摘要
目的探讨应用放射性碘125(^(125)I)粒子植入联合锶核素89(^(89)Srcl_(2))及云克治疗碘131(^(131)I)难治性甲状腺癌(RAIR-DTC)骨转移的临床疗效。方法选取北部战区总医院自2016年1月至2018年10月收治的57例^(131)I RAIR-DTC骨转移患者为研究对象。所有患者均初始给予^(89)Srcl_(2)内照射+云克联合治疗。3个月后,行CT引导下^(125)I粒子植入术。分别于治疗前后,记录并比较^(89)Srcl_(2)内照射+云克治疗、^(89)Srcl_(2)内照射+云克联合粒子治疗患者功能状态评分(KPS)、疼痛视觉模拟评分(VAS)。于术后1个月,比较不同疼痛评分患者的疼痛缓解率。按照世界卫生组织实体瘤近期疗效判别标准评价患者骨转移病灶疗效。记录并比较患者治疗前后血清Tg水平与不良反应发生情况。结果根据治疗前3 d患者的疼痛评分,将其分为Ⅰ级组(1~3分,n=10)、Ⅱ级组(4~6分,n=19)、Ⅲ级组(7~10分,n=28)。Ⅰ级组、Ⅱ级组、Ⅲ级组患者疼痛缓解率分别为100.00%(10/10)、78.95%(15/19)、82.14%(23/28)。治疗后,^(89)Srcl_(2)内照射+云克联合粒子治疗患者的KPS评分、VAS评分均明显优于^(89)SrCl_(2)+云克组,差异均有统计学意义(P<0.05)。^(89)Srcl_(2)内照射+云克联合粒子治疗患者的骨转移病灶治疗有效率为80.70%(46/57),明显优于^(89)SrCl_(2)+云克组的64.91%(37/57),差异有统计学意义(P<0.05)。结论^(125)I粒子植入联合^(89)Srcl_(2)及云克治疗^(131)I RAIR-DTC骨转移,局部疼痛症状缓解明显,并发症少,可多次重复治疗;特别对于溶骨性转移,^(89)Srcl_(2)+云克治疗效果不佳的患者,^(125)I放射性粒子植入治疗可作为一种有效的治疗方法。
Objective To investigate the clinical efficacy of radioactive iodine-125(^(125)I)seed implantation combined with strontium nuclide 89(^(89)SrCl_(2))and Yunke in the treatment of iodine-131(^(131)I)refractory thyroid cancer(RAIR-DTC)bone metastasis.Methods A total of 57 patients with^(131)I RAIR-DTC bone metastases admitted to General Hospital of Northern Theater Command from January 2016 to October 2018 were selected as the study subjects.All patients were initially treated with^(89)SrCl_(2)internal irradiation plus Yunke therapy.3 months later,CT-guided^(125)I seed implantation was performed.The functional status score(KPS)and pain visual analogue scale(VAS)of^(89)SrCl_(2)internal irradiation+Yunke treatment and^(89)SrCl_(2)internal irradiation+Yunke particle treatment were recorded and compared before and after treatment,respectively.The pain relief rate of patients with different pain scores was compared 1 month after surgery.The efficacy of bone metastases was evaluated according to who criteria for short-term efficacy of solid tumors.Serum Tg levels and adverse reactions before and after treatment were recorded and compared.Results According to the pain scores of the patients 3 days before treatment,they were divided into grade Ⅰ group(1-3 points,n=10),grade Ⅱ group(4-6 points,n=19)and grade Ⅲ group(7-10 points,n=28).The rate of pain relief in grade Ⅰ,Ⅱ and Ⅲ groups was 100.00%(10/10),78.95%(15/19)and 82.14%(23/28),respectively.After treatment,KPS score and VAS score of^(89)SrCl_(2)+Yunke group were significantly better than those of^(89)SrCl_(2)+Yunke group,the differences were statistically significant(P<0.05).The effective rate was 80.70%(46/57),significantly better than 64.91%(37/57)in^(89)SrCl_(2)+Yunke group,and the difference was statistically significant(P<0.05).Conclusion^(125)I seed implantation combined with^(89)SrCl_(2)and Yunke treatment of^(131)I RAIR-DTC bone metastasis,local pain symptoms relieved significantly,fewer complications,can be repeated treatment.Especially for patients with osteolytic metastases,for which^(89)SrCl_(2)+Yunke therapy is not effective,^(125)I radioactive seed implantation can be used as an effective treatment.
作者
张文文
郝珊瑚
王治国
纪立秋
葛香妍
李根
王有超
张国旭
ZHANG Wen-wen;HAO Shan-hu;WANG Zhi-guo;JI Li-qiu;GE Xiang-yan;Li Gen;WANG You-chao;ZHANG Guo-xu(Department of Nuclear Medicine,General Hospital of Northern Theater Command,Shenyang 110016,China)
出处
《临床军医杂志》
CAS
2022年第1期31-34,共4页
Clinical Journal of Medical Officers
基金
辽宁省自然科学基金项目(20180551010)
关键词
放射性碘125粒子
锶核素89
云克
碘135难治性甲状腺癌
骨转移
Radioactive iodine 125 particles
Strontium nuclide 89
Yunke
Iodine 135 refractory thyroid cancer
Bone metastases
