碘-125放射粒子組織間植入治療惡性腫瘤課件

PrimaryClinicalStudyofCT-guidedIodine-125SeedImplantationTherapyinPatientswithAdvancedPancreaticCancer

Brachytherapy1898年居里夫人發(fā)現(xiàn)鐳1905年即進行了第1例鐳針插管治療1930年Paterson及Parker建立了曼切斯特（Manchester）系統(tǒng)1935年小居里夫婦發(fā)現(xiàn)了人工放射性同位素80年代中期，現(xiàn)代近距離治療迅速發(fā)展生物學優(yōu)勢（外放療相比）腫瘤局部治療的持續(xù)時間長放射治療的劑量較低對周圍正常組織的損傷小對腫瘤細胞的殺傷力強

AnimalexperimentClinicalresearchHumanpancreaticcancerSw1990cellBABL/cwasinoculatedintothedorsalsideof

rightlower

extremityinguinalregionofnude

micePassaged

for3timssubcutaneously,initiatetheexperiments

aftertumorformationwasstablizedExperimentaldesign

SubcutaneouspancreaticcancerxenograftinnudemiceSeedimplantationgroupControlgroupExperimentalmethodChangeofxenograftvolumeinnudemiceExperimentalgrouppositiveTK1stainingcellsareexiguous（×200）ControlgrouppositiveTK1stainingcellsareabundent（×200）HE

staining

碘-125放射粒子組織間植入治療屬放射治療，

對周圍正常器官組織無明顯放射損傷裸鼠移植瘤組織植入碘-125粒子后，實驗組心、

肺、肝、腎、脾臟外觀大致正常，病理檢查未

見明顯放射性炎癥表現(xiàn)

PreliminaryresultZM.WangMD,ShanghaiRuijinHospitalIntroductionPancreaticcancerisadevastatingdisease

andtheprognosisremainspoorFewpatientsareeligibleforcurativesurgical

resectionAlternativetherapeuticoptionsareindemand

Traditionaltherapyvs.Externalirradiationtherapy

vs.percutaneousseedimplantationZM.WangMD,ShanghaiRuijinHospitalExternalirradiationtherapywasregardedasinsensitivetopancreaticcancerandassociatedwithmoresystemicsideeffectsRadioactiveiodine-125seedimplantationhasminimalsurgicaltraumaandfewcomplications

Themostcommonlyusedisotopeisiodine-125125IplacementwasroutinelyusedatourinstitutionforrecurrenttumorsatvarioussitesTheaimofthisstudywastotestitsfeasibilityforpancreaticlesions

CurrentControversies

11thIO2010,May

23Methodsandmaterials

PatientpopulationDecember2004toAugust2007,31consecutivepatientswereincludedinthisprospective,nonrandomizedstudy

PatientswerediagnosedbyCTorMRIwithhistologicalconfirmationofthediagnosisbyFNAAllpatientsenrolleddisplayedcontraindicationstosurgeryorhadrejectedsurgicaltreatmentduetopersonalreasons

Methodsandmaterials

Clinicalbenefitresponsewasderivedfrommeasurementofpain,functionalimpairmentandweightlossPatientswereexaminedbyCTaftertheoperationResponseratewasdefinedasthesumofCRandPR

Localtumorcontrolwasdefinedastheabsenceoftumorprogression(SD+PR+CR)

Methodsandmaterials

10patientsreceivedconcurrentchemotherapywitharterialinfusionofgemcitabinand5-fluorouracil(5-Fu)ChemotherapywasinitiatedoneweekafterandrepeateduptofourcyclesFollow-upvisitsat1month,3month,andevery3monthsforclinicalexamination,bloodsampling,andCTexaminationZM.WangMD,ShanghaiRuijinHospital禁忌證

放射性治療不宜(如血液病等)及有麻醉禁忌等病灶范圍廣泛惡液質(zhì)、全身衰竭腫瘤部位有活動性出血、壞死或潰瘍嚴重糖尿病Iodine-125TherapyinAdvancedPancreaticCancerResultsChangeofKarnofskyphysicalscore%(cases)ResultsOverallrespondingrate(CR+PR)=61.3%Localtumorcontrolratewas90.3%Mediansurvivaltimeforthewholegroupwas

10.31monthsMediansurvivaltimeforpureseedsimplantation

(21cases)was7monthsmediansurvivaltimefordrug-seedscombined

was11monthPre-implantCTscan(Caseone)

ZM.WangMD,ShanghaiRuijinHospitalPost-implantCTscan

ZM.WangMD,ShanghaiRuijinHospital術后CT掃描術中穿刺碘粒子植入Post-implantCTscanPost-implantCTscan病例2男性76歲

胰腺癌（胰體尾部）Pre-implantCTscan(CaseThree)

術后CT掃描Post-implantCTscanPre-implantCTscan(CaseFour)

Post-implantCTscan

術后CT二維重建Post-implantCTscanComplicationsNoseriouscomplicationsencountered2seedsofradioactive125Ifoundtomigrate

toliverin2patientsLeukopeniaandrenalfunctionimpairment

werefoundin4patientsofdrug-seeds

combinationgroupIodine-125TherapyinadvancedPancreaticCancerDiscussionPercutaneousimage-guidedseedimplantation

hasattractedincreasingattentionExtensiveexperienceswiththistechniquehad

beencollectedtargetingliverandlung

malignanciesThemostcommonlyusedisotopeis125I,and

125Iplacementhasbecomearoutinetreatment

forrecurrenttumorsatvarioussitesinour

institution

ZM.WangMD,ShanghaiRuijinHospitalTechnicalpointsduringtheprocedurePatientsfastedfor24hoursEnsuresteadybreathmovementduringtheprocedurePancreaticsecretionwasinhibitedTransgressstomachissaferthanintestine,avoiding

colonespeciallywhenusinglarge-boreneedlesForpatientswithjaundice,doPTCDfirstImmediateCTscanpostimplantationwasdonetoverify

thedistributionoftheseeds

ZM.WangMD,ShanghaiRuijinHospitalDrug-seedscombinedtherapyThereisdatasuggeststhatlocalcontrolrates

canbeenhancedbytheadditionof

chemotherapyInourstudythemediansurvivaltimebetween

thetwogroupsreachedstatastically

significantandencouragedfurtherevaluation

ZM.WangMD,ShanghaiRuijinHospitalConclusionsThisstudysuggestedthatCT-guidedbrachyth