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目的评价1.0T开放式MRI引导下经皮~(125)I放射性粒子植入治疗不可手术切除的晚期胰腺癌的可行性、安全性与有效性。方法选取31例无法外科手术切除的晚期胰腺癌患者,术前行MRI引导下穿刺活检,病理证实为胰腺癌。制定治疗计划系统(TPS),设定处方剂量(PD)120~160 Gy,D90>90%PD,V100>90%,V200<50%,在1.0T开放式磁共振引导下,结合呼吸门控技术行放射性~(125)I粒子植入。术后24 h内实施TPS剂量验证。结果31例患者均顺利穿刺并按术前计划植入~(125)I粒子,手术成功率100%。术后TPS验证,D90范围91%~112%PD,V100范围92%~106%,V200范围21%~49%。术后第1、3、6、12个月复查,以后每1年复查1次,中位生存时间为14.7个月,Ⅲ期和Ⅳ期的的中位生存时间分别为16.3个月和5.9个月。有效率83.8%,局部控制率93.5%。疼痛缓解有效率91.6%。未见胰腺炎、胰瘘、肠瘘、腹腔出血等严重并发症。结论 1.0T磁共振引导经皮放射性~(125)I粒子植入治疗不可手术切除的晚期胰腺癌可行、且安全有效。
Objective To evaluate the feasibility, safety and efficacy of 1.0T open MRI guided percutaneous 125I radioactive seed implantation in the treatment of unresectable advanced pancreatic cancer. Methods Totally 31 patients with advanced pancreatic cancer who could not be surgically removed were examined with MRI guided biopsy before operation. The pathology was confirmed as pancreatic cancer. The treatment planning system (TPS) was established. The prescription dose (PD) was 120 ~ 160 Gy, D90> 90% PD, V100> 90% and V200 <50%. Under the guidance of 1.0T open magnetic resonance Technical line radioactive ~ (125) I particle implantation. Within 24 h after the implementation of TPS dose verification. Results All the 31 patients were successfully punctured and implanted with ~ (125) I particles according to the preoperative planning. The successful rate was 100%. Postoperative TPS showed that D90 ranged from 91% to 112% PD, V100 ranged from 92% to 106% and V200 ranged from 21% to 49%. The patients were reviewed at 1, 3, 6 and 12 months after operation and once every 1 year after operation. The median survival time was 14.7 months. The median survival time in stage Ⅲ and Ⅳ were 16.3 months and 5.9 months month. Efficiency 83.8%, the local control rate of 93.5%. Pain relief effective rate of 91.6%. No pancreatitis, pancreatic fistula, intestinal fistula, abdominal bleeding and other serious complications. Conclusion 1.0T magnetic resonance guided percutaneous radioactive 125I seed implantation in the treatment of unresectable advanced pancreatic cancer is feasible, safe and effective.