超声引导下放射性粒子植入治疗肝细胞癌患者短期疗效研究*

doi:10.3969/j.issn.1672-5069.2022.02.028

摘要/Abstract

摘要： 目的探讨采用放射性125I粒子植入治疗肝细胞癌(HCC)患者的近期疗效及其影响因素。方法 2017年7月～2021年8月我院收治的HCC患者84例,在超声引导下行放射性125I粒子植入治疗,粒子活度为0.6～0.8 mCi,肿瘤匹配周边剂量(MPD)为110～160 Gy,术后2个月复查CT或MRI并参考RECIST标准1.1版评估近期疗效。应用多因素Logistic回归分析影响疾病控制(完全缓解、部分缓解和疾病稳定)的独立危险因素。结果 84例HCC患者均顺利植入放射性125I粒子;疾病控制69例(82.1%),其中完全缓解15例(17.9%),部分缓解47例(56.0%),疾病稳定7例(8.3%),而疾病进展15例(17.9%);单因素分析发现,疾病控制组Child-Pugh分级为B级、BCLC分期为C期、肿瘤直径＞5 cm和D90剂量＜110 Gy占比分别为40.0%、43.5%、40.9%和28.6%,均显著低于疾病进展组的60.0%、56.5%、59.1%和71.4%(P＜0.05);多因素Logistic回归分析显示,D90剂量＜110 Gy是HCC患者接受放射性125I粒子植入治疗后疾病控制的独立影响因素(OR=344.350,P＜0.05)。结论对于不能手术切除的HCC患者,采用超声引导下放射性125I粒子植入治疗需要达到一定的照射计量,才能使患者获益。

关键词: 肝细胞癌, 125I放射性粒子, 超声引导, 近期疗效

Abstract: Objective The aim of this study was to investigate the influencing factors of disease control after ultrasound-guided 125I radioactive seed implantation for patients with hepatocellular carcinoma (HCC). Methods 84 patients with HCC were admitted to our hospital betweenJuly 2017 and August 2021, and all patients received ultrasound-guided intrahepatic 125I radioactive seed implantation with particle activity of 0.6-0.8 mCi and the tumor matched peripheral dose (MPD) of 110-160 Gy. The CT or MRI scan was performed 2 months after the operation and the short-term efficacy was evaluated according to RECIST standard version 1.1. The multivariate Logistic regression analysis was applied to screen for independent factors impacting disease control (the sum of complete response, partial response and disease stable). Results The intratumorous implantation of radioactive125I seeds was successfully finished in our 84 patients with HCC; at the end of two months after surgery, the imaging showed disease control in 69 cases (82.1%), including complete remission in 15 cases (17.9%), partial remission in 47 cases (56.0%) and disease stable in 7 cases (8.3%), with disease progression in 15 cases (17.9%); the univariate Logistic regression analysis showed that the proportions of Child-Pugh class B, BCLC stage C, tumor diameter > 5 cm and the received irradiation dose of 90% target volume (D90 dose) < 110 Gy in thedisease control group were 40.0%, 43.5%, 40.9% and 28.6%, all significantly lower than 60.0%, 56.5%, 59.1% and 71.4% in the disease progression group (P<0.05); the multivariate Logistic regression analysis showed that the D90 dose was an independent factor impacting disease control in patients with HCC after ultrasound-guided radioactive125I seed implantation (OR=344.350, P<0.05). Conclusion The sufficient irradiation dose is necessary in patients with unresectable HCC receiving intratumorous radioactive125I seed implantation in order to gain therapeutic efficacy, which needs further clinical investigation.

Key words: Hepatoma, Ultrasound-guidance, 125I radioactive particles, Disease control

王欣然, 蒋燕东, 张猛. 超声引导下放射性粒子植入治疗肝细胞癌患者短期疗效研究^*[J]. 实用肝脏病杂志, 2022, 25(2): 263-266.

Wang Xinran, Jiang Yandong, Zhang Meng. Local control of tumors in patients with hepatocellular carcinoma receiving ultrasound-guided intratumorous125I radioactive particle implantation[J]. Journal of Practical Hepatology, 2022, 25(2): 263-266.

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超声引导下放射性粒子植入治疗肝细胞癌患者短期疗效研究^*

Local control of tumors in patients with hepatocellular carcinoma receiving ultrasound-guided intratumorous125I radioactive particle implantation

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