4D模板辅助^(125)I粒子治疗晚期恶性肿瘤的剂量学研究  

Dosimetric study of ^(125)I seed implantation guided by 4D template for advanced malignant tumors

作　　者：刘志刚 雷光焰 宋永春[2] 孙瑞芳[3] 吕卫东 宋养荣 张曦 刘佳 程蒿 韩乐 赵堃 高巍 李晓龙 宁小菊 强立彬 Liu Zhigang;Lei Guangyan;Song Yongchun;Sun Ruifang;Lyu Weidong;Song Yangrong;Zhang Xi;Liu Jia;Cheng Hao;Han Le;Zhao Kun;Gao Wei;Li Xiaolong;Ning Xiaoju;Qiang Libin(Department of Thoracic Surgery,Shaanxi Provincial Tumor Hospital,Xi′an 710061,China;Department of Surgical Oncology,The First Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710061,China;Department of Pathology,School of Basic Medical Sciences,Xi'an Jiaotong University,Xi'an 710061,China;Department of Oncology,Ningxia Chinese Medicine Hospital,Yinchuan 750021,China)

机构地区：[1]陕西省肿瘤医院胸外科,西安710061 [2]西安交通大学第一附属医院肿瘤外科,西安710061 [3]西安交通大学基础医学院病理学系,西安710061 [4]宁夏回族自治区中医医院肿瘤科,银川750021

出　　处：《中华放射肿瘤学杂志》2022年第1期55-58,共4页Chinese Journal of Radiation Oncology

基　　金：国家自然科学基金(81802788);陕西省自然科学基金(2018JM7028);中央高校基本科研业务费(xzy012020056)。

摘　　要：目的探讨4D模板在^(125)I粒子治疗晚期恶性肿瘤中的安全性及剂量研究。方法选取陕西省肿瘤医院胸外科自2018—2019年晚期恶性肿瘤患者98例, 采用4D模板导航放射性^(125)I粒子植入治疗。术前放疗计划、术中优化、术毕即刻剂量验证, 术后评定植入剂量。观察治疗结果。结果 98例肿瘤患者全部顺利完成粒子植入术, 植入部位行外照射和未行外照射的大体肿瘤体积植入剂量分别为(12 489±414) cGy和(15 036±514) cGy, V100%分别为84.7%~94.1%和88.2%~93.7%;临床靶体积植入剂量分别为(7 450±621) cGy和(9 080±761) cGy。剂量植入质量评估优91%(89/98)、良7%(7/98)、中2%(2/98)、差0。疼痛患者症状缓解率为92%(36/39)。行外照射和未行外照射1、2年局控率分别为61%、36%和82%、54%(P=0.02)。48例肺部植入者气胸发生率为19%(9例), 咯血发生率为10%(5例), 其他部位植入者均未出现相应并发症。结论 4D模板辅助^(125)I粒子治疗恶性肿瘤安全有效, 术中实时针道角度调节和剂量优化使植入剂量得到精准控制。Objective To investigate the safety and dose of 4D template(real-time adjustable angle template)in the treatment of advanced malignant tumors with ^(125)I seeds.Methods 98 patients with advanced malignant tumors admitted to Department of Thoracic Surgery of Shaanxi Provincial Tumor Hospital were treated with 4D template-navigated radioactive ^(125)I seed implantation from June 2018 to December 2019.Preoperative TPS plan,intraoperative optimization,postoperative verification of immediate dose and postoperative evaluation of implantation dose were performed.The treatment results were observed.Results All 98 patients completed the seed implantation.The implantation dose of GTV of implantation site receiving external irradiation was(12489±414)cGy and the dose of no external irradiation was(15036±514)cGy.V100%was 84.7%-94.1%,and 88.2%-93.7%.The implantation dose of CTV was(7450±621)cGy,and(9080±761)cGy.The quality of dose implantation was evaluated as:excellent in 89 cases(91%,89/98),good in 7 cases(7%,7/98),fair in 2 cases(2%,2/98),and poor in 0 case,respectively.The symptom relief rate of patients with pain was 92%(36/39).The 1-and 2-year local control rates were 61%,36%and 82%,54%in patients treated with and without external irradiation,respectively.The difference was statistically significant(P=0.02).The incidence rates of pneumothorax and hemoptysis were 19%(9/48)and 10%(5/48).No corresponding complications were observed in other parts of the patients.Conclusion 4D template-assisted ^(125)I seed therapy is safe and effective for malignant tumors,and intraoperative adjustment of needle angle and dose optimization can realize the precise control of implantation dose.

关 键 词：四维模板 实时可调角度模板 剂量学 恶性肿瘤 晚期/^(125)I粒子植入术 

分 类 号：R730.55[医药卫生—肿瘤]