术中实时计划在 125I粒子治疗恶性肺肿瘤中的应用  

The Application of Intraoperative TPS Real-time Planning in Treating Malignant Lung Cancer with 125I Seed Brachytherapy

作　　者：李海峰[1] 陈志军[1] 粟宇 吕巧莉 周琳 钟锦绣[1] 周爱清[1] LI Haifeng;CHEN Zhijun;SU Yu(Jiangxi Cancer Hospital,Nanchang,330029)

机构地区：[1]江西省肿瘤医院,330029 [2]江西省肿瘤转化医学重点实验室,330029

出　　处：《实用癌症杂志》2020年第4期594-597,635,共5页The Practical Journal of Cancer

基　　金：国家自然科学基金(编号:81860664);江西省卫健委基金(编号:20203566);江西省中医药管理局基金(编号:2019A226)。

摘　　要：目的探讨计算机三维治疗计划系统(TPS)术中实时治疗计划对CT引导下125I放射性粒子治疗恶性肺肿瘤的可行性,并推广术中实时计划引导下125I粒子植入方法。方法回顾性分析行CT引导下125I放射性粒子治疗的32例肺癌患者的相关资料,其中18例行TPS术中实时计划的为研究组(A组),14例未行TPS术中实时计划的为对照组(B组)。将术后CT扫描图像导入TPS系统行术后质量验证,比较A、B组手术前后粒子植入数目、90%和100%的靶区体积所占的剂量D90和D100,90%、100%和150%的处方剂量所占的靶区体积百分比V90、V100和V150,对临床疗效及不良反应发生率等进行分析比较。结果研究组(A组)术中、术后的D90、D100、V90、V100、V150的差值平均分别为6.742±2.011(Gy)、-0.431±3.494(Gy)、3.128±0.758(%)、2.650±1.204(%)、1.156±2.499(%);对照组(B组)术前、术后的D90、D100、V90、V100、V150的差值平均分别为30.506±38.778(Gy)、31.748±5.072(Gy)、12.336±1.482(%)、16.936±2.337(%)、14.821±3.824(%)。研究组于粒子植入前后在粒子植入质量、疗效评价、不良反应控制等方面明显优于对照组。结论通过术中实时计划,术者以剂量学为指导,可显著提高粒子植入肿瘤靶区剂量满意率,且具有可操作性;是一种精准、有效、安全的治疗方法,对肺癌125I放射性粒子治疗的规范化具有一定价值。Objective To discuss the feasibility of intraoperative use of treatment planning system(TPS)to make real-time planning for the treatment of malignant lung cancer with CT-guided 125I seed brachytherapy and promote the use of the application.Methods The clinical data of 32 patients with malignant lung cancer who received CT-guided 125I seed brachytherapy were retrospectively analyzed.The patients were divided into group A(n=18)and group B(n=14).The intraoperative TPS was employed to formulate the real-time planning for the patients of group A,while real time planning was not adopted for the patients of group B.The quality verification of postoperative effect was conducted for the patients of both groups with TPS.Comparing the preoperative and postoperative the 125I seed number,the curative effect,the adverse event rates,D90,D100,V90,V100,V150,etc were calculated in all patients of both groups,and the results were statistically analyzed.Results The mean difference of D90,D100,V90,V100,V150 in group A were 6.742±2.011(Gy),-0.431±3.494(Gy),3.128±0.758(%),2.650±1.204(%)and 1.156±2.499(%);B were 30.506±38.778(Gy),31.748±5.072(Gy),12.336±1.482(%),16.936±2.337(%)and 14.821±3.824(%)respectively.The results showed that group A were superior group B on the 125I seed quality evaluation,the curative effect and the control of adverse event,etc.Conclusion For the treatment of malignant lung cancer,the application of intraoperative real-time planning by CT guided with 125I seed implantation brachytherapy can significantly improve the consistency of target region dose,operational.It is an accurate,effective and safe treatment approach and may be of great important value to the standardization of the particle therapy of malignant lung cancer.

关 键 词：实时计划 恶性肺肿瘤 治疗计划系统 质量验证 

分 类 号：R734.2[医药卫生—肿瘤]