125I放射性粒子植入治疗对不能或不愿手术的早期非小细胞肺癌患者肺功能的影响

Effect of 125I implantation on pulmonary function in impossible non-small cell lung cancer

    摘要
  • 摘要:
    目的 评估CT引导下植入125I放射性粒子治疗早期（IA、IB期）非小细胞肺癌（NSCLC）后对患者肺功能的影响。
    方法 选取2013年10月至2018年6月接受125I放射性粒子植入治疗的早期NSCLC患者58例，根据治疗前的肺功能检测结果将患者分为合并慢性阻塞性肺疾病（COPD）组16例（男性10例、女性6例）和不合并COPD组42例（男性28例、女性14例），术后2~6个月检测肺功能指标，包括第一秒用力呼气容积(FEV1)、用力肺活量（FVC）、肺一氧化碳弥散量（DLCO）变化的情况。组间比较采用t检验。
    结果 覆盖90%靶体积时的剂量（D90）为（114.3±10.2）Gy，90%剂量覆盖的靶体积百分比（V90）为（92.3±7.2）%，术后验证匹配周边剂量（MPD）的中位值为112.8 Gy。随访6个月，不合并COPD组与合并COPD组患者治疗前后的 FVC%差异均无统计学意义（t=0.70、0.20，均P>0.05）。合并COPD组治疗前后的DLCO之间的差异无统计学意义（t=1.11，P=0.563），但不合并COPD组治疗前后的DLCO之间的差异有统计学意义（t=2.29，P=0.019）。治疗前后，合并COPD组和不合并COPD组肿瘤体积之间的差异均无统计学意义（t=1.82、1.26，均P>0.05），但合并COPD组和不合并COPD组在治疗前后肿瘤体积之间的差异均有统计学意义（t=5.78、9.96，均P<0.001）。根据术后质量验证MPD和D90大小分为2组（>110 Gy组和≤110 Gy组），合并COPD组和不合并COPD组的FEV1%之间、FVC%之间的差异均无统计学意义（t=0.54、0.37、0.21、0.22，均P>0.05）。
    结论 125I放射性粒子植入治疗早期NSCLC对患者FEV1%和FVC%无明显影响，但能够改善不合并COPD且肿瘤明显缩小患者的肺功能。

     

    Abstract:
    Objective To evaluate pulmonary function and tumor volume before and after CT-guided radioactive 125I seed implantation in inoperable patients with and without chronic obstructive pulmonary disease(COPD) in early-stage(IA, IB) lung cancer.
    Methods From October 2013 to June 2018, 58 patients with early non-small cell lung cancer were treated with 125I radioactive seed implantation. Patients were divided according to the results of pre-treatment pulmonary function tests: 16 patients(10 males and 6 females) were included in the COPD groups and 42 patients(28 males and 14 females) were included in the No-COPD group. Changes in pulmonary function forced expiratory volume in one second, diffusing capacity of the lungs for carbon monoxide(DLCO), and forced vital capacity were detected within 2–6 months after operation. Statistical analysis was conducted via t test.
    Results The D90 was(114.3±10.2) Gy, the V90 was(92.3±7.2)%, and the matched peripheral dose was 112.8 Gy. The pretreatment and post treatment FEV% of the COPD and No-COPD groups were similar at a mean follow-up time of 6 months(t =0.70, 0.20, both P＞0.05). The DLCO of the COPD group did not change after CT-guided radioactive 125I seed implantation treatment(t=1.11, P=0.563); however, DLCO significantly increased in the No-COPD group(t=2.29, P=0.019). There was no significant difference in the tumor volume between the COPD group and the No-COPD group before and after treatment(t=1.82, 1.26, both P＞0.05), but the difference between the COPD group and the tumor volume of the No-COPD group was statistically significant before and after the treatment(t=5.78, 9.96, both P＜0.001). According to postoperative quality validation of MPD and D90, all the patients were divided into > 110 Gy group(34 cases) and ≤110 Gy group(24 cases), differences in the FEV1% and FVC% of the COPD and No-COPD groups after implantation were not statistically significant(t=0.54, 0.37, 0.21, 0.22, all P＞0.05).
    Conclusion 125I implantation therapy for inoperable non-small cell lung cancer does not seem to affect FEV1% and FVC% but can shrink tumor volume and improve DLCO in patients without COPD

     

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