| Current late-stage malignant tumors minimally incasive treatment has become a hot topic of cancer treatment, based on the traditional cancer chemotherapy, targeted therapy, interventional treatment and after treatment, with the advance of technology, there have been all kinds of new technology and new method in tumor therapy clinic, for the majority of patients is good news, paper introduced of this research introduced of 125 I particles implanted as recently quickly application of micro-create of treatment technology has gradually was clinic accept, and for pase late tumor more sent transfer no effective contron means field of treatment in the related 125 I particles implanted based aspects research, on currently about hepatic portal system transfer tumor and lung within more sent transfer tumor 125 I particles implanted of reported relative less, effect has in liver lung more sent transfer tumor treatment in the of widely application. This study is based on the above problems, animal experiments and clinical studies, analysis of the safety and effectiveness of attempts to resolve the existing problems, for 125 I seeds provide a basis for further study and clinical application of implantation.First Part Hep G2 hepatoma of 125 I seeds implant treating load experimental study on the safety and efficacy of tumor in nude micePurpose: To explore the different doses of 125 I seeds interstitial iplantingon Hep G2 human hepatoma cells in nude mice transplanted tumor growthinhibition. Methods: Build 20 nude mice model of human hepatoma cell line Hep G2, were randomly divided into 4 groups, each group of 5. Respectively receive the 18.5MBq(group a), 29.6MBq(group b), 37MBq(c), 0MBq(d) of 125 I seeds treatment. Direct percutaneous tumor tissue implants are adopted by different doses of 125 I seeds implant treating mice tumors in vivo, tumors in mice in vivo 1 each particle 125 I seeds. Observe the changes of volume and weight of tumor in mice. To the 30 days killed all the mice, separating cancer tumor tissue around the particles changes were observed under the light microscope.Using the Graph Pad Prism V5 software statistical analysis, all measurement data are expressed as x±S, Using single-factor analysis of variance compare the differences between the groups, with P<0.05 for the difference was significant.Results: All 125 I seeds interstitial implantation metastases of 3 group of mice surviving 30 dasys of follow-up. Group 1 died of cachexia. In treating mice tumors by volume and weight growth rate decrease with the increased dose of 125 I seeds. Control mice tumor volume and weight differences are statistically significant(P<0.05), a, b, and c in mice compared with mice tumor volume in Group d, inhibition rate was 23.6%, 38.3%, 43.6%; A, b, c mice compared with Group d tumor weight in mice, inhibition rate of 21.6%, 37.2%, 40.5% respectively. Conclusion:Metastatic tumor of 125 I seeds interstitial implanting therapy is safe and effective, the inhibitory effect of the particles were positively correlated with dose, which transplanted tumor dose distribution in local tumor control plays a key role.Second Part Computed tomography-guided implantation of 125 I seeds(permanent brachytherapy) for metastatic tumors of the hepatic portal system: effectiveness and safety in 13 patientsPurpose: To retrospectively evaluate the efficacy and safety of computed tomography(CT)-guided implantation of iodine-125 seeds(permanent brachytherapy) for metastatic tumors of the hepatic portal system(HPS).Methods: Between January 2012 and January 2015, 13 patients with metastases measuring >3.0 cm in short-axis diameter(M 10, F 3; mean age of 52.9±3.8; range, 27-76), which remained in the HPS after conventional chemotherapy and/or TACE, and for which an effective therapeutic dose from external beam radiotherapy could not be delivered, received CT-guided 125 I brachytherapy. Clinical data were studied retrospectively. In terms of metrological requirements, the minimum dose to 90% of the target volume(D90) was 90–160 Gy for 125 I seeds with activity of 2.96×107Bq. CT-based evaluation after 2, 4 and 8 weeks, as well as 6 months after implantation enabled review of local control of tumors.8-18 months, an average of 12±1.1 months, no patients were lost to follow-up.Results: All symptoms were improved after 125 I brachytherapy. The mean value for D90 for implantation of 125 I seeds was 136 Gy.Complete response(CR) + partial response(PR) was documented in 61.5%, 69.2%, and 84.6% of patients at 2 weeks, 4 weeks, and 6 months after implantation, respectively. Four out of 13 patients had CR, 7 cases had PR, 1 patient had stable disease, and 1 case had progressive disease. All metastatic foci were controlled by implantation. No serious complications were observed. One patients with particle transfer to hearts, close follow-up, no lawsuit complaints. Conclusion: CT-guided 125 I brachytherapy is a safe and effective treatment for metastatic tumors of the HPS, and can achieve good local control in the short-term as long as the radiation dose is sufficient. CT-guided 125 I brachytherapy carries few complications, is simple, safe, and a good complement to cancer treatment.Third Part Computed tomography-guided implantation of 125 I seeds brachytherapy for multiple pulmonary metastatic tumorsPurpose: To retrospectively evaluate the efficacy and safety of computed tomography(CT)-guided percutaneous interstitial brachytherapy using iodione-125(125I) radioactive seeds for multiple pulmonary metastatic tumors(total metastasis number,≥2; largest diameter, 1.2 – 3.6 cm).Methods: Between September 2013 and December 2015, 22 patients with multiple pulmonary metastases(M 14, F 8; average age of 58.1±3.56; range, 16-81; mean number of metastases 3.0±0.40, range, 2-10), who after conventional chemotherapy and TACE therapy were considered unable to withstand stereotactic body radiation therapy(SBRT), received CT-guided 125 I brachytherapy. Clinical data were studied retrospectively. In terms of metrological requirements, a planning target volume of 90%(D90) was 120–160 Gy for 125 I seeds with an activity of 25.9 MBq. A CT-based evaluation performed 1, 2, and 6 month post-implantation enabled review of local control of tumors. Multiple pulmonary metastases were seen on CT 8 – 23 months(11.95 + 0.78) months after the first 125 I implantation. Results: Twenty-two patients successfully completed the treatment. The mean D90 value for 125I-seeds implantation was 132 Gy. Complete response(CR) + partial response(PR) was documented in 81.81%, 77.27%, and 77.27% of patients at 1, 2, and 6 months after implantation, respectively. Fourteen out of 22 patients had CR, 3 had PR, 2 had stable disease, and 3 had progressive disease. All metastatic foci were controlled by implantation. No serious complications were observed.In our study, there were 4 cases of pneumothorax, where in the pulmonary compression was less than 30%, with conservative treatment. Three days after the operation, 16 patients presented with cough, sputum, and hemoptysis. After 1 month of operation, 1 puncture subcutaneous metastasis.Conclusion: CT-guided 125 I brachytherapy is a safe and effective treatment for multiple pulmonary metastatic tumors(total metastasis number, ≥2; largest diameter, 1.2 – 3.6 cm), and can achieve good short-term local control so long as the radiation dose is sufficient. |
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