国产3D打印共面模板辅助125I粒子植入治疗伴重度腹痛局部进展型胰腺癌疗效观察

Efficacy of 125I seed implantation assisted by domestic 3D-printing coplanar template in the treatment of locally advanced pancreatic cancer with severe abdominal pain

摘要:

目的 评价国产3D打印共面模板辅助放射性125I粒子植入治疗伴重度腹痛局部进展型胰腺癌的临床疗效及安全性。方法 收集我院2017年2月~2021年7月，因腹痛就诊，诊断为局部进展型胰腺癌的病人51例，男36例，女15例，平均年龄平均62.512.939。疼痛评分用数字评分（NRS）法判定。肿瘤大小变化用改良实体瘤评估方法（mRECIST1.1）判定。51例患者均行国产3D打印共面模板辅助125I粒子植入术。比较术前术后肿瘤大小、疼痛评分、肿瘤标志物三相指标变化及并发症发生情况， P<0.05为有统计学意义。结果51例胰腺癌患者各行一次放射性125I粒子植入治疗，共植入125I粒子3213粒，粒子活度0.6-0.8mCi/粒。术前疼痛评分与术后3天比较差异无统计学意义（P = 0.077），与术后7天、30天比较差异具有统计学意义，P<0.001；术前、术后不同时间点的肿瘤大小差异具有统计学意义，P<0.001；未发现患者术前和术后不同时间点的CA199浓度存在的差异具有统计学意义（P =1.000）。并发症：1/51病人术后穿刺道出血，经保守治疗好转。无胰瘘、肠瘘、粒子移位等发生。结论 国产3D打印共面模板辅助下125I粒子植入治疗伴重度腹痛局部进展型胰腺癌缩小肿瘤的同时改善顽固性腹痛，并发症少，是一种安全、有效、重复性强、易于推广的的治疗方法。

Abstract:

Objective To evaluate the clinical efficacy and safety of radioactive 125I seed implantation assisted by domestic 3D-printing coplanar template in the treatment of locally advanced pancreatic cancer with severe abdominal pain. Methods A total of 51 patients with severe abdominal pain diagnosed as locally advanced pancreatic cancer (LAPC) were selected from February 2017 to July 2021 in our hospital. There were 36 males and 15 females, with a mean age of 62.5±12.939 years. Moreover, they underwent 125I seeds implantation under the guidance of the domestic 3D-printing coplanar template. The numeric pain rating scale (NRS) was used to score pain intensity. The modified Response Evaluation Criteria in Solid Tumors criteria 1.1 (mRECIST 1.1) was utilized to determine the change in tumor size. Further, the change in three indicators including tumor size, pain score, and tumor markers was compared retrospectively between pre- and postoperative the same patient. The occurrence of postoperative complications was observed and recorded. P < 0.05 was considered statistically significant. Result All 51 LAPC patients have successfully experienced 125I seed implantation therapy only once. In total, 3213 125I particles were implanted. The specific activity of 125I seeds was 0.6-0.8 mCi/seed. The pre-operative pain score had no significant difference with that of the 3 days post-operative (P?=?0.077), but was statistically significant compared with that at 7 days or 30 days post-operative (P?=0.000). The tumor size demonstrated a statistically significant change between before the operation and at each time point after the operation (P < 0.001). No statistically significant differences were found in the concentration of CA199 at different postoperative time points compared with the preoperative (P=1.000). In addition, a single case of puncture tract bleeding was detected, which improved after conservative treatment. No serious complications occurred, such as pancreatic fistula, intestinal fistula, and radioactive seeds dislodgement. Conclusion 125I seed implantation assisted by domestic 3D-printing coplanar template to cure the LAPC patients with severe abdominal pain can both reduce tumor mass size and improve intractable abdominal pain. This intervention is a safe, effective, repeatable, and readily generalizable therapeutic approach.