Preliminary Study On The Treatment Of Malignant Obstruction Of Esophagus Or Cardia By Gastric Tube Loaded With Radioactive ¹²⁵? Seeds

Part One: Preparation of gastric tube with radioactive ¹²⁵? seedsObjective: To explore the feasibility of developing radioactive gastric tube by pre-placing¹²⁵? seeds on common gastric tube.Methods: A circle with a diameter of 6mm was drawn on the white paper.The paper was scanned with a scanner and the data was stored in DICOM format through an image conversion program.Then,17 layers of images were created and imported into the treatment planning system?TPS?,which was to simulate the partial gastric tube loaded with ¹²⁵? seeds with a diameter of 6mm and a length of 8cm?layer spacing of 5mm?.TPS was used to delineate the tumor target.The simulated gastric tube boundary was used as the inner boundary of the tumor target,and the outer spread 0.5cm was used as the outer part.The circular target with the length of 6cm was delineated.The prescription dose of?PD?60Gy was given and the relevant dose parameters were calculated.Then,according to the data obtained from the simulated gastric tube,the radioactive ¹²⁵? seeds were fixed on the gastric tube by three kinds of fixation methods.Results: The D₉₀,D₁₀₀?90%,100% tumor volume prescription dose?calculated by TPS were 80 Gy,62Gy respectively,V₁₀₀?the volume percentage of the planned target area receiving 100% of the prescribed dose?was 100%,and D₉₀>PD.The radioactive ¹²⁵? seeds were attached to the wall of the gastric tube by means of "embedded" combination.The seeds were firmly combined without falling off,and the gastric tube was successfully produced.Conclusion: The design and manufacture of embedded radioactive ¹²⁵? seeds gastric tube is feasible.Part Two: The application of radioactive gastric tube in the treatment of malignant obstruction of esophagus or cardiaObjective: To investigate the feasibility,effectiveness and safety of radioactive ¹²⁵? seeds gastric tube for the treatment of malignant esophageal and cardiac obstruction,and to compare the nutritional status,complications and survival period between the radioactive gastric tube group and the common gastric tube group.Methods: 51 patients with malignant esophageal or cardiac obstruction who met the inclusion criteria were divided into two groups according to different treatment methods:radioactive ¹²⁵? seeds gastric tube group?experimental group?and common gastric tube group?control group?.The levels of prealbumin,albumin,leukocyte,erythrocyte and platelet in the two groups of patients at different postoperative time periods?2 weeks,1 month and 2 months?were detected.The physical condition and dysphagia grading of the patients were evaluated,and the complications and survival period were recorded.The statistical differences between the two groups were compared?P<0.05?.Results: There were no significant differences in age,gender,tumor pathological type,blood biochemistry and other baseline data between the two groups before operation?P>0.05?.Compared with the two groups after the operation,?1?nutritional status and physical status: the prealbumin and albumin levels were?174.74±35.25?mg/L and?37.32±2.11?g/L in the experimental group 2 weeks after the operation respectively.The control group was?166.38±23.17?mg/L and?37.80±2.03?g/L,respectively.Postoperative and preoperative differences between the two groups were statistically significant?P<0.05?,but there was no difference between the two groups?P>0.05?.The levels of prealbumin and albumin of 1 month after the operation vs.the pre-operation's between the two groups showed statistically significant differences?P<0.05?,while there was no difference between the two groups?P>0.05?.One month after the operation,the KPS score was 60?60,70?in the experimental group?P25,P75?and 60?60,60?in the control group,and the difference between the two groups was statistically significant?P<0.05?.The average postoperative increase was 8.15 points in the experimental group and 3.75 points in the control group.?2?the lumen unobstructed degree: 1 month after operation,the dysphagia classification?Stooler grade?of 11 patients in experimental group reach grade ???,while control group patients' are still grade ???,differences between the two groups was statistically significant?P <0.05?.Two months after the operation,the difference was still statistically significant?P<0.05?.During the follow-up,the extubation rate of the patients was 48.15% in the experimental group and 8.33% in the control group due to the unobstructed lumen and the ability to eat semi-fluid.The difference between the two groups was statistically significant?P<0.05?.?3?the postoperative complications: Blood routine examination was conducted 2weeks after the operation,and the white blood cell,red blood cell and platelet in the experimental group were?5.50±1.23?× 109/L,?4.29±0.32?× 1012/L,?204.33±46.12?× 109/L respectively,in the control group?4.85±1.33?×109/L,?4.17±0.46?×1012/L,?198.58±45.53?×109/L respectively,there was no statistically significant difference in the two groups?P>0.05?.Blood routine examination 1 month after surgery showed still no significant difference between the two groups?P>0.05?.Other postoperative complications,such as nasal mucosal erosion,displacement,diarrhea,gastroesophageal reflux,and aspiration pneumonia,were not statistically significant between the two groups?P>0.05?.?4?comparison of survival time: the average survival time of the patients in the experimental group was 172.94 days,and the median survival time was 181 days.The average survival time of patients in the control group was 168.78 days,and the median survival time was 172 days.There was no significant difference between the two groups?P>0.05?.Conclusion: The radioactive ¹²⁵? seeds gastric tube can not only provide nasal feeding,improve the nutritional status of patients and increase their physical strength,but also can irradiate tumors in the cavity and inhibit tumor growth,and there is no increase in postoperative complications compared with the common gastric tube.It is safe and feasible for clinical use,and can be used as a new palliative treatment for patients with malignant esophageal or cardiac obstruction.