125I粒子植入治疗非小细胞肺癌的剂量学优化研究  

Dosimetric optimization of 125I seed implantation and improvement of the therapeutic outcome for treating non-small cell lung cancer

作　　者：李小东[1] 张遵城[2] 郑广钧[3] 郭永涛[2] 陈艳芳[4] 郭妍妍[4] 王平[5] 常津[6] 

机构地区：[1]天津医科大学第二医院放射治疗科、核医学科,300211 [2]天津医科大学第二医院核医学科 [3]天津医科大学第二医院胸心外科 [4]天津医科大学第二医院放射治疗科 [5]天津医科大学附属肿瘤医院 [6]天津大学精密仪器与光电子工程学院,300072

出　　处：《中华核医学与分子影像杂志》2015年第1期36-40,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：天津市卫生局科技基金（2010KZl00）;天津医科大学第二临床学院科研基金（Y200404）

摘　　要：目的 通过实施放射剂量学优化等质量保证和质量控制措施,提高125I粒子植入治疗NSCLC的增益比.方法 经临床、支气管镜、影像学诊断及病理检查证实的NSCLC患者246例,其中男158例,女88例,平均年龄61.7岁;分别采用CT、18F-FDG符合线路显像和纤维支气管镜（FFB）进行靶区定位;应用TPS制定方案并优化,以剂量-体积直方图（DVH）等评估TPS;影像引导125I粒子植入,并进行实时位置验证、植入后剂量学验证、疗效判定和随访.结果 CT引导植入组的137例中129例植入粒子数与TPS计划粒子数及分布一致,符合率达94.16％ （129/137）;早期和晚期放射反应发生率分别为12.41％（17/137）％和2.19％（3/137）;匹配周缘剂量（MPD）最高达92.1 Gy,PTV外危及器官（心、肺及脊髓）的平均照射剂量明显低于正常组织耐受剂量,局部控制总有效率为91.97％（126/137）,1年和2年生存率分别为91.24％（125/137）和50.36％ （69/137）;18F-FDG符合线路显像引导植入组和FFB引导植入组的局部控制总有效率分别为91.43％（32/35）和77.27％（51/66）,1年生存率分别为88.57％（31/35）和80.30％ （53/66）;未发现放射性肺炎或肺纤维化.结论 适当采用生物靶区定位和规范实施质量保证和质量控制,是提高影像引导下125I粒子植入治疗增益比的保证,能够为无法耐受手术、根治放疗或全身化疗的NSCLC患者提供一种有效且低损的疗法.Objective To implement a dose optimization programme and improve the therapeutic gain ratio of 125I seed implantation in patients with stage Ⅲb to Ⅳ NSCLC.Methods A total of 246 NSCLC patients （158 males,88 females,mean age 61.7 years） were enrolled into this study.The target was located by CT,18F-FDG coincidence SPECT/CT or flexible fiberoptic bronchoscopy （FFB）.The treatment plan was generated and optimized by TPS,which was evaluated according to the dose volume histograms （DVH）.125I seeds were implanted and intraoperative position was validated in real time under guidance of imaging.Dosimetry was validated,and therapeutic efficiency was evaluated.The 1-and 2-year survival rates were calculated.Results The number and distribution of the implanted seeds were accorded with those planned by TPS in 129 of 137 cases （94.16%） in CT guided implantation group.The matched peripheral dose （MPD） was 92.1 Gy.The average dose of organs at risk such as heart,lung and spinal cord was significantly lower than the normal tissue tolerance dose.The early and late radioactive response rates were 12.41%（17/137） and 2.19%（3/137） respectively,and 91.97%（126/137） was under local control.The 1-and 2-year survival rates was 91.24 %（125/137） and 50.36 %（69/137） respectively.In SPECT/CT and FFB guided implantation groups,88.57%（31/35） and 77.27%（51/66） were under local control respectively,and 1-year survival rates were 91.43% （32/35） and 80.30% （53/66） respectively.Radiation pneumonitis and pulmonary fibrosis were not detected in all 3 groups.Conclusion Standard application of quality assurance and quality control is the guarantee of the improvement of therapeutic gain ratio of seed implantation guided by image.

关 键 词：癌 非小细胞肺 近距离放射疗法 碘放射性同位素 

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