论文部分内容阅读
目的 :探讨组织间植入放射碘 - 1 2 5 ( 12 5I)粒子近距离放疗辅助治疗直肠癌的疗效。方法 :对 1 997～ 1 998年间 1 1 2例施行前切除加全直肠系膜切除手术 ( TME)的直肠癌患者进行前瞻性对照性治疗研究。患者分 TME+静脉化疗 (四氢叶酸钙 + 5 Fu) +顺铂 ( DDP)腹腔灌注 +术中 12 5I植入组 (实验组 49例 )和 TME+静脉化疗 + DDP腹腔灌注 +术后放疗组 (对照组 63例 ) ,随访比较两组间控便功能、并发症、局部复发率、转移率和 5年生存率等。结果 :两组术后控便功能、吻合口瘘、吻合口狭窄发生率和远处转移率差异无统计学意义 ;实验组 Duke C、D期局部复发率低于对照组 ( P<0 .0 5 ) ,5年生存率高于对照组 ( P<0 .0 5 ) ,实验组放射反应少于对照组 ( P<0 .0 1 ) ;粒子植入数量超过 5 0枚时吻合口瘘的发生率增加( P<0 .0 5 ) ,并影响控便功能 ( P<0 .0 5 ) ,而 5年生存率并无增加。结论 :组织间植入 12 5I粒子近距离放疗辅助治疗直肠癌疗效优于外照射 ,能降低 Duke C、D期的局部复发率和提高 5年生存率 ,无严重放射反应。但可能会增加吻合口瘘的发生率 ,故应恰当使用放射剂量 ,以避免吻合口瘘的发生
Objective: To investigate the effect of interstitial brachytherapy with adjuvant radiotherapy with radioactive iodine - 125 (125) brachytherapy on rectal cancer. METHODS: A prospective controlled study of 112 patients with rectal cancer who had undergone resection and total mesorectal excision (TME) between 1997 and 1998 was performed. The patients were divided into TME + intravenous chemotherapy (calcium folinate + 5 Fu) + cisplatin (DDP) intraperitoneal perfusion + intraoperative 125I implantation group (experimental group 49 cases) and TME + intravenous chemotherapy + DDP intraperitoneal perfusion + postoperative radiotherapy group Control group of 63 cases). The follow-up was compared between the two groups inter-control function, complications, local recurrence rate, metastasis rate and 5-year survival rate. Results: There was no significant difference in postoperative defecation function, anastomotic fistula, anastomotic stenosis and distant metastasis rate in the two groups. The local recurrence rate of Duke C and D in the experimental group was lower than that in the control group (P <0. 0 5), the 5-year survival rate was higher than that in the control group (P <0.05), and the radiotherapy in the experimental group was less than that in the control group (P <0.01). The number of particles implanted in more than 50 anastomotic fistula (P <0.05), and affected the bowel function (P <0.05), while the 5-year survival rate did not increase. CONCLUSIONS: Tissue implantation of 125I brachytherapy as a adjuvant treatment of rectal cancer is superior to external irradiation in reducing the local recurrence rate and increasing the 5-year survival rate of Duke C and D stages without serious radiation reaction. But may increase the incidence of anastomotic fistula, it should be appropriate to use radiation dose to avoid the occurrence of anastomotic leakage