CT-guided 125 I seeds implantation combined with chemotherapy in treatment of lung metastatic tumors from colorectal cancer: an analysis of clinical efficacy and prognostic tactors
LI Yanjun, CHEN Minjiang,TU Jianfei, PAN Yiying, WANG Junhe, JI Jiansong.
LI Yanjun, CHEN Minjiang,TU Jianfei, PAN Yiying, WANG Junhe, JI Jiansong.
LI Yanjun,CHEN Minjiang,TU Jianfei, et al. CT-guided 125 I seeds implantation combined with chemotherapy in treatment of lung metastatic tumors from colorectal cancer: an analysis of clinical efficacy and prognostic tactors[J]. JOURNAL OF WEZHOU MEDICAL UNIVERSITY, 2023, 53(7): 556-564.
Abstract：Objective: To investigate the feasibility of percutaneous 125I implantation guided by computed tomography combined with chemotherapy in the treatment of lung metastases of colorectal cancer, and to evaluate its clinical efficacy and prognostic factors. Methods: Retrospective analysis was performed on 97 patients with lung metastatic tumor of colorectal cancer admitted to the Fifth Affiliated Hospital of Wenzhou Medical University from January 1, 2016 to December 31, 2020. According to different treatment, they were divided into combination treatment group (n=43) and control group (n=54). The combination treatment group received percutaneous 125I seed implantation combined with chemotherapy, while the control group was treated with conventional chemotherapy alone. With general clinical data collected, we compared the efficacy and adverse reactions of the two groups. The last follow-up was January 1, 2022. Results: The target objective response rate (ORR) and the
disease control rate (DCR) of the combined treatment group was 72.1% and 93.0%, respectively, with statistical difference (P<0.05). The survival time analysis of the two groups showed the median PFS and OS of the combined treatment group were significantly better, up to 13 (7.0, 16.0) months and 20.0 (14.0, 40.0) months, with significant difference (P<0.05). After 3 months of treatment, CA19-9 in the combined treatment group waslower than the control group, with statistical significance (P<0.05). There was no significant difference in the rate of adverse reactions after chemotherapy between the two groups (P>0.05). All adverse reactions in both groups
were 1-2 mild adverse reactions. Cox proportional risk regression model analysis showed that after particle implantation (HR=0.35), the TNM stage of the primary tumor was stage I-II (HR=2.59), DFI>12 months (HR=1.71) and ECOG score 0-1 (HR=2.18) patients had longer PFS; Patients with primary TNM stage I-II (HR=2.08), no more than 3 metastases (HR=2.27), and metastatic sites in a single lung (HR=2.61, 3.30) had longer OS. Conclusion: CT-guided 125I seed implantation combined with chemotherapy can be used as the preferred treatment for its effectiveness in the treatment of colorectal cancer lung metastases. The TNM stage of the primary tumor is found to be an independent risk factor affecting PFS and OS, with the ECOG score and DFI of patients related to PFS, and the preoperative CA19-9 level, the number and site of metastases related to OS. Therefore, patients with primary colorectal cancer stage TNM I and II benefit the most from 125I seed implantation combined with chemotherapy.
