摘要
目的探讨射频消融联合放射性125I粒子植入治疗中晚期非小细胞肺癌的近期疗效及安全性。方法回顾性分析2012年1月至2016年7月该院收治的34例不能耐受手术或不愿接受手术治疗的中晚期非小细胞肺癌患者的临床资料,在CT引导下行射频消融治疗,1个月后复查胸部增强CT了解肿块大小及坏死范围,评价疗效,其中22例患者消融不完全,行放射性125I粒子植入治疗。放射性125I粒子组织间植入前用计算机三维治疗计划系统(TPS)制定治疗计划,了解粒子分布及数量,术后应用TPS给予验证。34例患者术后前2个月每1个月复查1次,2个月后每2个月复查1次,6个月后复查胸部增强CT,评价临床疗效。随诊8~24个月。结果 34例患者中射频消融治疗完全缓解(CR)12例(35.29%),部分缓解(PR)4例(11.76%),近期有效率为47.06%(16/34)。其中22例消融不完全患者行放射性125I粒子植入治疗后完全缓解(CR)8例(36.36%),部分缓解(PR)7例(31.82%),近期有效率为68.18%(15/22);对22例消融不完全患者术后半年每3个月随访1次,中位生存期为12个月,1年生存率为86.36%(19/22)。不良反应主要为气胸、肺内出血、发热等,经对症处理均恢复正常。结论射频消融联合放射性125I粒子植入是治疗中晚期非小细胞肺癌的一种可行方法,二者联合治疗可显著提高疗效,创伤小,并发症轻且发生率低,值得临床关注。
ObjectiveTo explore the short-term effect and safety of radiofrequency ablation combined with radioactive125I particle implantation on non-small cell lung cancer(NSCLC)in middle and advanced stage.MethodsRetrospective analysis was conducted on the clinical data of34NSCLC patients,who were received in the hospital from January2012to August2016and could not endure operations or unwilling to receive operations,and radiofrequency ablation was performed under the guidance of CT.One month later,enhanced chest CT was conducted to recheck the size of the tumor as well as the scope of the necrosis,and according to the evaluation on the therapeutic effects,22patients,who were then treated with radioactive125I particle implantation,had incomplete ablation.Computer three-dimensional radiotherapy planning system was taken to develop treatment plans before the radioactive125I particle implantation to understand the particle distribution and quantity,and TPS was taken to conduct verification after the implantation.During the first two months after the operation,review was done once a month,and after the first two months,review was done once two months.Six months after the operation,enhanced chest CT was reviewed to evaluate the clinical efficacy.ResultsAmong the34cases,12cases(35.29%)achieved complete response(CR)after radiofrequency ablation and4cases(11.77%)achieved partial response(PR)with the short-term effective rate of47.06%(16/34).After radioactive125I particle implantation in22cases with incomplete ablation,8cases(36.36%)achieved CR and7cases(31.82%)achieved PR with the short-term effective rate of68.18%(15/22).To the22cases with incomplete ablation,follow-up visit was conducted once three months for half a year after the operation,and the median survival time was12months with the1-year survival rate of86.36%(19/22).The most frequent adverse reactions were penumothorax,internal hemorrhage,fever and so on,which returned to normal after symptomatic treatment.ConclusionRadiofrequency ablation combined with radioactive125I particle implantation on non-small cell lung cancer is a feasible method for treating NSCLC patients in middle and advanced stage,and the combination can obviously improve the curative effect with little trauma,low complication and incidence rate,so it is worthy of clinical attention.
作者
蒲德利
廖江荣
Pu Deli;Liao Jiangrong(Center for Oncotherapy,Guizhou Astronautics Hospital,Zunyi,Guizhou 563003,China)
出处
《现代医药卫生》
2017年第22期3410-3413,共4页
Journal of Modern Medicine & Health
