项目:国家自然科学基金（81871457） |
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| 中文摘要: |
| 目的 探讨CT联合支气管镜引导放射性125I粒子植入治疗中心型肺癌合并肺不张的可行性、疗效及安全性。方法 回顾性分析2016年5月至2019年10月天津医科大学第二医院因医学原因不可手术的中心型非小细胞肺癌合并肺不张患者29例。所有患者先于支气管镜引导直视下行大气管内肿瘤粒子植入，再行CT联合模板引导经皮穿刺肺门部肿瘤粒子植入，后期序贯接受吉西他滨联合顺铂或培美曲塞联合顺铂方案化疗4周期。选用125I粒子活度18.5~29.6 MBq，处方剂量120 Gy，术前及术后行治疗计划和质量验证。观察肺不张再通率、剂量验证满意率、气促指数改善情况、生存时间（OS）、术中及术后不良事件。结果 29例肺癌合并肺不张患者均顺利完成支气管镜及CT引导粒子植入，术后质量验证满意率为93.1%。术后2、6、12、18和24个月肺不张再通率达到93.1%、89.7%、78.6%、76.2%和60%。患者治疗前的气促指数为（2.8±0.8）级，治疗后气促指数为（1.4±0.9）级，治疗后呼吸困难、乏氧症状较前明显缓解，改善持续时间为5~28个月。中位随访20个月，中位生存期21个月。与粒子治疗相关的不良事件包括气胸、咳血、咳嗽、发热及粒子移位，无3级或更高级别不良事件发生。结论 对于中心型非小细胞肺癌合并肺不张患者，CT联合支气管镜引导放射性粒子植入治疗局部再通率高，可以迅速改善临床状况和提高生活质量，不良反应少，可作为安全有效的治疗选择之一。 |
| 英文摘要: |
| Objective To investigate the feasibility, efficacy, and safety of CT- and bronchoscopy-guided 125I seed implantation in the treatment of central lung cancer complicated with atelectasis.Methods Retrospective analysis was conducted on twenty-nine patients who were treated from May 2016 to Oct 2019 in the Second Hospital of Tianjin Medical University for central non-small-cell lung carcinoma complicated with pulmonary atelectasis that was inoperable due to medical reasons.125I seeds were implanted into the trachea under the guidance of bronchoscopy first.The 125I seeds were then implanted into the hilum of the lungs by percutaneous puncture under the guidance of the CT and template.The seed activity was 18.5-29.6 MBq,and the prescription dose was 120 Gy.TPS planning and quality verification were performed before and after the operations.The rate of atelectasis recanalization, the satisfactory rate of dose verification, the improvement of dyspnea index, the survival time, and the adverse events during and after operation were observed.Results All 29 patients with lung cancer complicated with atelectasis successfully completed the seed implantation, and the satisfactory rate of quality verification was 93.1%.The rate of atelectasis recanalization at 2, 6, 12, 18, and 24 months was 93.1%, 89.7%, 78.6%, 76.2%, and 60%, respectively.Their dyspnea and anoxia symptoms were significantly relieved in 5-28 months after treatment.The results showed that the patients' dyspnea index was 2.8-0.8 before treatment and 1.4-0.9 after treatment.The median follow-up period was 20 months and median survival was 21 months.Adverse events associated with the radiation therapy included pneumothorax, hemoptysis, cough, fever, and particle displacement.No level-3 or more serious adverse events occurred.Conclusions The CT- and bronchoscopy-guided 125I seed implantation is a safe and effective therapy option for the treatment of central non-small-cell lung carcinoma associated with atelectasis.It contributes to a high rate of local recanalization, and can rapidly improve clinical conditions and quality of life of the patients with few adverse reactions. |
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