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目的评价 CT 导向下~(125)I 粒子植入治疗局部晚期肺癌的临床价值。方法 CT 导向下~(125)I 粒子植入32例(A 组)经一线化疗未控的局部晚期肺癌患者。32例患者病灶数48个,所有病灶与正常组织间有较清楚的边界,最大径4.5～7.5 cm,平均5.5 cm。全部病例均经病理证实。应用放射性~(125)I 粒子源强为23.3～30.0 MBq,肿瘤匹配周边剂量为100～150 Gy。采用 TPS 计算布源,在CT 导向下将~(125)I 粒子植入瘤灶内。对照组为随机抽取一线化疗局部晚期肺癌病例30例(B 组)。结果2个月后 CT 复查,A 组局控率78.1%。一年生存率为65.0%,中位生存时间15个月。术中肺内会有少量渗出;4例出现气胸,肺压缩均在30%以内,经保守治疗好转;术后1周痰中带血15例。未见骨髓抑制等严重并发症。B 组局控率43.3%。一年生存率为48.0%,中位生存时间11个月,骨髓抑制发生率46.3%。两者差异有统计学意义。结论放射性粒子植入治疗局部晚期肺癌临床疗效好,并发症发生率低,生活质量改善明显,近期效果好,是一种治疗局部晚期肺癌的简单、安全、有效的方法。
Objective To evaluate the clinical value of CT guided 125 I seed implantation in the treatment of locally advanced lung cancer. Methods Thirty-two patients with locally advanced lung cancer undergoing CT-guided 125I I implantation were enrolled in this study. The number of lesions in 32 patients was 48, with a clear boundary between all lesions and normal tissues, with a maximum diameter of 4.5-7.5 cm, an average of 5.5 cm. All cases were confirmed by pathology. The source intensity of radioactive 125 I seeds was 23.3-30.0 MBq, and the peripheral dose of tumor matching was 100-150 Gy. The cloth source was calculated using TPS and ~ (125) I particles were implanted into the tumor lesion under CT guidance. The control group was randomized to first-line chemotherapy for locally advanced lung cancer in 30 cases (group B). Results 2 months after CT review, A group of 78.1% rate of control. The one-year survival rate was 65.0% and the median survival time was 15 months. A small amount of intraoperative lung effusion; 4 cases of pneumothorax, pulmonary compression were less than 30%, conservative treatment improved; 1 week after sputum bloody in 15 cases. No serious complications such as bone marrow suppression. Group B control rate of 43.3%. The one-year survival rate was 48.0%, the median survival time was 11 months, and the incidence of myelosuppression was 46.3%. The difference between the two was statistically significant. Conclusions Radioactive seed implantation is a simple, safe and effective method for the treatment of locally advanced lung cancer with good clinical efficacy, low complication rate, obvious improvement of quality of life and good short-term effect.