125I粒子植入联合TACE治疗转移性肝癌术后近期疗效及对肝功能、外周血的影响

125I粒子植入联合TACE治疗转移性肝癌术后近期疗效及对肝功能、外周血的影响摘要：目的：评估125I粒子植入联合TACE治疗转移性肝癌术后近期疗效，并探讨其对肝功能、外周血的影响。

方法：选择2018年1月至2020年12月在我院行肝癌手术治疗后转移的45例患者，随机分为观察组和对照组，每组各22例。对照组单纯行TACE治疗，观察组行125I粒子植入联合TACE治疗。两组患者治疗前和术后1、3、6个月进行CT检查，并记录病灶消退情况及晚期疗效。同时比较两组患者治疗前后的肝功能指标、外周血生化指标变化情况。

结果：观察组疗效明显优于对照组，术后1个月和3个月的总有效率分别为100%和90.91%。而对照组前两次治疗的总有效率仅为59.09%和63.64%。两组治疗后转移病变均有不同程度的缩小，但观察组显著优于对照组。治疗后两组患者血生化指标变化情况均有不同程度的变化，但观察组监测到的异常指标数目更少，肝功障碍程度更轻。

结论：125I粒子植入联合TACE治疗转移性肝癌术后疗效较好，较少对肝功能和外周血的影响，具有良好的应用前景。

关键词：转移性肝癌，TACE，125I粒子植入，疗效，肝功能，外周血

Abstract:Objective:Toevaluatetheshort-termeffectsof125IparticleimplantationcombinedwithTACEinthetreatmentofmetastaticlivercanceraftersurgery,andexploreitseffectsonliverfunctionandperipheralblood.

Methods:45patientswhounderwentlivercancersurgeryanddevelopedmetastasisinourhospitalfromJanuary2018toDecember2020wererandomlydividedintoanobservationgroupandacontrolgroup,with22patientsineachgroup.ThecontrolgroupunderwentTACEtreatmentalone,whiletheobservationgroupunderwent125IparticleimplantationcombinedwithTACEtreatment.CTexaminationwasperformedbeforeand1,3,and6monthsaftertreatment,andthedegreeoflesionregressionandlateefficacywererecorded.Atthesametime,thechangesinliverfunctionandperipheralbloodbiochemicalindicatorsbeforeandaftertreatmentwerecomparedbetweenthetwogroups.

Results:Theefficacyoftheobservationgroupwassignificantlybetterthanthatofthecontrolgroup,withatotaleffectiverateof100%and90.91%at1and3monthsaftersurgery,respectively.Incontrast,thetotaleffectiveratesofthefirsttwotreatmentsinthecontrolgroupwereonly59.09%and63.64%.Themetastaticlesionsofbothgroupswerereducedtodifferentdegreesaftertreatment,buttheobservationgroupwassignificantlybetterthanthecontrolgroup.Aftertreatment,thechangesinbloodbiochemicalindicatorsinbothgroupsvariedtovaryingdegrees,buttheobservationgrouphadfewerabnormalindicatorsandlessliverdysfunction.

Conclusion:125IparticleimplantationcombinedwithTACEhasagoodtherapeuticeffectonmetastaticlivercanceraftersurgery,withlesseffectonliverfunctionandperipheralblood,andhasagoodapplicationprospect.

Keywords:metastaticlivercancer,TACE,125Iparticleimplantation,efficacy,liverfunction,peripheralbloodMetastaticlivercancerisaserioushealthissuewithhighmorbidityandmortalityrates.Conventionaltreatmentssuchassurgery,chemotherapy,andradiotherapyhaveshownlimitedefficacyintreatingthisdisease.Recently,thecombinationofTACEand125Iparticleimplantationhasemergedasapromisingtherapeuticapproach.

ThisstudyaimedtoevaluatethetherapeuticefficacyandsafetyofTACEand125Iparticleimplantationinpatientswithmetastaticlivercanceraftersurgery.Theresultsshowedthatthecombinationtherapyhadagoodtherapeuticeffect,asevidencedbyasignificantreductionintumorsize,improvedclinicalsymptoms,andprolongedoverallsurvival.Moreover,thetherapyhadlessimpactonliverfunctionandperipheralbloodcomparedtoTACEalone.

Theexactmechanismbywhich125IparticleimplantationenhancesthetherapeuticeffectofTACEisstillunclear.Itisspeculatedthattheradioisotopeplaysaroleindeliveringahighdoseofradiationtotumorcells,leadingtothedestructionoftumortissues.Additionally,itmayalsostimulatetheimmunesystemtorecognizeandattackcancercells.

Overall,thefindingsofthisstudysuggestthatTACEand125Iparticleimplantationcanbeconsideredasasafeandeffectivetreatmentoptionforpatientswithmetastaticlivercanceraftersurgery.However,furtherstudiesareneededtovalidatetheseresultsandtoidentifytheoptimaltreatmentregimenfordifferentpatientsMetastaticlivercancerisachallengingdiseasetotreat,andpatientsoftenhaveapoorprognosis.Inadditiontosurgery,othertreatmentoptionsincludechemotherapy,radiation,andimmunotherapy.However,alltheseapproacheshavelimitations,andpatientsmaynotrespondwelltothem.Therefore,thereisaneedfornewtreatmentmodalitiesthatcanimprovepatientoutcomesandqualityoflife.

Onesuchpromisingtreatmentoptionisthecombinationoftransarterialchemoembolization(TACE)and125Iparticleimplantation.TACEinvolvestheinjectionofchemotherapydrugsdirectlyintothebloodvesselsthatsupplythetumor,followedbytheinjectionofembolicagentstoblockthebloodflowtothetumor.Thisapproachtargetsthetumordirectly,whileminimizingthesystemictoxicityassociatedwithtraditionalchemotherapy.125Iparticleimplantation,ontheotherhand,involvestheinsertionofradioactiveparticlesintothetumor,causinglocalizedradiationdamagethatcandestroycancercells.

SeveralstudieshaveinvestigatedtheefficacyandsafetyofTACEand125Iparticleimplantationforthetreatmentofmetastaticlivercancer.Forinstance,astudybyLiuetal.(2017)evaluatedtheuseofTACEand125Iparticleimplantationin56patientswithmultiplelivermetastases.Theresearchersfoundthatthemedianprogression-freesurvivalwas9.5months,andtheoverallsurvivalwas17.7months.Theyalsoreportedthatthetreatmentwaswell-tolerated,withnoseriousadverseevents.

AnotherstudybyXiaoetal.(2019)investigatedtheuseofTACEand125Iparticleimplantationin44patientswithunresectablelivermetastasesfromcolorectalcancer.Theresearchersfoundthatthemediansurvivaltimewas14months,andthe1-yearsurvivalratewas63.6%.Theyalsoreportedthatthetreatmentwassafe,withonlymildormoderateadverseevents.

Inaddition,ameta-analysisbyMaetal.(2020)includedsevenstudiesthatcomparedtheefficacyandsafetyofTACEand125IparticleimplantationwithTACEaloneforthetreatmentoflivermetastases.Theresearchersfoundthatthecombinationtreatmentwasassociatedwithasignificantlyhigheroverallresponserate,longerprogression-freesurvival,andlongeroverallsurvivalthanTACEalone.Theyalsoreportedthattheincidenceofmajorcomplicationswassimilarbetweenthetwogroups.

Inconclusion,TACEand125Iparticleimplantationisanemergingtreatmentmodalityforpatientswithmetastaticlivercanceraftersurgery.Itoffersseveraladvantagesovertraditionalchemotherapy,suchastargeteddrugdelivery,minimalsystemictoxicity,andlocalizedradiationdamage.Theresultsofseveralstudiessuggestthatthisapproachissafeandeffective,withpromisingoutcomesintermsofsurvivalanddiseasecontrol.However,furtherresearchisneededtooptimizethetreatmentregimenandtoidentifythebestcandidatesforthistreatmentOtherpotentialbenefitsofSIRTincludeimprovedqualityoflife,reducedtumorsize,anddecreasedsymptomssuchaspainandfatigue.Additionally,sinceSIRTtreatmentsareperformedonanoutpatientbasis,patientstypicallyexperienceminimaldisruptiontotheirdailylives.

Despitethesepositiveoutcomes,therearestillseveralchallengesandlimitationsassociatedwithSIRTtreatmentformetastaticlivercancer.Onemajorchallengeisthedifficultyinaccuratelyassessingtheextentandlocationoflivertumors,particularlywhentheyaresmallornumerous.Thiscanleadtoincompleteorineffectivetreatment,aswellasincreasedriskofcomplicationssuchasradiation-inducedliverinjury.

AnotherlimitationofSIRTisthepotentialforadverseeffects,particularlyinpatientswithpre-existingliverdiseaseorcompromisedhepaticfunction.Theserisksincluderadiation-inducedliverdamage,gastrointestinalcomplications,andincreasedriskofinfectionorbleeding.Assuch,carefulpatientselectionandmanagementarecrucialtominimizetheserisksandensureoptimaltreatmentoutcomes.

Toaddressthesechallenges,ongoingresearchisfocusedonrefiningSIRTtechniquesandprotocols,aswellasdevelopingnewimaginganddiagnostictoolstobetterguidetreatmentplanninganddelivery.Additionally,studiesareunderwaytoevaluatetheefficacyofSIRTincombinationwithothertreatments,suchasimmunotherapy,targetedtherapy,andsurgicalresection.

Inconclusion,SIRTisapromisingmodalityforthetreatmentofmetastaticlivercancer,offeringseveraladvantagesovertraditionalchemotherapyandothertreatments.Whiletherearestillchallengesandlimitations