CT-guided radioactive seed implantation for recurrent rectal carcinoma after multiple therapy
CT-guided radioactive seed implantation for recurrent rectal carcinoma after multiple therapy
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DOI：
10.1007/s12032-009-9227-7
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发表时间：
2010-06-01
期刊：
影响因子：
3.4
通讯作者：
Yang, Rui Jie
中科院分区：
文献类型：
--
作者：
Wang, Jun Jie;Yuan, Hui Shu;Yang, Rui Jie
局部复发直肠癌在手术和放疗后难以控制，广泛切除与显著的发病率和死亡率相关。再照射，即使与化疗结合也显示出很短的存活率。我们评估了ct引导下（125）I或（103）Pd粒子间质永久性近距离放射治疗多次治疗后复发性直肠癌的可行性和疗效。15例局部复发直肠癌患者在CT引导下接受（125）I或（103）Pd粒子植入。种子植入的最小外周剂量为110-165 Gy（中位数为150 Gy）。粒子植入2周后，给予1例50 Gy立体定向放疗；4例患者接受2-4个周期的化疗。中位随访为8个月（范围4-50个月）。无痛生存期0 ~ 50个月（中位7个月）。局部控制维持3-50个月（中位7个月）。1年和2年的局部对照分别为16.2%和8.1%。死亡11例：局部复发2例（18.2%），局部复发并转移7例（63.6%），转移2例（18.2%）。4例患者（26.7%）存活，中位生存期为9个月。1年和2年精算总生存率分别为42.9%和10.7%。1例（7.6%）发生4级毒性事件；没有相关的神经病变。ct引导下放射性粒子植入作为复发直肠癌术后放疗后的抢救性或姑息性镇痛治疗是可行且安全的。
The recurrent carcinoma has been difficult to manage after surgery and radiotherapy, extensive resection of locally recurrent rectal cancer is associated with significant morbidity and mortality. Re-irradiation, even in combination with chemotherapy has shown very short survival. We assess the feasibility and efficacy of CT-guided interstitial permanent brachytherapy with (125)I or (103)Pd seeds for recurrent rectal cancer after multiple treatments. Fifteen patients with locally recurrent rectal carcinoma received (125)I or (103)Pd seed implants under CT guidance. The minimal peripheral dose of seed implants was 110-165 Gy (median 150 Gy). Two weeks after seed implantation, a 50 Gy of stereotactic radiotherapy was given to one patient; four patients received 2-4 cycles of chemotherapy. A median follow-up was 8 months (range 4-50 months). The duration of pain-free survival was 0-50 months (median 7 months). Local control was maintained for 3-50 months (median 7 months). The 1- and 2-year local controls were 16.2 and 8.1%, respectively. Eleven patients died: two (18.2%) of local recurrence, seven (63.6%) of local recurrence and metastases, and two (18.2%) of metastases. Four patients (26.7%) survived the median survival was 9 months. The 1- and 2-year actuarial overall survival rates were 42.9% and 10.7%, respectively. One patient (7.6%) experienced a grade 4 toxic event; there was no associated neuropathy. CT-guided radioactive seed implantation is feasible and safe as a salvage or palliative pain relief treatment for patients with recurrent rectal cancers after surgery and radiotherapy.