放射性粒子植入在肿瘤残留、复发、转移小病灶治疗中的优势-肿瘤学专业论文.docx

汕头大 汕头大学医学院硕士学位论文 I I 中文摘要 目的 放射性粒子植入是将封闭型放射性核素植入瘤体内，通过其发出持续低能量的射线治 疗肿瘤的一种方法。本文通过对 20 例晚期肿瘤患者采用 125I 放射性粒子植入治疗，探讨放 射性粒子植入治疗肿瘤的临床疗效及安全性，并讨论放射性粒子植入在肿瘤治疗的病例选 择及优势。 材料与方法 20 例曾接受手术、化疗或 TACE、射频消融等其他微创治疗的晚期肿瘤患者，全部经 病理或影像学诊断为肿瘤残留、复发、转移，病灶最大直径均小于 5cm。采用计算机立体 定位计划系统计算布源，在 CT 导向下将 29.6MBq 活度的 125I 粒子相隔 1.0～1.5 cm 平面播 植。手术结束后 1～3 个月复查 CT 评价肿瘤治疗效果，并随访观察伴有疼痛患者症状缓解 情况及并发症的发生。 结果 20 例患者均顺利完成手术，治疗有效率（CR+PR）47.6%，局部控制率（CR+PR+NC） 81.0%。术前病灶直径 1.0～4.5 cm，平均 3.05±1.09 cm，术后复查影像学检查病灶直径 0～ 5.7 cm，平均 2.33±1.65 cm。病灶治疗后较术前缩小，其差异有统计学意义（P=0.039）。治 疗前 10 例有疼痛症状，术后 7 例疼痛症状得到不同程度缓解，止痛有效率为 70%，生活 质量明显提高。全组病例术中术后均无严重并发症发生。 结论 放射性粒子植入治疗肿瘤疗效确切，安全性高，创伤小，并发症发生率低，在肿瘤残 留、复发转移小病灶的治疗及部分肿瘤引起的疼痛的缓解具有较高的临床价值。 关键词 125I 放射性粒子植入；肿瘤；CT 引导 II II Abstact Purpose Radioactive seeds implantation is a treatment of tumor designed to integrate closed radionuclide into the targeted tumor which continually produces low energy radiation ray. The present s tudy aimed to explore the clinical efficacy and safety of radioactive seed implantation in treating advanced cancer, and discuss the indications and advantages of the treatment. Materials and Methods 20 patients with advanced cancer were diagnosed tumor residual, recurrence or metastasis after operations, chemotherapy or other minimally invasive treatments like TACE, radiofrequency ablation, and the diameter of all the lesions were under 5 cm. Treatment planning system was used to design the distribution of 125I seeds. Under CT guidance, 125I seeds of 29.6MBq were implanted into the lesions at a distance of 1.0 to 1.5 cm. After 125I seeds implantation, CT re-examination was performed within 1 to 6 months to evaluate the clinical efficacy, and follow-up was conducted to observe the remission of pain and complications. Results After successful operations, the effectiveness rate of the twenty patients reached 47.6% and locality control rate (CR+PR+NC）arrived 81.0%. Before the operation, lesions diameter ranged from 1.0 to 4.5 cm, at the average of (3.05±1.09) cm. CT re-exam