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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
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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/OL]. 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/OL]. 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
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