切换至 "中华医学电子期刊资源库"
高级检索
中华介入放射学电子杂志

中华介入放射学电子杂志 ›› 2018, Vol. 06 ›› Issue (03) : 216 -221. doi: 10.3877/cma.j.issn.2095-5782.2018.03.008

所属专题： 文献；

肿瘤介入

碘125粒子植入治疗与立体定向放射治疗肠癌术后反复复发肺转移瘤的临床效果比较
李杰1, 谢其根1, 孙宗琼2, 王卫国1, 华燕艳1   
  1. 1. 214062　江南大学附属医院（无锡市第四人民医院）介入科
    2. 214062　江南大学附属医院（无锡市第四人民医院）放射科
  • 收稿日期:2018-02-09 出版日期:2018-08-01
  • 基金资助:
    江苏省卫生计生委2016年度青年科研项目(Q201615); 江苏省无锡市医院管理中心科技发展基金项目(YGM1123); 江苏省无锡市卫生计生委科研面上项目(MS201643)

Comparison on 125I seed brachytherapy and stereotactic body radiation therapy in treatment of recurrent pulmonary metastases of colorectal carcinoma

Jie Li1, Qigen Xie1, Zongqiong Sun2, Weiguo Wang1, Yanyan Hua1   

  1. 1. Department of Interventional Radiology, The Affiliated Hospital of Jiangnan University (Wuxi 4th People's Hospital) , Wuxi 214062, China
    2. Department of Radiology, The Affiliated Hospital of Jiangnan University (Wuxi 4th People's Hospital) , Wuxi 214062, China
  • Received:2018-02-09 Published:2018-08-01
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

李杰, 谢其根, 孙宗琼, 王卫国, 华燕艳. 碘125粒子植入治疗与立体定向放射治疗肠癌术后反复复发肺转移瘤的临床效果比较[J]. 中华介入放射学电子杂志, 2018, 06(03): 216-221.

Jie Li, Qigen Xie, Zongqiong Sun, Weiguo Wang, Yanyan Hua. Comparison on 125I seed brachytherapy and stereotactic body radiation therapy in treatment of recurrent pulmonary metastases of colorectal carcinoma[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2018, 06(03): 216-221.

目的：

比较碘125粒子植入治疗与立体定向放射治疗肠癌术后肺转移瘤的临床疗效和耐受性，分析影响生存预后的因素。

方法：

回顾性分析36例肠癌术后肺转移患者，依据治疗方式的不同分为碘125粒子植入组（A组，20例）与立体定向放射治疗组（B组，16例）。分析并比较两组的局部控制率、生存期及术后并发症。采用Kaplan-Meier法计算累积生存率，采用Cox模型分析生存预后的影响因素。

结果：

A组的中位生存时间为15个月，与B组的13个月比较差异无统计学意义（Log-Rank χ2=1.131, P=0.440），两组第1、3、6、12个月的局部控制率均达到80%以上，差异无统计学意义（P=0.897）。A组肺转移瘤的反复治疗次数多于B组，差异有统计学意义[（2.35±0.58）次vs.（1.69±0.48）次，t=3.729，P=0.001]；治疗后随访，B组放射性肺炎和放射性肺纤维化的损伤程度较A组严重，差异有统计学意义。放射性肺炎分级较高为预后的独立危险因素（HR=2.213，95%CI：1.013~4.834，P=0.046）。

结论：

与立体定向放射治疗相比，碘125粒子植入治疗可以短时间内反复应用，肺组织的放射性反应轻微，治疗肺转移瘤安全、高效，临床应用限制较小。

关键词: 肠癌, 碘125粒子, 立体定向放射治疗, 肺转移, 预后
Objective:

To evaluate the efficacy of 125I seed implantation and stereotactic body radiation therapy (SBRT) in the treatment of lung metastases postoperative resection of colorectal cancer, to compare the tolerance of lung tissue to both radiotherapy, and to analyze the factors that affect the prognosis.

Methods:

Thirty-six colorectal cancer patients with postoperative lung metastases were divided into two groups according to the treatment, 125I seed implantation group (group A, n=20) and SBRT group (group B, n=16) . Patients were followed up, and the local control rate, survival rate, and postoperative complications were analyzed retrospectively. Kaplan-Meier method was used for analysis of survival rate. Cox proportional hazards model was used to identify the independent predictors of poor prognosis and to analyze the prognostic factors.

Results:

Survival rate had no significant difference between groups A and B (median live time of 15 months and 13 months, respectively; Log-Rank χ2=1.131, P=0.440) . Local control rates after 1, 3, 6 and 12 months of treatment were all >80%, with no significant difference between the two groups (P=0.897) . The incidence of radiation-induced lung injury in group B was higher than that in group A, with significant differences between the two groups in the number of recurrent treatments [ (2.35±0.58) times vs. (1.69±0.48) times, t=3.729, P=0.001], the incidence of radiation pneumonia (P<0.001) and radiation-induced pulmonary fibrosis (P=0.004) . Multivariate regression analysis showed that radiation pneumonitis was an independent predictor of poor prognosis (HR=2.213, 95%CI: 1.013-4.834, P=0.046) .

Conclusions:

Compared with SBRT, 125I seeds brachytherapy can be repeated within a short time, and causes milder lung tissue damage. The treatment of pulmonary metastasis is safe and effective, and the clinical application is less limited.

Key words: Colorectalcancer, 125I seed, Stereotacticbodyradiationtherapy, Lungmetastasis, Prognosis
表1 两组肺转移瘤患者的基线情况
组别 例数 年龄（岁） 性别（男/女） ECOG评分 转移瘤直径(cm) 癌胚抗原 首次发现肺转移时间（月） 再发肺转移时间（月） 转移瘤数（个）
0分 1分 2分 升高 正常
A组 20 60.8±14.1 13/7 13 5 2 1.42±0.67 13 7 11.11±3.33 5.45±2.23 2.60±0.55
B组 16 55.3±14.9 9/7 12 3 1 1.12±0.44 11 5 10.95±3.89 5.29±2.23 2.77±0.54
统计量 ? t=1.683 χ2=0.280 χ2=0.632 t=1.581 χ2=0.055 t=0.718 t=0.350 t=0.301
P值 ? 0.101 0.598 0.579 0.123 0.815 0.453 0.845 0.833
表2 两组的治疗情况及结果
组别 例数 治疗数（次） 肺炎分级（例） 肺纤维化分级（例） 转移灶局部控制率(%)
1级 2级 3级 1级 2级 3级 1个月 3个月 6个月 12个月
A组 20 2.35±0.58 20 0 0 20 0 0 86.5 92.3 82.7 80.8
B组 16 1.69±0.48 4 9 3 10 5 1 84.2 89.5 81.6 81.6
统计量 ? t=3.729 ? Z=5.654 ? ? Z=5.677 ? ? ? ?
P值 ? 0.001 ? <0.001 ? ? <0.001 ? ? 0.897 ?
图1 两组生存曲线比较
图2 典型病例（女性，66岁，结肠癌切除术后1年余右上肺转移瘤，直径约0.9 cm）行碘125粒子植入治疗前后
图3 典型病例（女性，51岁，结肠癌切除术后5年右上肺转移瘤，直径约1.8 cm）行局部SBRT放疗（DT 50 Gy/10Fx）前后
[1]
Chen W，Zheng R，Zeng H，et al. Annual report on status of cancer in China，2011[J]. Chin J Cancer Res，2015，27（1）: 2-12.
[2]
Gonzalez M，Ris HB，Krueger T，et al. Colorectal cancer and thoracic surgeons: close encounters of the third kind[J]. Expert Rev Anticancer Ther，2012，12（4）:495-503.
[3]
Chen F，Sakai H，Miyahara R，et al. Repeat resection of pulmonary metastasis is beneficial for patients with colorectal carcinoma[J]. World J Surg，2010，34（10）:2373-2378.
[4]
Kanzaki R，Higashiyama M，Oda K，et al. Outcome of surgical resection for recurrent pulmonary metastasis from colorectal carcinoma[J]. Am J Surg，2011，202（4）:419-426.
[5]
Ridge CA，Solomon SB. Percutaneous ablation of colorectal lung metastases[J]. J Gastrointest Oncol，2015，6（6）:685-692.
[6]
Yan TD，King J，Sjarif A，et al. Percutaneous radiofrequency ablation of pulmonary metastases from colorectal carcinoma: prognostic determinants for survival[J]. Ann Surg Oncol，2006，13（11）:1529-1537.
[7]
Jung J，Song SY，Kim JH，et al. Clinical efficacy of stereotactic ablative radiotherapy for lung metastases arising from colorectal cancer[J]. Radiat Oncol，2015，10:238.
[8]
Pasqualetti F，Montrone S，Vivaldi C，et al. Stereotactic body radiotherapy in patients with lung oligometastases from colorectal cancer[J]. Anticancer Res，2017，37（1）:315-319.
[9]
Navarria P，Ascolese AM，Tomatis S，et al. Stereotactic body radiotherapy（sbrt）in lung oligometastatic patients: role of local treatments[J]. Radiat Oncol，2014，9（1）:91.
[10]
Ricco A，Davis J，Rate W，et al. Lung metastases treated with stereotactic body radiotherapy: the RSSearch® patient Registry's experience[J]. Radiat Oncol，2017，12（1）:35.
[11]
Shi S，Yang J，Sun D. CT-guided 125I brachytherapy on pulmonary metastases after resection of colorectal cancer: A report of six cases[J]. Oncol Lett，2015，9（1）:375-380.
[12]
Wang G，Zhang F，Yang B，et al. Feasibility and clinical value of CT-guided（125）I brachytherapy for bilateral lung recurrences from colorectal carcinoma[J]. Radiology，2016，278（3）:897-905.
[13]
Kang KH，Okoye CC，Patel RB，et al. Complications from stereotactic body radiotherapy for lung cancer[J]. Cancers（Basel），2015，7（2）:981-1004.
[14]
Li J，Zhang LJ，Xu WH，et al. Computed tomography-guided implantation of 125I seeds brachytherapy for recurrent multiple pulmonary oligometastases: initial experience and results[J]. J Contemp Brachytherapy，2017，9（2）:132-138.
[15]
Lencioni R，Llovet JM. Modified RECIST（mRECIST）assessment for hepatocellular carcinoma[J]. Semin Liver Dis，2010，30（1）:52-60.
[16]
Filippi AR，Badellino S，Ceccarelli M，et al. Stereotactic ablative radiation therapy as first local therapy for lung oligometastases from colorectal cancer: a single-institution cohort study[J]. Int J Radiat Oncol Biol Phys，2015，91（3）:524-529.
[17]
Trakul N，Harris JP，Le QT，et al. Stereotactic ablative radiotherapy for reirradiation of locally recurrent lung tumors[J]. J Thorac Oncol，2012，7（9）:1462-1465.
[18]
Tochio M，Takaki H，Yamakado K，et al. A case report of 20 lung radiofrequency ablation sessions for 50 lung metastases from parathyroid carcinoma causing hyperparathyroidism[J]. Cardiovasc Intervent Radiol，2010，33（3）:657-659.
[19]
Crombé A，Buy X，Godbert Y，et al. 23 Lung metastases treated by radiofrequency ablation over 10 years in a single patient: successful oncological outcome of a metastatic cancer without altered respiratory function[J]. Cardiovasc Intervent Radiol，2016，39（12）:1779-1784.
[20]
Agolli L，Bracci S，Nicosia L，et al. Lung metastases treated with stereotactic ablative radiation therapy in oligometastatic colorectal cancer patients: outcomes and prognostic factors after long-term follow-up[J]. Clinical Colorectal Cancer，2017，16（1）:58-64.
[21]
Owen D，Olivier KR，Mayo CS，et al. Outcomes of stereotactic body radiotherapy（SBRT）treatment of multiple synchronous and recurrent lung nodules[J]. Radiat Oncol，2015，10:43.
[22]
Li J，Xie QG，Wang WG，et al. CT-guided implantation of 125I seeds（permanent brachytherapy）for metastatic tumors of the hepatic portal system: Effectiveness and safety in 13 patients[J]. Brachytherapy，2016，15:224-230.
[1] 姚宏伟, 魏鹏宇, 高加勒, 张忠涛. 不断提高腹腔镜右半结肠癌D3根治术的规范化[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 1-4.
[2] 杜晓辉, 崔建新. 腹腔镜右半结肠癌D3根治术淋巴结清扫范围与策略[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 5-8.
[3] 杨倩, 李翠芳, 张婉秋. 原发性肝癌自发性破裂出血急诊TACE术后的近远期预后及影响因素分析[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 33-36.
[4] 栗艳松, 冯会敏, 刘明超, 刘泽鹏, 姜秋霞. STIP1在三阴性乳腺癌组织中的表达及临床意义研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 52-56.
[5] 马伟强, 马斌林, 吴中语, 张莹. microRNA在三阴性乳腺癌进展中发挥的作用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 111-114.
[6] 曹迪, 张玉茹. 经腹腔镜生物补片修补直肠癌根治术后盆底疝1例[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 115-116.
[7] 钟广俊, 刘春华, 朱万森, 徐晓雷, 王兆军. MRI联合不同扫描序列在胃癌术前分期诊断及化疗效果和预后的评估[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 378-382.
[8] 胡宝茹, 尚乃舰, 高迪. 中晚期肝细胞癌的DCE-MRI及DWI表现与免疫治疗预后的相关性分析[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 399-403.
[9] 李永胜, 孙家和, 郭书伟, 卢义康, 刘洪洲. 高龄结直肠癌患者根治术后短期并发症及其影响因素[J]. 中华临床医师杂志(电子版), 2023, 17(9): 962-967.
[10] 王军, 刘鲲鹏, 姚兰, 张华, 魏越, 索利斌, 陈骏, 苗成利, 罗成华. 腹膜后肿瘤切除术中大量输血患者的麻醉管理特点与分析[J]. 中华临床医师杂志(电子版), 2023, 17(08): 844-849.
[11] 王飞飞, 王光林, 孟泽松, 李保坤, 曹龙飞, 张娟, 周超熙, 丁源一, 王贵英. 敲低IMPDH1对结肠癌SW480、HT29细胞生物功能的影响[J]. 中华临床医师杂志(电子版), 2023, 17(08): 884-890.
[12] 索利斌, 刘鲲鹏, 姚兰, 张华, 魏越, 王军, 陈骏, 苗成利, 罗成华. 原发性腹膜后副神经节瘤切除术麻醉管理的特点和分析[J]. 中华临床医师杂志(电子版), 2023, 17(07): 771-776.
[13] 孔凡彪, 杨建荣. 肝脏基础疾病与结直肠癌肝转移之间关系的研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(07): 818-822.
[14] 王亚丹, 吴静, 黄博洋, 王苗苗, 郭春梅, 宿慧, 王沧海, 王静, 丁鹏鹏, 刘红. 白光内镜下结直肠肿瘤性质预测模型的构建与验证[J]. 中华临床医师杂志(电子版), 2023, 17(06): 655-661.
[15] 朴成林, 蓝炘, 司振铎, 冯健, 安峰铎, 李强, 谈明坤, 赵娜, 冷建军. 局部晚期右半结肠癌行结肠癌根治联合胰十二指肠切除术疗效分析：附5例报告[J]. 中华临床医师杂志(电子版), 2023, 17(06): 666-670.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号