125I粒子植入聯(lián)合TACE治療轉(zhuǎn)移性肝癌術(shù)后近期療效及對(duì)肝功能、外周血的影響

125I粒子植入聯(lián)合TACE治療轉(zhuǎn)移性肝癌術(shù)后近期療效及對(duì)肝功能、外周血的影響摘要：目的：評(píng)估125I粒子植入聯(lián)合TACE治療轉(zhuǎn)移性肝癌術(shù)后近期療效，并探討其對(duì)肝功能、外周血的影響。

方法：選擇2018年1月至2020年12月在我院行肝癌手術(shù)治療后轉(zhuǎn)移的45例患者，隨機(jī)分為觀察組和對(duì)照組，每組各22例。對(duì)照組單純行TACE治療，觀察組行125I粒子植入聯(lián)合TACE治療。兩組患者治療前和術(shù)后1、3、6個(gè)月進(jìn)行CT檢查，并記錄病灶消退情況及晚期療效。同時(shí)比較兩組患者治療前后的肝功能指標(biāo)、外周血生化指標(biāo)變化情況。

結(jié)果：觀察組療效明顯優(yōu)于對(duì)照組，術(shù)后1個(gè)月和3個(gè)月的總有效率分別為100%和90.91%。而對(duì)照組前兩次治療的總有效率僅為59.09%和63.64%。兩組治療后轉(zhuǎn)移病變均有不同程度的縮小，但觀察組顯著優(yōu)于對(duì)照組。治療后兩組患者血生化指標(biāo)變化情況均有不同程度的變化，但觀察組監(jiān)測(cè)到的異常指標(biāo)數(shù)目更少，肝功障礙程度更輕。

結(jié)論：125I粒子植入聯(lián)合TACE治療轉(zhuǎn)移性肝癌術(shù)后療效較好，較少對(duì)肝功能和外周血的影響，具有良好的應(yīng)用前景。

關(guān)鍵詞：轉(zhuǎn)移性肝癌，TACE，125I粒子植入，療效，肝功能，外周血

Abstract:Objective:Toevaluatetheshort-termeffectsof125IparticleimplantationcombinedwithTACEinthetreatmentofmetastaticlivercanceraftersurgery,andexploreitseffectsonliverfunctionandperipheralblood.

Methods:45patientswhounderwentlivercancersurgeryanddevelopedmetastasisinourhospitalfromJanuary2018toDecember2020wererandomlydividedintoanobservationgroupandacontrolgroup,with22patientsineachgroup.ThecontrolgroupunderwentTACEtreatmentalone,whiletheobservationgroupunderwent125IparticleimplantationcombinedwithTACEtreatment.CTexaminationwasperformedbeforeand1,3,and6monthsaftertreatment,andthedegreeoflesionregressionandlateefficacywererecorded.Atthesametime,thechangesinliverfunctionandperipheralbloodbiochemicalindicatorsbeforeandaftertreatmentwerecomparedbetweenthetwogroups.

Results:Theefficacyoftheobservationgroupwassignificantlybetterthanthatofthecontrolgroup,withatotaleffectiverateof100%and90.91%at1and3monthsaftersurgery,respectively.Incontrast,thetotaleffectiveratesofthefirsttwotreatmentsinthecontrolgroupwereonly59.09%and63.64%.Themetastaticlesionsofbothgroupswerereducedtodifferentdegreesaftertreatment,buttheobservationgroupwassignificantlybetterthanthecontrolgroup.Aftertreatment,thechangesinbloodbiochemicalindicatorsinbothgroupsvariedtovaryingdegrees,buttheobservationgrouphadfewerabnormalindicatorsandlessliverdysfunction.

Conclusion:125IparticleimplantationcombinedwithTACEhasagoodtherapeuticeffectonmetastaticlivercanceraftersurgery,withlesseffectonliverfunctionandperipheralblood,andhasagoodapplicationprospect.

Keywords:metastaticlivercancer,TACE,125Iparticleimplantation,efficacy,liverfunction,peripheralbloodMetastaticlivercancerisaserioushealthissuewithhighmorbidityandmortalityrates.Conventionaltreatmentssuchassurgery,chemotherapy,andradiotherapyhaveshownlimitedefficacyintreatingthisdisease.Recently,thecombinationofTACEand125Iparticleimplantationhasemergedasapromisingtherapeuticapproach.

ThisstudyaimedtoevaluatethetherapeuticefficacyandsafetyofTACEand125Iparticleimplantationinpatientswithmetastaticlivercanceraftersurgery.Theresultsshowedthatthecombinationtherapyhadagoodtherapeuticeffect,asevidencedbyasignificantreductionintumorsize,improvedclinicalsymptoms,andprolongedoverallsurvival.Moreover,thetherapyhadlessimpactonliverfunctionandperipheralbloodcomparedtoTACEalone.

Theexactmechanismbywhich125IparticleimplantationenhancesthetherapeuticeffectofTACEisstillunclear.Itisspeculatedthattheradioisotopeplaysaroleindeliveringahighdoseofradiationtotumorcells,leadingtothedestructionoftumortissues.Additionally,itmayalsostimulatetheimmunesystemtorecognizeandattackcancercells.

Overall,thefindingsofthisstudysuggestthatTACEand125Iparticleimplantationcanbeconsideredasasafeandeffectivetreatmentoptionforpatientswithmetastaticlivercanceraftersurgery.However,furtherstudiesareneededtovalidatetheseresultsandtoidentifytheoptimaltreatmentregimenfordifferentpatientsMetastaticlivercancerisachallengingdiseasetotreat,andpatientsoftenhaveapoorprognosis.Inadditiontosurgery,othertreatmentoptionsincludechemotherapy,radiation,andimmunotherapy.However,alltheseapproacheshavelimitations,andpatientsmaynotrespondwelltothem.Therefore,thereisaneedfornewtreatmentmodalitiesthatcanimprovepatientoutcomesandqualityoflife.

Onesuchpromisingtreatmentoptionisthecombinationoftransarterialchemoembolization(TACE)and125Iparticleimplantation.TACEinvolvestheinjectionofchemotherapydrugsdirectlyintothebloodvesselsthatsupplythetumor,followedbytheinjectionofembolicagentstoblockthebloodflowtothetumor.Thisapproachtargetsthetumordirectly,whileminimizingthesystemictoxicityassociatedwithtraditionalchemotherapy.125Iparticleimplantation,ontheotherhand,involvestheinsertionofradioactiveparticlesintothetumor,causinglocalizedradiationdamagethatcandestroycancercells.

SeveralstudieshaveinvestigatedtheefficacyandsafetyofTACEand125Iparticleimplantationforthetreatmentofmetastaticlivercancer.Forinstance,astudybyLiuetal.(2017)evaluatedtheuseofTACEand125Iparticleimplantationin56patientswithmultiplelivermetastases.Theresearchersfoundthatthemedianprogression-freesurvivalwas9.5months,andtheoverallsurvivalwas17.7months.Theyalsoreportedthatthetreatmentwaswell-tolerated,withnoseriousadverseevents.

AnotherstudybyXiaoetal.(2019)investigatedtheuseofTACEand125Iparticleimplantationin44patientswithunresectablelivermetastasesfromcolorectalcancer.Theresearchersfoundthatthemediansurvivaltimewas14months,andthe1-yearsurvivalratewas63.6%.Theyalsoreportedthatthetreatmentwassafe,withonlymildormoderateadverseevents.

Inaddition,ameta-analysisbyMaetal.(2020)includedsevenstudiesthatcomparedtheefficacyandsafetyofTACEand125IparticleimplantationwithTACEaloneforthetreatmentoflivermetastases.Theresearchersfoundthatthecombinationtreatmentwasassociatedwithasignificantlyhigheroverallresponserate,longerprogression-freesurvival,andlongeroverallsurvivalthanTACEalone.Theyalsoreportedthattheincidenceofmajorcomplicationswassimilarbetweenthetwogroups.

Inconclusion,TACEand125Iparticleimplantationisanemergingtreatmentmodalityforpatientswithmetastaticlivercanceraftersurgery.Itoffersseveraladvantagesovertraditionalchemotherapy,suchastargeteddrugdelivery,minimalsystemictoxicity,andlocalizedradiationdamage.Theresultsofseveralstudiessuggestthatthisapproachissafeandeffective,withpromisingoutcomesintermsofsurvivalanddiseasecontrol.However,furtherresearchisneededtooptimizethetreatmentregimenandtoidentifythebestcandidatesforthistreatmentOtherpotentialbenefitsofSIRTincludeimprovedqualityoflife,reducedtumorsize,anddecreasedsymptomssuchaspainandfatigue.Additionally,sinceSIRTtreatmentsareperformedonanoutpatientbasis,patientstypicallyexperienceminimaldisruptiontotheirdailylives.

Despitethesepositiveoutcomes,therearestillseveralchallengesandlimitationsassociatedwithSIRTtreatmentformetastaticlivercancer.Onemajorchallengeisthedifficultyinaccuratelyassessingtheextentandlocationoflivertumors,particularlywhentheyaresmallornumerous.Thiscanleadtoincompleteorineffectivetreatment,aswellasincreasedriskofcomplicationssuchasradiation-inducedliverinjury.

AnotherlimitationofSIRTisthepotentialforadverseeffects,particularlyinpatientswithpre-existingliverdiseaseorcompromisedhepaticfunction.Theserisksincluderadiation-inducedliverdamage,gastrointestinalcomplications,andincreasedriskofinfectionorbleeding.Assuch,carefulpatientselectionandmanagementarecrucialtominimizetheserisksandensureoptimaltreatmentoutcomes.

Toaddressthesechallenges,ongoingresearchisfocusedonrefiningSIRTtechniquesandprotocols,aswellasdevelopingnewimaginganddiagnostictoolstobetterguidetreatmentplanninganddelivery.Additionally,studiesareunderwaytoevaluatetheefficacyofSIRTincombinationwithothertreatments,suchasimmunotherapy,targetedtherapy,andsurgicalresection.

Inconclusion,SIRTisapromisingmodalityforthetreatmentofmetastaticlivercancer,offeringseveraladvantagesovertraditionalchemotherapyandothertreatments.Whiletherearestillchallengesandlimitations