ZHANG Fu-jun*, WU Pei-hong, ZHANG Liang, LIU Jian, HUANG Jin-hua, FAN Wei-jun, Li Chuan-xing, ZHAO Ming, GU Yang-kui, , WU Yue-xia,Li Kui, LU Ming-jian.
Background Lung cancer is highly malignant and its biological character is very complex. At the same time, the lung is the predilection site of most malignant tumors .When lung metastasis occurs, the course of the disease has developed to the advanced stage .Except very few situations, most cases have lost the opportunities of operation. Brachytherapy for malignant tumor emerges as a new treatment method.
Methods We analyse restrospectively the clinical data of 45 patients with pulmonary malignant tumors, who undergone radioactive seed 125I implantation from October,2002 to July,2005, so as to summarize the experiences and techniques. All cases have been confirmed by pathology. 45 patients (male 27, female 18, the age ranged from 31 to 73, average age is 52) with pulmonary malignant tumors accepted CT guided radioactive seeds 125I implantation were enrolled in this study. Among these patients, 16 cases had local advanced primary lung cancer, 29 cases had pulmoary metastatic tumor, 13 cases had pulmonary hilar lymph node metastasis or mediastinal lymph node metastasis, 7 cases had poor lung function and 5 cases had chest wall encroachment. The maximum diameter of tumors was 1.5-5.5cm (The average diameter is 3.5 cm). 38 patients made progression in pulmoary focus after repeated radiotherapy and chemotherapy. All cases have been confirmed by pathology. 125I seeds of 2.2~3.3×107 Bq were implanted into the lesions. Prescribed matched peripheral dose (MPD) was 90～160 Gy, and the total number of the seeds in every focus was 3～45 granules. The dosage in the region around the tumor was 90~160Gy. Under CT guidance, 125I seeds were implanted into the tumors. According to TPS, for the tumor with thickness less than 1 cm , we adopted plane implantation technique with 125I seeds of 0.5-0.8 mCi every 1.0-1.5 cm. 125I seeds can kill the tumor within the scope of 1.7cm around it.
Results The CT imaging outcome two months after the procedure proved that 10 cases obtained CR, 20 obtained PR, 9 NC and 6 PD. The response rate is 66.7%. The side effects occurred during the procedure including a little effusion in all patients, pneumothorax in 7 cases with lung compressed less than 30 percent and haematothorax in one case, all recovered after conservative treatment. One week after the procedure, sputum cruentum occurred in 26 cases. Seeds migration (in lung) occurred in 8 cases during the following two months. WBC decreased slightly in 4 cases 2 weeks after the procedure, WBC≥3×109/L, without other severe complications.
Conclusion CT guided radioactive seed 125I implantation is an effective method in treating pulmonary malignant tumors with few complications, and its short term outcome is definite. It’s a simple, safe and effective method, which can improve the quality of life obviously significantly.
【Key words】Iodine radioisotopes; Radiology; Interventional; Brachytherapy; Pulmonary tumor; Evaluation studies