薄层CT对^(125)I粒子植入治疗非小细胞肺癌的质量控制和保证的意义  

The Significance of Thin-Section CT in Quality Assurance and Control of Non-Small Cell Lung Cancer Therapy through ^(125)I Seed Implantation

作　　者：王琳[1] 李小东[1] 张遵城[2] 郑广钧[3] 郭永涛[2] 张雪宁[4] 戴越[1] 

机构地区：[1]天津医科大学第二医院放射治疗科,300211 [2]天津医科大学第二医院核医学科,300211 [3]天津医科大学第二医院心胸外科,300211 [4]天津医科大学第二医院放射科,300211

出　　处：《天津医药》2014年第4期341-344,共4页Tianjin Medical Journal

基　　金：天津市卫生局科技基金计划项目(项目编号:2010KZ100)

摘　　要：目的探讨薄层CT扫描在125I粒子植入治疗非小细胞肺癌(NSCLC)各个环节中的临床价值。方法确诊的137例NSCLC患者,植入前CT扫描进行靶区勾画,应用治疗计划系统(TPS)制定植入方案;CT引导植入,并在植入过程中逐层扫描已植入粒子,进行实时位置验证和修正;植入后CT扫描协助进行放射剂量学验证,必要时调整粒子的分布和数量,使剂量分布符合有效和微创的原则;定期随访和疗效评价也需要CT检查。结果剂量-体积直方图(DVH)均显示靶区放射剂量分布能满足处方剂量要求,周围危及器官的平均照射剂量明显低于正常组织耐受剂量;137例患者中129例(94%)植入粒子数与TPS计划的植入方案一致;植入治疗后6个月CT扫描显示局部控制总有效率为91.9%,1年和2年生存率分别为91.2%和50.4%;无治疗相关的严重并发症。结论薄层CT应用于125I粒子植入治疗NSCLC过程的各环节,尤其是在粒子植入的质量保证和质量控制方面具有重要的、不可替代的临床价值。Objective To explore the clinical value of the thin-section CT scanning in all the steps of non-small cell lung cancer （NSCLC） therapy through 125I seed implantation. Methods In the 137 patients who were diagnosed with non-small cell cancer （NSCLC）, the preoperative targets were delineated by CT scan, and the implantation plan was accom-plished according to treatment planning system （TPS）; Intraoperative 125I seeds were implanted under the guidance of CT, then their positions were confirmed and corrected by CT scan layer-by-layer in real time;Post implantation dosimetry was validated also under the help of CT scan. If necessary, distribution and number of seeds should be adjusted to conform dose distribution under the principle of effectivity and micro-invasion;Follow-up and periodic evaluation should also be accom-plished by CT scan. Results Dose-volume histograms （DVHs） showed that the dose in line with the targets meet the re-quirement of prescription dose while the surrounding organs at risk were within the scope of their tolerance dose. Among 137 patients, implanted seeds number was the same with seeds number of TPS plan in 129 patients, and the coincidence rate was 94%. CT scan showed the local control efficient rate was 91.9%after 6 months. The 1-year and 2-year survival rates were 91.2%and 50.4%respectively. No serious operation-led complication was found during treatment. Conclusion The thin-section CT could be applied in all key steps of 125I seed implantation in NSCLC therapy, especially it is clinical significant and irreplaceable in quality assurance and control of seed implantation therapy.

关 键 词：癌 非小细胞肺 碘放射性同位素 近距离放射疗法 体层摄影术  X线计算机 质量控制 125I粒子 质量保证 

分 类 号：R734.2[医药卫生—肿瘤] R730.55[医药卫生—临床医学]