Cao Qianqian, Wang Hao, Meng Na, Jiang Yuliang, Jiang Ping, Gao Yang, Tian Suqing, Liu Chen, Yang Ruijie, Wang Junjie, Zhang Kaixian
Department of Radiation Oncology, Cancer center, Peking University Third Hospital, No. 49 North Garden road, Haidian district, Beijing, 100191, China.
Department of Radiology, Peking University Third Hospital, No. 49 North Garden road, Haidian district, Beijing, 100191, China.
Radiat Oncol. 2014 Dec 23;9:301. doi: 10.1186/s13014-014-0301-8.
Management of spinal neoplasms has relied on open surgery and external beam radiotherapy (EBRT). Although primary spinal tumors are rare, their treatment remains a pervasive problem. This analysis sought to evaluate the safety and efficacy of CT-guided (125)I seed brachytherapy for recurrent paraspinous and vertebral primary tumors.
From November 2002 to June 2014, 17 patients who met the inclusion criteria were retrospectively reviewed. 14 (82.4%) had previously undergone surgery, 15 (88.2%) had received conventional EBRT and 3 (17.6%) had chosen chemotherapy. The number of (125)I seeds implanted ranged from 7 to 122 (median 79) with specific activity of 0.5-0.8 mCi (median 0.7 mCi). The post-plan showed that the actuarial D90 of (125)I seeds were 90-183 Gy (median 137 Gy). The follow-up period ranged from 2 to 69 months (median 19 months). The local control rate was calculated by the Kaplan-Meier method.
For 5 Chondrosarcomas, the 1-, 2-, 3-year local control rates were 75%, 37.5%, and 37.5%, respectively, with a median of 34 months (range, 4-39 months). For 4 chordomas, the local control rate was 50% with a median follow-up of 13 months (range, 3-17 months). For 3 fibromatosis, all of them were survival without local recurrence at the end of follow-up. During the follow-up period, 35.3% (6/17) died from metastases, 17.6% (3/17) developed local recurrence by 8, 14 and 34 months while 64.7% (11/17) remained alive. 100% experienced pain relief and normal or improved ambulation, without more than Frankel grade 3 radiation myelopathy.
Percutaneous (125)I seed implantation can be an alternative or retreatment for recurrent spinal primary tumors.
脊柱肿瘤的治疗一直依赖于开放手术和外照射放疗（EBRT）。尽管原发性脊柱肿瘤很少见，但其治疗仍然是一个普遍存在的问题。本分析旨在评估CT引导下（125）I粒子近距离放疗治疗复发性椎旁和椎体原发性肿瘤的安全性和有效性。
回顾性分析2002年11月至2014年6月期间符合纳入标准的17例患者。14例（82.4%）曾接受过手术，15例（88.2%）接受过传统EBRT，3例（17.6%）选择过化疗。植入的（125）I粒子数量为7至122枚（中位数79枚），比活度为0.5 - 0.8 mCi（中位数0.7 mCi）。计划后显示（125）I粒子的精算D90为90 - 183 Gy（中位数137 Gy）。随访期为2至69个月（中位数19个月）。局部控制率采用Kaplan-Meier法计算。
5例软骨肉瘤患者，1年、2年、3年局部控制率分别为75%、37.5%和37.5%，中位时间为34个月（范围4 - 39个月）。4例脊索瘤患者，局部控制率为50%，中位随访时间为13个月（范围3 - 17个月）。3例纤维瘤病患者，随访结束时均存活且无局部复发。随访期间，35.3%（6/17）死于转移，17.6%（3/17）分别在8、14和34个月出现局部复发，64.7%（11/17）仍存活。100%的患者疼痛缓解，行走能力正常或改善，无超过Frankel 3级的放射性脊髓病。
经皮（125）I粒子植入可作为复发性脊柱原发性肿瘤的一种替代或补救治疗方法。
