探讨非小细胞肺癌(NSCLC)¹²⁵I放射性粒子植入术中靶区的勾画对术后疗效的影响。

选取自2012年1月至2014年12月在天津医科大学第二医院接受治疗的经病理学明确诊断的NSCLC患者60例，根据入组编号将患者分为两组，每组30例，组1依据胸部CT肺窗沿瘤体边缘直接勾画靶区，应用治疗计划系统(TPS)制定术前计划，指导术中¹²⁵I放射性粒子植入；组2按照胸部CT肺窗沿瘤体边缘再外放0.5 cm认定为靶区，根据此靶区制定术前计划，再行¹²⁵I放射性粒子植入。术后定期复查胸部CT及肺功能，比较两组患者肿瘤原位复发率及出现放射性肺损伤(RIPD)的情况，随访期为1年。根据术后第6个月时复查胸部CT结果，与粒子植入前进行比较，按照实体肿瘤疗效评价标准判定疗效。

全部患者顺利完成粒子植入治疗，随访期内无死亡病例。组1与组2的有效率比较，差异无统计学意义(86.7% vs 90.0%；χ²＝0.991，P＝0.326)；组1的肿瘤原位复发率显著高于组2，差异有统计学意义(20.0% vs 6.7%；χ²＝2.071，P＝0.043)。两组患者术后与术前肺功能指标FEV₁%和DLCO%比较差异均无统计学意义(P>0.05)。

按照胸部CT肺窗将沿瘤体边界外放0.5 cm后进行肺癌¹²⁵I粒子植入，可减少肿瘤原位复发，且不会影响治疗效果及引发明显肺功能损伤。

To evaluate the efficacy of different target area selection in implantation of ¹²⁵I radioactive seeds in treatment of non-small cell lung cancer.

Sixty patients with non-small cell lung cancer confirmed by pathology undergoing treatment in The 2^nd Hospital of Tianjin Medical University between January 2012 and December 2014 were enrolled. Patients were divided into two groups according to the sequence number, with 30 patients in each group. In group 1, target area was defined along the tumor margin based on lung-window CT, and treatment plan system (TPS) was used to make pre-operative plans and guide the implantation process of ¹²⁵I radioactive seeds. In group 2, target area was extended by 0.5 cm in all dimensions outside the tumor margin based on lung-window CT, and TPS was also used with the same implantation method. Patients were followed up for one year, chest CT and pulmonary function examinations were conducted, and the locoregional recurrence rate and status of radiation-induced pulmonary damage were observed in two groups. Chest CT examination performed 6 months after operation was utilized to evaluate the treatment efficacy according to response evaluation criteria in solid tumors.

All patients went through implantation procedure successfully, with no death during follow-up. There was no significant difference in effective rate between two groups (86.7% vs 90.0%; χ²=0.991, P=0.326). The recurrence rate in group 1 was significantly higher than that in group 2 (20.0% vs 6.7%; χ²=2.071, P=0.043). There was no significant difference between preoperative and postoperative lung function indicators of FEV₁% and DLCO% in two groups (P>0.05).

Extending the target area by 0.5 cm outside the tumor margin in implantation of ¹²⁵I radioactive seeds in treatment of non-small cell lung cancer can reduce the risk of locoregional recurrence, with no effect on treatment efficacy and no obvious radioactive lung injury.