Clinical Application Of Operation Combined With¹²⁵I Radioactive Seeds Implantation In The Treatment Of Brain Malignant Tumor

Objective:Research1To compare with surgical treatment through the clinical retrospectivestudy of brain surgery combined with¹²⁵I seed implantation treatment of recurrentmalignant glioma disease; To analyse and summarize the lessons from implantationprocedure through postoperative evaluation and follow-up on the effect of surgery and anumber of prognostic indicators; To draw recommendations and conclusions on seedimplantation and clinical efficacy.Research2By retrospective studying of surgery combined with¹²⁵I seedimplantation to discuss treatment of brain metastases tumor disease; comparing with othertreatment modalities and records and statistical analysis of the follow-up on a number ofprognostic indicators, to analyze and draw conclusions ultimately on the clinical efficacyof the treatment of brain metastases tumor disease.Research3To analyse the survival of breast cancer patients with brain metastases inpatients with the treatment and prognostic factors by collecting data on surgery combinedwith¹²⁵I seed implantation in the treatment of brain metastases from breast patient, inorder to further improve the patient’s overall prognosis survival and risk factors of possiblecontrol options.Research4To analysis IOUS in improving intraoperative tumor removal rate andimprove surgery radioactive seed implantation in the treatment of malignant gliomasprognosis, To find other factors may affect the prognosis of the treatment process at thesame time. Looking for new and more effective methods for patients with malignantglioma tumor removal rate and improve the prognosis of such patients with diseases. Method:Research1A total of34cases collected in our hospital during the period from June2009to March2013surgery combined with¹²⁵I seed implantation operation treatment ofpatients with recurrent malignant glioma disease were compared withχ²5cases of patientsundergone surgery alone with malignant glioma. The patients were divided into twogroups by two treatment programmes, the data concerning the main indicators of patientsfor evaluation and follow-up data was recorded, to see whether there is a differencebetween two postoperative incidence of adverse reactions is tested by the chi-square testand finally by using the Kaplan-Meier survival analysis and Cox hazard regressionanalysis on the survival of the two groups of patients and the prognostic factors, we draw apreliminary comparative research and analysis to summarize the experience in the processof seed implantation.Research2A total of24cases collected in our hospital during the period from June2009to March2013surgery combined with¹²⁵I seed implantation operation treatment ofbrain metastases disease information, and collect and collate the past history of surgicalCommonwealth of stereotactic radiosurgery treatment and surgery alone in the treatmentof brain metastasis tumor patient clinical data of52cases. Depending on the treatment, thepatients were divided into three groups, a number of indicators on which to conduct afollow-up record on preliminary comparison of the three groups of patients’ survival andprognostic factors, and finally by using the Kaplan-Meier survival analysis and Coxhazard regression analysis and statistical methods we did the research and analysis.Research3A total of47patients collected between January2005and March2013surgery combined with¹²⁵I seed implantation operation treatment of brain metastases frombreast tumor disease, they are divided into surgical＋¹²⁵I seed implantation and surgical＋¹²⁵I particle implantation＋WBRT treatment group, depending on the treatmentgroup. Dothe The follow-up record by a number of indicators. Finally, through the use of theKaplan-Meier survival analysis and Cox hazard regression analysis, we can get thestatistical analysis of prognostic factors in the treatment of breast cancer brain metastasessurgery combined with¹²⁵I seed.Research4Collected30patients of malignant gliomas during the period from June2009March2013through the IOUS assisted surgery combined with¹²⁵I seed implantationoperation treatment. contrast with the same without IOUS assisted surgery combined with¹²⁵I seed implantation, patients with a total of32cases were compared by the betweenIOUS same MRI to determine the extent of tumor removal, to compare the diagnostic analysis of the consistency between the two methods. In addition, through thepostoperative follow-up of two different treatment group, Their survival prognosis ofpatients with different impact may affect patient prognostic factors were analyzed by adaptanalysis, using the Kaplan-Meier survival analysis method, followed by Cox hazardregression coefficient method for multi-the factors risk indicators calculated.Result:Research1No significant difference between the classification and comparison ofthe two groups of patients with postoperative adverse obtained after two treatments appearobvious adverse reactions （2=0.159, P=0.69）. From the subsequent statistical analysis ofdata for the group of patients during follow-up, we get the first set of overall survival inpatients with a median time of75weeks （95%CI,55.5-94.5） the surgery survival mediantime of45weeks （95%CI,38.0-52.0）. second group of patients median overall survivaltime of65weeks （95%CI,48.5-81.5） the surgery survival median time of29weeks （95%CI,23.0-35.0weeks）. Patients show preoperative KPS score＜70（P=0.035） and gliomagrade Ⅳ （P=0.033）.These two indicators are indicators of poor prognosis factors. The twogroups of different treatment options determined the survival time of patients withrelapsed different surgery combined with seed implantation patients, the median survivaltime compared with surgical resection group survives longer time （P=0.014）. The patient’sage, gender, recurrent tumor diameter, tumor location on prognosis is not directly relevant（P＞0.05）. The two groups of patients with recurrent postoperative survival time andoverall survival difference was statistically significant （P=0.014and P=0.034）.Multivariate analysis showed that patients with KPS score （P=0.031） and glioma grade（P=0.026） are independent risk prognostic factors.Research2Of the76patients of the two groups, according to the patient’s sex, age,KPS score, number of lesions, whether other parts of the transfer case, the primaryfocipathological type and treatment were stratified. Single factor analysis show beforetreatment KPS score＜70（P＜0.001）, lesion number of2（P=0.017）（P=0.035）, Otherparts of the transfer is significant poor prognostic factors. The prognostic survival time ofthe patients depends on the different treatment options, including surgery＋seedimplantation group of patients, the median survival longest （P＜0.001）. The patient’s age,gender, primary tumor pathological type （P＞0.05） for the latter is not significantlyaffected. Multivariate analysis showed that KPS score （P＜0.001）, with or without othermetastases （P=0.004） and the number of lesions （P=0.018） was an independent risk factor affecting prognosis.Research3To obtain the following results after the data collation and statisticalanalysis of the whole group of patients: The median follow-up time was30months （95%CI26.4-33.6）, to the end of the follow-up41cases （87.2%） patients died, five cases（12.8%） patients survived, and1case （2.1%） patient was lost to follow. Full group ofpatients, the median survival time was28months （95%CI,21.7-34.3）, surgery plus seedimplantation treatment group after a median survival time was24months （95%CI,16.2-31.8） surgery plus seed implantation＋WBRT for treatment group, the mediansurvival time was34months （95%CI,27.2-40.8）, with a significant difference intreatment in the two groups of patients with postoperative survival time （P=0.009,χ²=6.8）. In the by subsequent single factor analysis, we get: tumor recurrence in patientswith multiple intracranial metastases transfer interval≤24months, triple negative breastcancer, tumors, non-total resection, KPS score less than70points, extracranial lesionsprogress the situation prompted poor prognostic factor （P＜0.05）. Univariate analysis （P＜0.05）, factors using Cox hazard regression model analysis further analysis calculation,multi-factor analysis showed that only breast cancer receptor type and preoperative KPSscore level are independent risk factors affecting prognosis （P＜0.05）, the performance ofits risk distribution trend showed a gradual increase. By Cox regression analysis and otherindicators in the analysis, there is no evidence of a statistically significant difference, notas an independent risk factor assessment associated with the disease.Research4Through the study found enhanced IOUS judgment of intraoperativetumor resection rate and postoperative MRI scanned to determine with a high degree ofconsistency of the results. By the group of62patients, according to the patient’s sex, age,KPS score, tumor size, degree of resection of metastases, the primary foci pathologicaltype and treatment were stratified median surviva. analysis showed that pre-treatment KPSscore＜70（P＜0.001, χ²=12.6）, whether the tumor total resection （P＜0.001, χ²=15.4）,Ⅳ grade gliomas （P＜0.001, χ²=15.3） is one of the factors leading to the prognosis ofpatients with reduced survival time. Treatment options, the prognostic survival time ofpatients with different decisions, which the IOUS＋seed implantation in patients mediansurvival time was longer than that of the control group （P=0.034,2=4.52）. The patient’sage, gender, tumor diameter after not significantly affect （P＞0.05）. Multivariate analysisshowed that KPS score （P=0.013, χ²=6.116）, the degree of tumor resection （P=0.02,χ²=5.434） and tumor grade （P=0.014, χ²=6.1） is an independent prognostic risk factors. Conclusion:Research1By studying we believe that for brain malignant recurrent glioma patients,surgery combined with¹²⁵I seed implantation is a safe and feasible treatment, The surgerycan achieve the greatest degree of tumor load reduction, and has played a key role in delaythe recurrence of glioma disease. intraoperative radiation by radioactive particles furtherdestoy to limit the proliferation of tumor cells to prevent tumor recurrence on invisibleresidual tumor cells. Radioactive seeds implantation can further improve the prognosis ofsurvival of patients with recurrent glioma, compared with simple surgical excision, themedian survival time and overall survival timesignificantly improved after surgery,. Seedimplantation process is relatively safe, simple, and efficient. No serious side effects afterimplantation, and therefore has certain advantages as effective adjunctive treatment forrecurrent malignant glioma.Research2The number of local treatment for brain metastases measures are alsovery important, through our research and analysis, brain metastases in patients with KPSscore metastases, and presence of other metastases are factors affecting the survival timeof patients, surgery with¹²⁵I seed implantation combination therapy can effectively extendthe survival time of patients, the effect to be superior to the of stereotactic radiotherapysurgery and treated with surgery alone. Therefore,¹²⁵I seeds quality radiotherapy is animportant auxiliary measures for better treatments, and its main function is to inhibit localtumor recurrence, the implantation effectively improve the patient’s quality of life, forbrain metastases topical treatment of interstitial radiotherapy in patients with surgerycombined with¹²⁵I seed implantation is recommended. However, due to insufficientsample size, as well as for case selection and treatment of the process, there may be errors,or a certain impact on the accuracy of the research results, the result can only be as acertain frame of reference, and it still needs further research and demonstration. Inaddition, the same problems exist with intracranial primary malignant tumors of thetreatment process, how to further adjust radioactive seed implantation, optimize localradiation dose distribution and better application of radioactive sources are the fewimportant aspect, which we need to continue to explore and improve.Research3Whether there is a relapse of the tumor preoperatively, whether the tumoris metastatic lesions showed more than a single, primary lesions found to metastasizeinterval≤24months, tumor type triple negative breast cancer, the tumor in the surgicaloperation is notfull cut, preoperative KPS score＜70, the course of treatment in patientswith extracranial lesions progress of these factors may be one of the relevant factorsaffecting the survival time of patients. In addition, the type of patients with tumor lesions （whether for triple negative breast cancer） and patients with preoperative KPS scoredifferent independent risk factors affect the survival of patients. Through appropriatetreatment and prevention measures to further improve the rate of total resection of thetumor and KPS score to reduce the lead to the level of risk of death due to illness, whilethe clinicians in preoperative prognosis of patients with a better evaluation criteria, andguide clinical patients the latter part of the treatment and follow-up work.Research4The use of IOUS technology during the surgery, we are able to furtherimprove the degree of full cut for glioma lesions, so as to achieve the effect of furtherimproving the operation combined with¹²⁵I seed implantation treatment of malignantgliomas disease prognosis. Through research, we get IOUS can effectively improve thesurgery for the degree of glioma lesions cut its assessment for glioma resection withpostoperative MRI enhancement Attorney has a high degree of consistency can be adegree of evaluation of intraoperative glioma resection one of the criteria. By increasingthe extent of glioma resection improve the survival time of the patients, the effect issuperior to patients with malignant glioma Joint the IOUS assisted surgery particlesimplanted operation. Found by studying the degree of different pre-treatment KPS score,whether the use of IOUS confirm tumor resection and tumor grading and prognosissurvival time, and the risk factors associated with the disease leads to death. Therefore, byimproving the general and the use of IOUS preoperative adjuvant resection operation isone of the effective means to further improve the survival of patients with malignantglioma reduce its prognostic risk. Through research, we concluded that IOUS can be usedas one of the standard to judge the degree of tumor resection surgery surgery and seedimplantation operation can further improve the prognosis of patients is a safe and effectiveapplication of auxiliary technology recommended.