CT引导放射性碘-125粒子治疗纵隔淋巴结转移瘤的动态剂量验证研究  

Dynamic dose validation study of CT-guided radioactive iodine 125 particles for mediastinal lymph node metastases

作　　者：韩雅钧 朱涛 樊喜文[2] 刘登尧[2] HAN Yajun;ZHU Tao;FAN Xiwen;LIU Dengyao(The Third Clinical School of Medicine,the Affiliated Tumor Hospital,Xinjiang Medical University,Urumqi 830002,China;Department of Interventional Radiology,the Affiliated Tumor Hospital,Xinjiang Medical University,Urumqi 830002,China)

机构地区：[1]新疆医科大学第三临床医学院,乌鲁木齐830002 [2]新疆医科大学附属肿瘤医院介入诊疗科,乌鲁木齐830002

出　　处：《新疆医科大学学报》2023年第9期1187-1192,共6页Journal of Xinjiang Medical University

基　　金：新疆维吾尔自治区自然科学基金项目(2020D01C217);新疆维吾尔自治区科技支疆项目(2022E02048)。

摘　　要：目的基于近距离放射治疗计划系统(Brachytherapy treatment planning system,BTPS)模拟肿瘤靶区变化,探究植入放射性碘-125(Iodine 125,125I)粒子后随时间延长靶区体积与剂量参数的关系。方法利用3D打印技术制作均匀球体模型模拟不同肿瘤体积,按体积变化速度分组,适形指数(CI)、外部体积指数(EI)、均匀性指数(HI)做线性回归分析,初步得出在植入粒子后最佳的靶体积缩小速度及对剂量的影响。进一步通过对36例纵隔淋巴结转移瘤患者粒子植入术前计划及术后剂量参数对比,验证该技术的可行性与准确性,分析术后3个月的动态剂量验证,初步分析靶区变化与时间对剂量的交互作用。结果EI与模拟靶体积缩小速度呈正相关(B=251.323,P<0.005)。HI与模拟靶体积缩小速度呈负相关(B=-355.296,P<0.001)。肿瘤靶体积缩小30%~35%最为理想。36例纵隔淋巴结转移瘤患者术后验证与术前计划各剂量参数比较,差异均无统计学意义(P>0.05)。粒子植入患者的靶体积缩小<30%、30%~35%、>35%组的时间与剂量之间存在交互作用。不同靶体积缩小速度组和时间的交互作用对D90值的影响有统计学意义,F(1,11)=53.147,P<0.001。结论CT引导下放射性碘-125粒子植入纵隔淋巴结转移瘤术后各剂量指标与术前比较无差别,可以较好实施术前计划方案,避免重要脏器损伤,是一种安全、有效的治疗手段,可能成为重复性好的标准术式。植入时间与肿瘤靶区缩小对剂量有显著的交互作用。当靶体积缩小30%~35%范围时各剂量参数可维持在理想水平。Objective To investigate the relationship between target volume and dose parameters after radioactive iodine-125(Iodine 125I)seeds implantation with time lengthening based on the BTPS system simulating changes in the tumor target area.Methods 3D printing technology was used to make a uniform spherical model to simulate different tumor volumes,and the groups were grouped according to the volume change rate.Linear regression analysis was performed on Conform ability Index(CI),External Volume Index(EI),and Homogeneity Index(HI),and the optimal target volume reduction rate and the impact on dose after implantation of particles were preliminatively obtained.The feasibility and accuracy of the technique were further verified by comparing the pre-implantation plan and postoperative dose parameters of 36 patients with mediastinal lymph node metastases,and the dynamic dose validation 3 months after surgery was analyzed to preliminarily analysis of the interaction between the change of target area and time on dose.Results EI was positively correlated with the simulated target volume reduction rate(B=251.323,P<0.005).HI was negatively correlated with the simulated target volume reduction rate(B=-355.296,P<0.001).A 30%~35%reduction in tumor target volume was ideal.There were no statistically significant differences between postoperative validation and preoperative planning for each dose parameter(P>0.05)among 36 cases of mediastinal lymph node metastases.There was an interaction between time and dose in patients with seed implantation and target volume reduction in<30%,30%~35%and>35%groups.The interaction between different target volume reduction rate groups and time had a statistically significant effect on D90 values,F(1,11)=53.147,P<0.001.Conclusion CT-guided radioiodine 125 seed implantation for mediastinal lymph node metastases showed no difference in each dose index after surgery compared to preoperative planning,allowing better implementation of the preoperative planning protocol and avoiding important organ damage.It

关 键 词：碘-125粒子 靶体积变化 动态剂量验证 纵隔淋巴结转移瘤 

分 类 号：R451[医药卫生—治疗学]