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目的:探讨CT引导下放射性125I粒子置入治疗脊柱转移性肿瘤的价值。方法:14例无法手术切除或放化疗的脊柱转移性肿瘤患者,均在CT引导下行放射性125I粒子置入术。置入术前应用三维治疗计划系统制定粒子置入计划。术中根据CT影像采取不同置入针排列方式种植粒子,粒子间距0.5～1.0cm。根据肿瘤大小及对放射线敏感程度置入粒子数范围26～145颗,粒子活度范围0.50～0.80mCi。术后即刻复查CT观察粒子分布情况,并再次应用三维治疗计划系统进行剂量验证。结果:14例患者均顺利完成手术。所有病例随访1～75个月,中位随访时间12.0个月。局部有效率50.0%,中位局部控制时间为26.0个月,1年、2年和3年局部控制率分别为62.5%、50.0%和37.5%。中位生存时间11.0个月,1年、2年和3年生存率分别为50.0%、41.7%和20.8%。神经功能保留率和恢复率分别为92.9%(13/14)和71.4%(10/14)。镇痛有效率和疼痛完全缓解率分别为78.6%(11/14)和64.3%(9/14)。结论:CT引导下放射性125I粒子置入治疗脊柱转移性肿瘤安全,并发症少,疗效确切,可作为不宜手术切除或放化疗患者的补充治疗方式。
Objective: To investigate the value of radioactive 125I particles guided by CT in the treatment of spinal metastatic tumors. Methods: Fourteen patients with metastatic spinal metastasis who could not be surgically removed or treated with radiotherapy were treated with radioactive 125I guided by CT. Preoperative application of three-dimensional treatment planning system to develop particle implantation plan. Intraoperative CT images taken by different needle arrangement of planting particles, particle spacing 0.5 ~ 1.0cm. According to tumor size and sensitivity to radiation into the range of particle number 26 ~ 145, the particle activity range 0.50 ~ 0.80mCi. Immediately after the review CT observation of particle distribution, and again using the three-dimensional treatment planning system for dose verification. Results: All 14 patients successfully completed the operation. All patients were followed up for 1 to 75 months, with a median follow-up time of 12.0 months. The local effective rate was 50.0%, the median local control time was 26.0 months, and the local control rates at 1 year, 2 years and 3 years were 62.5%, 50.0% and 37.5% respectively. The median survival time was 11.0 months, and the 1-year, 2-year and 3-year survival rates were 50.0%, 41.7% and 20.8%, respectively. Nerve function retention rate and recovery rate were 92.9% (13/14) and 71.4% (10/14) respectively. Efficacy of pain relief and complete pain relief rates were 78.6% (11/14) and 64.3% (9/14), respectively. CONCLUSION: Radioactive 125I particles guided by CT are safe to treat metastatic spine tumors, with fewer complications and definite curative effect. It can be used as supplementary treatment for patients who are not suitable for surgical resection or radiotherapy and chemotherapy.