导航辅助CT引导放射性粒子治疗盆腔复发恶性肿瘤剂量学研究  

Dosimetry evaluation of navigation system-assisted and CT-guided seed implantation in the treatment of recurrent malignant pelvic tumors

作　　者：江萍[1] 吉喆[1] 姜玉良[1] 郭福新[1] 孙海涛[1] 王俊杰[1] Jiang Ping;Ji Zhe;Jiang Yuliang;Guo Fuxin;Sun Haitao;Wang Junjie(Department of Radiation Oncology,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院肿瘤放疗科,100191

出　　处：《中华放射医学与防护杂志》2021年第1期50-55,共6页Chinese Journal of Radiological Medicine and Protection

基　　金：国家重点研发计划(2019YFB1311300)。

摘　　要：目的通过比较导航辅助CT引导放射性粒子治疗盆腔复发恶性肿瘤的术前、术后计划剂量学参数探讨该技术治疗的精确性。方法回顾性纳入2018年12月至2020年2月于北京大学第三医院接受导航联合3D打印个体化模板(3D-PIT)辅助CT引导放射性125I粒子植入治疗的盆腔复发恶性肿瘤患者共15例,其中宫颈癌7例,直肠癌7例,前列腺癌1例。患者年龄34~84岁,中位年龄55岁。术前处方剂量100~150 Gy。比较术前、术后粒子数、针数、剂量学参数差别。剂量学参数包括90%和100%靶区体积剂量(D_(90),D_(100))及100%、150%和200%处方剂量的靶区体积(V_(100)、V_(150)、V_(200))、适形指数(CI)、靶区外体积指数(EI)、均匀性指数(HI)。结果中位病灶体积为29.20 cm^3,中位粒子数43颗,中位D_(90) 150 Gy。术后剂量评估的的V150较术前计划低(64.1%vs.67.1%,t=2.937,P=0.011);术后HI较术前增大(32.01%vs.26.68%,t=-2.950,P=0.011);其余指标术前及术后计划差异无统计学意义(P>0.05)。结论导航辅助3D-PIT辅助CT引导放射性粒子植入治疗盆腔复发恶性肿瘤,术后验证实际剂量分布达到术前计划设计要求,具有良好的治疗精确性和一致性。Objective To explore the accuracy of CT-guided 125I seed implantation assisted by a navigation system and 3D-printing template in the treatment of recurrent malignant pelvic tumors by comparing pre-plan and intraoperative physical dosimetric parameters.Methods This study involved 15 patients with recurrent malignant pelvic tumors who received CT-guided radioactive 125I seed implantation assisted by a navigation system and 3D-printing template in the Peking University Third Hospital from Dec 2018 to Feb 2020.Seven of the patients had cervical cancers,seven had rectal cancers,and one had prostate cancer.The median age was 55 years(34-84 years old).The prescription dose was 100-150 Gy.The pre-plan and post-implant data were compared,including the number of implanted seeds,implantation needle number,and some dosimetric parameters such as the minimum prescription doses delivered to 90%and 100%of target volume(D_(90),D_(100)),mean percentages of volume receiving 100%,150%,and 200%of the prescription doses(V_(100),V_(150),and V_(200)),conformity index(CI),external index(EI),and homogeneity index(HI)of the target volume.Results The median lesion volume was 29.20 cm3,the median seed number was 54,and the median D_(90) was 150 Gy.The post-implant V150 was lower than pre-plan V150(64.1%vs.67.1%,t=2.937,P=0.011),and the post-implant mean HI was higher than pre-plan HI(32.01%vs.26.68%,t=-2.950,P=0.011).There were no significant differences in other dosimetric parameters before and after seed implantation.Conclusions With CT-guided radioactive seed implantation assisted by a navigation system and 3D-printing template in the treatment of recurrent malignant pelvic tumors,the actual postoperative dose could meet the preoperative plan requirement,ensuring the accuracy and consistency of the dose delivered.

关 键 词：导航系统 3D打印个体化模板 放射性粒子植入 剂量学 盆腔复发肿瘤 

分 类 号：R730.55[医药卫生—肿瘤]