| BackgroundLung cancer is the leading cause of cancer-related deaths worldwide,accounting for about 13 percent of cancer deaths each year.Lung cancer can be divided into small cell carcinoma(SCLC)and non-small cell carcinoma(NSCLC)according to different pathological types.NSCLC accounts for approximately 80%of all patients with lung cancer,and about 75%of patients have been diagnosed in the middle and late stage,with a very low 5-year survival rate.Elderly patients account for the majority,and about 50%of lung cancer patients are>65 years old.Except for ?b and ?,NSCLC should be treated mainly by surgical treatment.The treatment of NSCLC in the ?,? stage and some ?a stage patients is still mainly surgical treatment,but approximately 70%of patients have lost the opportunity of surgery due to advanced stage or tumor metastasis,and the recurrence rate is relatively high after surgery.Therefore,chemotherapy has become one of the most effective treatment methods for NSCLC.However,the prognosis of advanced NSCLC is very poor,and the use of chemotherapy could reduce the tumor body and improve the efficacy of surgery or radiotherapy.Due to the low sensitivity of tumor to chemotherapy drugs,gastrointestinal reactions of platinum drugs and renal toxicity,its clinical application is limited.For patients with low clinical stage NSCLC,cardiopulmonary insufficiency and other patients who are not suitable for surgery,radiotherapy often has a better effect.But radiotherapy often leads to hair loss,bone marrow inhibition,radioactive esophagitis,decreased peripheral blood leukocyte number,fatigue and other symptoms and radioactive lung injury.In recent years,with the development of artificial isotopes and the advent of computer three-dimensional stereotactic treatment plan system,the implantation of isotopic particles in tumor for brachytherapy has attracted more and more attention.The implantation of radioactive 125I seeds into tumor tissues for the treatment of lung cancer improved the killing effect of tumor and significantly improved the local control rate of lung cancer,and a better effect can be achieved combined with systemic chemotherapy.Compared with external radiotherapy,125I seed implantation brachytherapy has the advantages of short action distance,strong controllability of radiation dose distribution,small damage to surrounding normal tissues,short hospitalization time,reliable local efficacy and good tolerance of patients.At present,the studies of 125I seed implantation in the treatment of NSCLC are mostly simple statistical description of the complications and survival conditions of patients,and there is lack of studies with in-depth analysis of the complications and survival data of patients through long-term follow-up observation.ObjectivesCurrent studies mainly focus on descriptive statistical analysis of patient complications and survival,while relatively few studies have explored the risk factors affecting the safety of seed implantation and the survival status of patients.The purpose of this study was to evaluate the safety and prognosis of CT guided 125I seed implantation surgery patients,and to explore related factors affecting the occurrence of complications and prognosis,so as to provide reference for clinical doctors to judge the safety of operation and prognosis of patients,and then predict the therapeutic effect and survival status.Methods and materialsData from 153 NSCLC patients who were treated with CT guided percutaneous 125I radioactive seed implantation in the Cancer Therapy and Research Center,Shandong Provincial Hospital from January 2014 to April 2018 were collected.A questionnaire was designed to collect the information of patients.The information collected included the personal basic information of the patient,the first confirmed tumor information table and previous treatment history,the diagnosis of hospitalization,laboratory examination and follow-up information and so on.Using SPSS24.0 software for statistical analysis and graphic drawing,the main analysis methods include:descriptive analysis,chi-square test,log-rank test and Kaplan-Meier method,logistic regression analysis and cox proportional hazard regression model.Results1.After 125I seed implantation,153 patients had no recent serious complications,and minor complications(55.6%)included 32 cases of intrapulmonary hemorrhage(20.9%),51 cases of pneumothorax(33.3%),18 cases of hemoptysis(11.8%),6 cases of subcutaneous emphysema(3.9%),and 3 cases of pain(2.0%).2.Univariate analysis showed that gender,age,BMI,tumor location,organ metastasis,pathologic stage,KPS,and number of seeds were correlated with postoperative complications in patients with NSCLC.Multivariate analysis of logistic regression model showed that the number of implanted seeds>30(OR=2.479,95%CI:1.198-5.130,P=0.010)and clinical staging were in stage I and II(OR=3.192,95%CI:1.033-9.864,P=0.044)were risk factors that affects the patients'complications.3.By the end of September 2018,127 out of 153 NSCLC patients were followed up,with a follow-up rate of 83.0%(127/153)and a follow-up period of 1-49 months.The cumulative survival rates of 1,2,3 and 4 years were 62.8%,37.1%,32.0%and 28.5%,respectively.Median survival time was 16.83 months and average survival time was 23.76 months.4.Univariate analysis showed that pre-treatment hemoglobin,adjuvant chemotherapy,patient positions,KPS,seed activity,number of seeds,and number of puncture needles were related to survival rate of NSCLC patients.Multivariate analysis of cox proportional hazard regression model showed that pre-treatment hemoglobin<130g/L(HR=1.597,95%CO:1.044-2.445,P=0.031),KPS<70(HR=1.759,95%CI:1.132-2.733,P=0.012)and seed activity>0.7mCi(HR=2.028,95%CI:1.182-3.477.P=0.010)were risk factors affecting the prognosis of patients.Patients with pre-treatment hemoglobin>130g/L,KPS>70 and seed activity?0.7mCi had better prognosis.Conclusions1.CT guided radioactive 125I seed implantation for the treatment of NSCLC patients is a safe method with a low incidence of complications.2.Pathologic stage of tumor and the number of seeds are the risk factors influencing the postoperative complications after 125I seed brachytherapy.Patients with low pathologic stage of tumor and high number of seeds are prone to postoperative complications.3· After receiving 125I seed implantation treatment for 153 NSCLC patients,the overall 1-year,2-year,3-year and 4-year cumulative survival rates were 62.8%,37.1%,32.0%and 28.5%,respectively,and the clinical effects were significant.4.Pre-treatment hemoglobin,KPS and seed activity were risk factors influencing the prognosis of patients with 125I brachytherapy.5.Before 125I seed implantation therapy,the necessary treatment to improve the general condition and hemoglobin value of patients,and the reasonable choice of seed activity during operation can play a positive role in the prognosis of patients. |
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