三维打印共面坐标模板联合CT引导^125I粒子植入治疗胸部恶性肿瘤的剂量学评价  

Dosimetry evaluation for CT guided 125I seeds implantation assisted by three-dimensional-printing coplanar coordinate template in chest malignant tumor

作　　者：吉喆[1] 姜玉良[1] 郭福新[1] 彭冉[1] 孙海涛[1] 范京红[1] 王俊杰[1] 

机构地区：[1]北京大学第三医院肿瘤放疗科,100191

出　　处：《中华核医学与分子影像杂志》2018年第1期4-8,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：首都临床特色应用研究项目（Z151100004015171）

摘　　要：目的在剂量学层面验证三维打印共面坐标模板（3D－PCCT）在辅助125I粒子植入治疗胸部恶性肿瘤中的精确性。方法回顾性分析2016年1月至2017年6月于本院接受3D－PCCT辅助CT引导125I粒子植入治疗胸部肿瘤的22例患者（男15例、女7例，中位年龄62岁），其中原发性肺癌8例，转移癌14例。植入部位包括肺（12例）、纵隔（2例）、胸壁（8例）。处方剂量为110～180 Gy。患者行术前计划设计、模板引导下穿刺及植入粒子，将术后验证的剂量学结果与术前计划对比，剂量参数包括靶区90%大体肿瘤体积接受的剂量（D90）、最小边缘剂量、GTV接受100%处方剂量的体积百分比（V100）、GTV接受150%处方剂量的体积百分比（V150）、适形指数、靶区外体积指数、均匀性指数以及脊髓和胸主动脉2 cm3范围正常组织所受的剂量（D2 cm3）和患侧肺接受20 Gy剂量的肺体积百分比（V20）。采用Wilcoxon符号秩检验分析数据。结果术后靶区中位D90为150.4（125.6，187.0） Gy。术后68%（15/22）的患者GTV D90高于处方剂量。术后靶区中位V100较术前下降（95.5%与97.2%），差异有统计学意义（P＝0.040）；余剂量学指标较术前差异均无统计学意义（均P〉0.05）。结论3D－PCCT用于胸部肿瘤的125I粒子植入的治疗精确性良好。ObjectiveTo verify the accuracy of three-dimensional printing coplanar coordinate template （3D-PCCT） technology for 125I seeds implantations in chest tumor at dosimetry level.MethodsFrom January 2016 to June 2017, a total of 22 patients （15 males, 7 females; median age 62 years） with chest tumors who received 3D-PCCT assisted 125I seeds implantation in Peking University Third Hospital were enrolled in this retrospective study. There were 8 patients with primary lung cancer and 14 with metastatic carcinoma. The sites for implantation included lung （12 cases）, mediastinum （2 cases） and chest wall （8 cases）. The prescribed dose was 110-180 Gy. The preoperative plan design, puncture and seeds implantation guided by template were carried out and the dose distribution of postoperative plan was compared with that of preoperative plan. Dose parameters included dose delivered to 90% gross tumor volume （D90）, minimum peripheral dose, the percentage of GTV receiving 100% prescription dose （V100）, the percentage of GTV receiving 150% prescription dose （V150）, conformity index, external index of target volume, uniformity index, D2 cm3 of spinal cord and aorta, and V20 of affected side lung. Wilcoxon signed rank test was used to analyze the data.ResultsThe median D90 was 150.4（125.6, 187.0） Gy. Postoperative D90 was higher than the prescribed dose in 68%（15/22） cases. For median value of most parameters, there were no significant differences between the postoperative plans and preoperative plans （all P〉0.05） except for the actual V100, which was lower than the preplanned （95.5% vs 97.2%; P=0.040）.Conclusion3D-PCCT could provide good accuracy in 125I seeds implantation for chest tumor.

关 键 词：胸部肿瘤 近距离放射疗法 碘放射性同位素 打印 三维 放射疗法 影像引导 体层 摄影术 x线计算机 辐射剂量 

分 类 号：R730.55[医药卫生—肿瘤]