手术联合125I粒子植入治疗复发高级别胶质瘤的临床初步应用

目的探讨采用手术联合125I放射性粒子植入治疗复发高级别胶质瘤的安全性与可行性，并与手术联合常规放疗的疗效进行比较。方法选取2014年10月—2019年1月浙江大学附属金华医院神经外科收治的复发高级别胶质瘤63例，根据治疗方式分为粒子组（n=27）和对照组(n=36)。所有患者均行开颅肿瘤切除，粒子组患者术中在黄荧光和神经导航引导下根据术前TPS方案植入125I放射粒子，对照组术后则行常规放疗，同时比较两组患者随访情况。结果两组术后并发症发生率、术后1个月和3个月的KPS评分无统计学差异（P>0.05），但粒子组术后6个月KPS评分（t=1.143,P=0.023）、2年生存率（X2=4.855,P=0.028）更高，中位生存时间（X2=1.570,P<0.001）更长。结论手术联合125I放射性粒子植入治疗复发高级别胶质瘤是一种可行且安全的治疗方式，可提高患者生存质量和总体生存率，并延长生存时间。

ObjectiveTo investigate the safety and feasibility of operation combined with iodine-125 radioactive implantation in the treatment of recurrent high-grade glioma, and to compare the effect with operation combined with conventional radiotherapy. Methods63 patients with recurrent high-grade gliomas, admitted in the Department of Neurosurgery, Jinhua Hospital Affiliated to Zhejiang University from October 2014 to January 2019, were divided into observation group(n=27) and control group(n=36) based on the treatment plans. All the patients underwent tumor resection. The patients in the observation group were implanted with iodine-125 radioactive seeds intra-operationly which were planned by TPS before the operation, the patients in the control group received conventional radiotherapy, the results of the follow-up were compared between the two groups. ResultsThere was no significant difference in the incidence of post-operative complications, the KPS scores of 1 month and 3 months post-op, 1-year survival rate between the two groups(P>0.05), while the observation group had higher KPS scores of 6 months post-op（t=1.143,P=0.023）, a higher 2-year survival rate（X2=4.855,P=0.028） and a longer the median survival time（X2=1.570,P<0.001）. ConclusionOperation combined with iodine-125 radioactive implantation is feasible and safe for recurrent high-grade glioma, which can improve the quality of life,increase the overall survival rate and prolong the survival time.