Objective: To investigate the clinical efficacy and safety of 125I seed implantation in the treatment of mediastinal lymph node metastasis of lung cancer. Methods: Clinical data of 36 patients who underwent CT-guided 125I seed implantation for mediastinal lymph node metastasis of lung cancer from August 2013 to April 2020 in three hospitals of the Northern radioactive particle implantation treatment collaboration group were retrospectively collected, including 24 males and 12 females, aged 46 to 84 years. Cox regression model was used to analyze the relationship between local control rate, survival rate and tumor stage, pathological type, postoperative D90, postoperative D100 and other variables, and to analyze the occurrence of complications. Results: The objective response rate of CT-guided 125I seed implantation in the treatment of mediastinal lymph node metastasis of lung cancer was 75% (27/36), the median control time was 12 months, the 1-year local control rate was 47.2% (17/36), and the median survival time was 17 months. The 1-year and 2-year survival rates were 61.1% (22/36) and 22.2% (8/36) respectively. Univariate analysis showed that in the treatment of mediastinal lymph node metastasis with CT-guided 125I implantation, factors related to local control included tumor stage (HR=5.246, 95%CI: 2.243-12.268, P<0.001), postoperative D90 (HR=0.191, 95%CI: 0.085-0.431, P<0.001), postoperative D100 (HR=0.240, 95%CI: 0.108-0.533, P<0.001); The factors affecting survival were tumor stage (HR=2.712, 95%CI: 1.356-5.425, P=0.005), postoperative D90 (HR=0.110, 95%CI: 0.041-0.294, P<0.001), postoperative D100 (HR=0.212, 95%CI: 0.092-0.489, P<0.001). Multivariate analysis showed that tumor stage (HR=5.305, 95%CI: 2.187-12.872, P<0.001) and postoperative D100 (HR=0.237, 95%CI: 0.099-0.568, P<0.001) were correlated with local control rate. Tumor stage (HR=2.347, 95%CI: 1.095-5.032, P=0.028) and postoperative D90 (HR=0.144, 95%CI: 0.051-0.410, P<0.001) were correlated with survival. In terms of complications, 9 of the 36 patients had pneumothorax, and 1 of them was cured by closed thoracic drainage for severe pneumothorax; 5 cases developed pulmonary hemorrhage and 5 cases developed hemoptysis, which recovered after hemostasis treatment. One case developed pulmonary infection and recovered after anti-inflammatory treatment. No radiation esophagitis and radiation pneumonia occurred; No grade 3 or higher complications occurred. Conclusion: 125I seed implantation in the treatment of lung cancer mediastinal lymph node metastasis has a high local control rate and controllable adverse effects.
目的： 探讨125I粒子植入治疗肺癌纵隔淋巴结转移的临床疗效及安全性。 方法： 回顾性收集2013年8月至2020年4月北方放射性粒子植入治疗协作组三家医院36例行CT引导下125I粒子植入治疗肺癌纵隔淋巴结转移患者的临床资料，其中男24例，女12例，年龄46~84岁。采用Cox回归模型进行单因素和多因素分析局部控制率、生存率与肿瘤分期、病理类型、术后90%的靶体积所受的剂量（D90）、术后100%的靶体积所受的剂量（D100）等指标之间的关系，并分析并发症的发生情况。 结果： CT引导下125I粒子植入治疗肺癌纵隔淋巴结转移的客观缓解率为75%（27/36），中位控制时间为12个月，1年局部控制率为47.2%（17/36），中位生存时间为17个月，1、2年生存率分别为61.1%（22/36）、22.2%（8/36）。单因素分析显示，CT引导下125I粒子植入治疗肺癌纵隔淋巴结转移时，与局部控制相关的因素有肿瘤分期（HR=5.246，95%CI：2.243~12.268，P<0.001）、术后D90（HR=0.191，95%CI：0.085~0.431，P<0.001）、术后D100（HR=0.240，95%CI：0.108~0.533，P<0.001）；影响生存的因素有肿瘤分期（HR=2.712，95%CI：1.356~5.425，P=0.005）、术后D90（HR=0.110，95%CI：0.041~0.294，P<0.001）、术后D100（HR=0.212，95%CI：0.092~0.489，P<0.001）。多因素分析显示，肿瘤分期（HR=5.305，95%CI：2.187~12.872，P<0.001）及术后D100（HR=0.237，95%CI：0.099~0.568，P<0.001）与局部控制率相关；肿瘤分期（HR=2.347，95%CI：1.095~5.032，P=0.028）及术后D90（HR=0.144，95%CI：0.051~0.410，P<0.001）与生存率相关。并发症方面，全部36例患者中有9例发生气胸，其中1例为重度气胸行胸腔闭式引流后治愈；5例发生肺内出血，5例发生咯血，予以止血治疗后恢复；1例发生肺部感染，予以抗炎治疗后痊愈；无放射性食管炎及放射性肺炎发生；无3级及以上并发症发生。 结论： 125I粒子植入治疗肺癌纵隔淋巴结转移有较高的局部控制率，不良反应可以控制。.