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目的:探讨放射性粒子置入近距离照射治疗脊柱肿瘤的方法和初步结果。方法:2002年10月～2004年5月对收治的13例脊柱肿瘤患者在CT监测下经皮穿刺活检明确病理诊断,确定肿瘤对放疗敏感后应用125I粒子置入近距离照射治疗。依术前的计算机模拟计算结果确定粒子置入的数量和三维间隔,2例术中在C型臂X线机监视下于残存肿瘤内置入粒子;11例于CT监测下经皮穿刺在肿瘤病灶内置入粒子。随访观察治疗效果。结果:术中无并发症发生。平均随访25个月。术后4～11d起效,疼痛缓解9例(VAS评分<20mm),减轻4例(VAS评分20～40mm),疗效持续3～19个月。3例肿瘤生长得到抑制。2例分别于术后3个月、9个月死于肝脏衰竭,1例于术后6个月死于肺转移,1例术后16个月死于多器官衰竭,其他9例患者末次随访时仍存活。随访中无放射性脊髓神经病发生。结论:对于不宜采用手术治疗或术中无法全切而又对放疗敏感的脊柱肿瘤患者采用瘤体内置入放射性粒子近距离照射治疗可以延缓肿瘤生长、缓解疼痛,保持生活质量、减少手术治疗并发症;是治疗晚期脊柱肿瘤的一种新方法。
Objective: To investigate the method and preliminary results of radiotherapy for spinal tumors treated with brachytherapy. Methods: From October 2002 to May 2004, 13 cases of patients with spinal tumors admitted to our hospital underwent CT-guided percutaneous biopsy to confirm the pathological diagnosis. The tumors were treated with 125I particles and treated with brachytherapy after being sensitive to radiotherapy. According to preoperative computer simulation results to determine the number of particles placed and three-dimensional intervals, 2 cases of surgery in the C-arm X-ray machine in the residual tumor built-in particles; 11 cases of CT under the percutaneous puncture in the tumor lesions Built-in particles. Follow-up observation of the therapeutic effect. Results: No intraoperative complications occurred. The average follow-up of 25 months. From 4 to 11 days after operation, 9 cases were relieved of pain (VAS score <20mm) and 4 cases (VAS score 20-40mm). The curative effect lasted for 3 to 19 months. Three cases of tumor growth was inhibited. 2 died of liver failure at 3 months and 9 months after operation, 1 died of lung metastasis 6 months after operation, 1 died of multiple organ failure 16 months after operation, and the other 9 patients were followed up Still alive. No radioactive spinal cord neuropathy occurred during follow-up. CONCLUSIONS: For patients with spinal tumors that are not suitable for surgical treatment or can not be completely excised during radiotherapy, tumor growth, pain relief, quality of life, and surgical complications can be reduced by the use of radioactive particle brachytherapy ; Is a new method of treatment of advanced spinal tumors.