碘-125放射粒子組織間植入治療惡性腫瘤

1、Primary Clinical Study of CT-guided Iodine-125 Seed Implantation Therapy in Patients with Advanced Pancreatic CancerBrachytherapyu1898年居里夫人發(fā)現(xiàn)鐳年居里夫人發(fā)現(xiàn)鐳u1905年即進行了第年即進行了第1例鐳針插管治療例鐳針插管治療u1930年年P(guān)aterson及及Parker建立了曼切斯特建立了曼切斯特（Manchester）系統(tǒng)）系統(tǒng)u1935年小居里夫婦發(fā)現(xiàn)了人工放射性同位素年小居里夫婦發(fā)現(xiàn)了人工放射性同位素u80年代中期，現(xiàn)代近距離治療迅速發(fā)展年代中期，現(xiàn)

2、代近距離治療迅速發(fā)展生物學(xué)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 Implant radioactive seeds into tumorsEmit continueous low energy raysInjury of tissues and cellsCell death and mutation leading to cancerInteract with biomacromolecule Animal Animal experimentexperimentClinical Clinical researchres

3、earchHuman pancreatic cancer Sw1990 cellBABL/c was inoculated into the dorsal side of right lower extremity inguinal region of nude micePassaged for 3 tims subcutaneously, initiate the experiments after tumor formation was stablizedExperimental design Subcutaneous pancreatic cancer xenograft in nude

4、 miceSeed implantation groupSeed implantation groupC Controlontrol group groupExperimental methodChange of xenograft volume in nude miceComparison of tumor inhibition rateObvious liquefaction necrosis can be seen in the centeral area of Experimental group tumor, there are sparse cells aroud the necr

5、osis area (100)HE stainingThere is no or little necrosis area in center of control group tumor, there are multiple tumor cells (100)Experimental group positive TK1 staining cells are exiguous（200）Control group positive TK1 staining cells are abundent （200）HE staining碘碘-125放射粒子組織間植入治療屬放射治療，放射粒子組織間植入治

6、療屬放射治療， 對周圍正常器官組織無明顯放射損傷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裸鼠移植瘤組織植入碘-125粒子后，實驗組心、粒子后，實驗組心、 肺、肝、腎、脾臟外觀大致正常，病理檢查未肺、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)見明顯放射性炎癥表現(xiàn) Preliminary resultZM. Wang MD, Shanghai Ruijin HospitalIntroductionPancreatic cancer is a devastating disease and the prognosis remains poorFew patients ar

7、e eligible for curative surgical resectionAlternative therapeutic options are in demand Traditional therapy vs. External irradiation therapy vs. percutaneous seed implantationZM. Wang MD, Shanghai Ruijin HospitalExternal irradiation therapy was regarded as insensitive to pancreatic cancer and associ

8、ated with more systemic side effectsRadioactive iodine-125 seed implantation has minimal surgical trauma and few complications The most commonly used isotope is iodine-125125I placement was routinely used at our institution for recurrent tumors at various sitesThe aim of this study was to test its f

9、easibility for pancreatic lesions Current Controversies 11th IO 2010, May 23Methods and materials Patient populationo December 2004 to August 2007, 31 consecutive patients were included in this prospective, nonrandomized study o Patients were diagnosed by CT or MRI with histological confirmation of

10、the diagnosis by FNAo All patients enrolled displayed contraindications to surgery or had rejected surgical treatment due to personal reasons ZM. Wang MD, Shanghai Ruijin HospitalMethods and materials The total volume of each tumor was calculated with the treatment planning system (TPS) before impla

11、ntationThe expected number of implanted seed was calculated according to the modified level formulaPatients were kept in our radiooncology/interventional ward with an usual stay of 4 full days Methods and materials Clinical benefit response was derived from measurement of pain, functional impairment

12、 and weight lossPatients were examined by CT after the operationResponse rate was defined as the sum of CR and PR Local tumor control was defined as the absence of tumor progression (SD+PR+CR) Methods and materials 10 patients received concurrent chemotherapy with arterial infusion of gemcitabin and

13、 5-fluorouracil (5-Fu)Chemotherapy was initiated one week after and repeated up to four cyclesFollow-up visits at 1 month, 3 month, and every 3 months for clinical examination, blood sampling, and CT examinationZM. Wang MD, Shanghai Ruijin Hospital適應(yīng)癥適應(yīng)癥 實體瘤（如前列腺癌）的根治性治療 實體瘤術(shù)后殘余組織的預(yù)防性治療 轉(zhuǎn)移性腫瘤病灶或術(shù)后孤立

14、性腫瘤轉(zhuǎn)移灶而失去手術(shù)價值者 無法手術(shù)的原發(fā)腫瘤的姑息性治療禁忌證禁忌證 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-125 Therapy in Advanced Pancreatic CancerResults Change of Karnofsky physical score % (cases)Karnofsky score 1009080706050Pre-op0（0/31） 3.2（1/31） 9.7(3/31) 41.9(13/31) 35.5(11/31) 9.7（3/31） Post-o

15、p0（0/31） 48.4(15/31) 16.1(5/31) 9.7(3/31) 19.4(6/31) 6.4(2/31) Results Change of pain score % (cases)Iodine-125 Therapy in Advanced Pancreatic CancerNo Pain (%)Mild Pain (%)Moderate Pain (%)Severe Pain (%)Pre-op6.5（2/31） 22.5(7/31) 32.3(10/31) 38.7(12/31) Post-op38.7(12/31) 32.3(10/31) 16.1(5/31) 12

16、.9(4/31) ResultsOverall responding rate (CR+PR) =61.3% Local tumor control rate was 90.3%Median survival time for the whole group was 10.31 monthsMedian survival time for pure seeds implantation (21 cases) was 7 monthsmedian survival time for drug-seeds combined was 11 monthPre-implant CT scan (Case

17、 one) ZM. Wang MD, Shanghai Ruijin HospitalPost-implant CT scan ZM. Wang MD, Shanghai Ruijin HospitalPre-implant CT scan (Case Two) 術(shù)后術(shù)后CTCT掃描掃描術(shù)中穿刺碘粒子植入術(shù)中穿刺碘粒子植入Post-implant CT scanPost-implant CT scan病例病例2 2 男性男性 7676歲歲 胰腺癌胰腺癌（胰體尾部）（胰體尾部）Pre-implant CT scan (Case Three) 術(shù)后術(shù)后CTCT掃描掃描Post-implant CT

18、 scanPre-implant CT scan (Case Four) Post-implant CT scan 術(shù)后術(shù)后CTCT二維重建二維重建Post-implant CT scanComplicationsNo serious complications encountered 2 seeds of radioactive 125I found to migrate to liver in 2 patients Leukopenia and renal function impairment were found in 4 patients of drug-seeds combinat

19、ion groupIodine-125 Therapy in advanced Pancreatic CancerDiscussionPercutaneous image-guided seed implantation has attracted increasing attentionExtensive experiences with this technique had been collected targeting liver and lung malignanciesThe most commonly used isotope is 125I , and 125I placeme

20、nt has become a routine treatment for recurrent tumors at various sites in our institution ZM. Wang MD, Shanghai Ruijin HospitalTechnical points during the procedurePatients fasted for 24 hoursEnsure steady breath movement during the procedurePancreatic secretion was inhibitedTransgress stomach is s

21、afer than intestine, avoiding colon especially when using large-bore needlesFor patients with jaundice, do PTCD firstImmediate CT scan post implantation was done to verify the distribution of the seeds ZM. Wang MD, Shanghai Ruijin HospitalDrug-seeds combined therapyThere is data suggests that local control rates can be enhanced by the addition of chemotherapyIn our study the median survival time between the two groups reached statastically