125I放射性粒子植入并外照射治疗NSCLC近期效果

                    作者：刘希光 张传玉 杜利力 王勇杰 宋婷婷

【摘要】  目的 探讨 125I放射性粒子（125I粒子）植入联合外照射治疗非小细胞肺癌的放射剂量、安全性和近期疗效。方法 对经病理学确诊的12例非小细胞肺癌病人（12例均为周围型，腺癌7例，鳞癌5例；6例为初治）应用125I粒子植入联合外照射治疗。术前经三维立体定向125I粒子植入放射治疗计划系统（TPS）制定治疗计划，根据TPS结果计算所需 125I粒子数和布源方法。在CT引导下经皮穿刺组织间植入125I粒子，内照射剂量为90~100 Gy。术后应用TPS进行剂量验证。4周左右复查胸部CT，观察肿瘤退缩情况，并开始给予外照射（6 MV的X线常规放疗）治疗，50~60 Gy/(25~30)次。结果 125I粒子植入术后4周，肺部肿瘤部分退缩者10例，稳定2例，未观察到完全消退者。12例病人接受外放射治疗后随访6~16个月，每3个月左右复查胸部CT，结果肿瘤完全消退者6例，部分退缩6例，长期生存率在随访中。12例病人接受125I粒子植入术中发生少量气胸者1例；术后4例出现咳血痰，给予止咳和止血药物后1~2 d症状消失；粒子局部脱落者1例。外放射治疗后3个月复查胸部CT，发生肺放射性损伤0级者1例，Ⅰ级者6例，Ⅱ级者1例。结论 125I粒子植入联合外照射治疗非小细胞肺癌是一种有效的方法，且肺放射性损伤程度低，值得进一步扩大病例研究。 
【关键词】  癌，非小细胞肺；放射疗法；放射性同位素
    ［ABSTRACT］  Objective  To explore radiation dose, safety and short-term efficacy of 125I radioactive seed implantation combined with external irradiation for non-small cell lung cancer (NSCLC).  Methods  Twelve NSCLC patients confirmed pathologically were recruited, all were peripheral, which included seven adenocarcinoma and five squamous cell carcinoma, of which, six for initial treatment.  The seed was implanted percutaneously in all cases under CT guidance, the internal irradiation was 90-100 Gy. They were evaluated with TPS (treatmeant planning system). A chest CT scan done about four weeks later to observe the tumor shrink, and external irradiation started (6 MV X line of conventional radiotherapy) 50-60 Gy/(25-30) times.  Results  Four weeks after the implantation, partial resolution of the tumors were seen in 10 cases, stable in two cases, no complete regression observed. The patients were followed for six to 16 months after radiation, and a chest CT done every three months. The results showed complete regression and partial regression were six cases, respectively. For those receiving seed implantation, four experienced blood sputum, the symptoms disappeared within 1-2 days after  cough remedy and anastaltic administration;  one with mild pneumothorax and one partly lost the seed.  A chest CT taken after three months of irradiation found that radiation lung damage was grade 0,one case; grade Ⅰ,  six cases, and grade Ⅱ, one case.  Conclusion  125I seed implantation plus external irradiation for non-small cell lung cancer is an effective way to lower lung radioactive damage and is worth further studying.
    ［KEY WORDS］  Carcinoma, non-small-cell lung; Radiotherapy; Radioisotopes

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