长期常规高剂量放射治疗可导致晚期输尿管癌(UC)患者腹膜后纤维化和神经损伤。目的评价肾造口术联合碘-125种子链(ISS)近距离放射治疗治疗UC的安全性和有效性。
21例UC患者接受肾造口术联合ISS近距离放射治疗。记录了以下参数:技术成功率,程序时间,并发症,平均D90(递送至90%总肿瘤体积的剂量),危险器官(OAR)剂量,本地控制率(LCR),输尿管通畅(UP),局部肿瘤进展(LTP),总生存率(OS)。肾积水评分(HS),视觉模拟评分(VAS),比较术前和术后8周的Karnofsky评分和最大直径(MD)。
技术成功率100%,平均手术时间为54.6分钟。3例(14.5%)有膀胱种植转移但无其他主要并发症,如输尿管穿孔,感染,或者严重出血,发生了。平均D90和OAR剂量为50.7和3.8Gy,分别。在8周评估时,LCR为100%,UP为28.6%。平均随访16.6个月,LTP4例(19.1%),中位OS为25.0个月(95%CI21.3-28.5)。HS,VAS,Karnofsky评分和MD均有显著变化(均P<0.01)。
肾造瘘术联合ISS近距离放射治疗可以安全有效地治疗UC,对于不能接受或拒绝手术切除的患者来说,这是一个可行的选择。
Long-term conventional high-dose radiation therapy can lead to retroperitoneal fibrosis and nerve damage in patients with advanced ureteral carcinoma (UC). The purpose of this study is to evaluate the safety and efficacy of nephrostomy combined with iodine-125 seed strand (ISS) brachytherapy for the treatment of UC.
Twenty-one patients with UC were treated with nephrostomy combined with ISS brachytherapy. The following parameters were recorded: technical success rate, procedure time, complications, mean D90 (dose delivered to the 90% gross tumor volume), organ at risk (OAR) dose, local control rate (LCR), ureteral patency (UP), local tumor progression (LTP), and overall survival (OS). The hydronephrosis score (HS), visual analog score (VAS), Karnofsky score and maximum diameter (MD) were compared before and 8 weeks after the operation.
The technical success rate was 100%, with a mean procedure time of 54.6 min. Three cases (14.5%) had bladder implant metastasis but no other major complications, such as ureteral perforation, infection, or severe bleeding, occurred. The mean D90 and OAR doses were 50.7 and 3.8 Gy, respectively. LCR was 100% with 28.6% UP at the 8-week evaluation. During the mean follow-up of 16.6 months, LTP occurred in 4 cases (19.1%), and the median OS was 25.0 months (95% CI 21.3-28.5). The HS, VAS, Karnofsky score and MD showed significant changes (all P < 0.01).
UC can be safely and effectively treated by nephrostomy combined with ISS brachytherapy, a viable option for patients who cannot undergo or refuse surgical resection.