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目的 探讨应用放、化疗粒子联合植入法综合治疗复发性直肠癌的可行性、安全性及短期疗效。方法 北京铁路总医院自 2 0 0 1年 12月至 2 0 0 3年 8月 ,应用放、化疗粒子联合植入法综合治疗复发性直肠癌 19例 ,均为直肠癌Mile’s术后盆腔复发病人。在治疗计划指导下 ,交替植入 5 FU缓释化疗粒子和放射性12 5I粒子。放射性粒子的肿瘤匹配周边剂量 (Matchedperipheraldose ,MPD)为 90～ 130Gy。平均每例使用12 5I粒子 11粒 ,5 FU6 0 0mg。结果 19例病人手术均顺利完成 ,未发生出血、感染等并发症 ,经盆腔摄片证实放射性粒子的位置无变化。疼痛缓解率为 85 7% (12 / 14 ) ,平均疼痛缓解时间为 5～ 9d。于术后 3～ 6个月CT复查肿瘤变化 ,提示瘤体不同程度缩小 ,其中 2例完全缓解 ,12例部分缓解 ,4例稳定 ,局部控制率为 74 %。随访 6～ 2 8个月 ,中位生存期为 17个月 ,最长 1例随访时间为术后 2 6个月 ,现仍存活。 1例术后 6个月死于全身广泛转移。结论 放射性12 5I粒子和 5 FU缓释化疗粒子联合应用局部植入技术具有安全、微创及并发症发生率低的特点 ,是综合治疗复发性直肠癌的较有效手段之一
Objective To investigate the feasibility, safety and short-term curative effect of radiotherapy and chemotherapy combined with particle implantation in the treatment of recurrent rectal cancer. Methods Beijing Railway General Hospital from December 2001 to August 2003, the application of radiotherapy and chemotherapy combined particle implantation combined treatment of recurrent rectal cancer in 19 cases, all patients with rectal cancer after Mile’s pelvic recurrence . Guided by the treatment plan, 5 FU sustained release chemotherapy particles and radioactive 12 5I particles were alternately implanted. The radioactive particles have a Matched Pei- peripheral Dose (MPD) of 90-130 Gy. The average use of each 12 5I particles 11, 5 FU6 0 0mg. Results The operation of 19 patients was successfully completed without any complications such as bleeding and infection. No change of radioactive particle position was confirmed by pelvic radiography. The pain relief rate was 85.7% (12/14) and the average pain relief time was 5 ~ 9 days. At 3 to 6 months after operation, CT examination of tumor changes showed that the tumors were reduced to varying degrees, of which 2 cases were completely relieved, 12 cases partially relieved, 4 cases stable, and the local control rate was 74%. The follow-up ranged from 6 months to 28 months. The median survival time was 17 months. The longest follow-up time was 26 months after operation, and still survived. One patient died from extensive systemic metastasis 6 months after surgery. Conclusion The combination of radioactive 12 5I particles and 5 FU sustained-release chemotherapy particles with local implantation has the characteristics of safe, minimally invasive and low incidence of complications, which is one of the more effective methods for the comprehensive treatment of recurrent rectal cancer