3D-打印非共面模板辅助CT引导放射性粒子植入治疗中晚期胰腺癌的临床研究  

Clinical Study of 3D-Printed Non-Coplanar Template for ^(125)I Seed Implantation Therapy in Patients with Advanced Pancreatic Cancer

作　　者：黎鑫乐 陆健[1] 贡桔[1] 李超杰 王力伟 刘琳[1] LI Xinyue;LU Jian;GONG Ju;LI Chaojie;WANG Liwei;LIU Lin(Department of Radiology and Intervention,Rujin Hospital Luwan Branch Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Department of Radiology,Mental Health Center Affliated to Tongji University)

机构地区：[1]上海交通大学医学院附属瑞金医院卢湾分院,上海200025 [2]同济大学附属精神卫生中心

出　　处：《中国医学计算机成像杂志》2024年第4期457-463,共7页Chinese Computed Medical Imaging

摘　　要：目的:评估3D-打印非共面模板辅助CT引导^(125)I粒子植入治疗中晚期胰腺癌的临床价值。方法:回顾性分析2017年1月-2023年6月在2家医院接受放射性^(125)I粒子植入治疗的84例中晚期胰腺癌患者资料。其中20例为3D-打印非共面模板辅助125I粒子植入(A组),64例为徒手植入^(125)I粒子(B组)。所有患者进行术前计划、术后剂量验证。计算术前术后D_(90)、V_(90)、V_(100)、V_(150),以及2组患者手术操作时间。A组的中位随访时间为8.1个月,B组的中位随访时间为6.6个月。术后1~3个月行CT扫描,参照世界卫生组织(WHO)实体肿瘤疗效标准(RECIST)进行疗效评估。比较分析2组的总体生存(OS)及不良事件发生。Kaplan-Meier生存曲线用于计算生存率,并使用对数秩检验进行比较。Cox回归分析用于估计变量和结果之间关联的风险比(HR)和95%置信区间(CI)。结果:所有患者均成功植入^(125)I粒子。植入术后,A组和B组术后D_(90)均值、V_(90)、V_(100)、V_(150)与术前相比,差异均无统计学意义(均P>0.05),分别为(145.18±5.00)Gy vs (135.14±4.21)Gy、(96.37±0.71)%vs (95.25±0.81)%、(94.47±0.92)%vs (92.84±1.08)%、(75.89±2.17)%vs(76.10±1.77)%,以及(136.15±1.58)Gy vs (134.96±1.49)Gy、(96.20±0.35)%vs (96.59±0.31)%、(93.80±0.40)%vs (93.93±0.40)%、(74.49±0.96)%vs (74.22±0.49)%。A组手术操作时间为(42.1±7.1)min (1次穿刺将全部穿刺针同时植入),低于B组的(57.6±6.5)min(穿刺次数一般2~3次),差异有统计学意义(P<0.05)。A组治疗总有效率为75.0%,B组治疗总有效率为70.3%,2组间差异无统计学意义(P=0.685)。A组和B组半年、1年、2年OS率分别为65%、20%、10%和56.7%、12.5%、4.7%,2组间差异无统计学意义(P=0.662)。病灶大小是OS的独立预测因素(P=0.001)。A组仅有2例患者发生术后少量渗血,静推2 U注射用蛇毒血凝酶(巴曲亭)后24 h内吸收。结论:3D打印模板辅助碘粒子植入治疗胰腺癌证明了有效性且缩短�Purpose:To evaluate the clinical value of 3D-printed non-coplanar template(3D-PNCT)for ^(125)I seed implantation therapy in patients with advanced pancreatic cancer.Methods:A retrospective analysis of our database was performed,and a total of 84 patients with advanced pancreatic cancer who underwent ^(125)I seed implantation between January 2017 and June 2023 in 2 hospitals were analyzed.Of these,20 implantations were assisted by a 3D-PNCT(group A),and 64 implantations performed freehand were selected as a control group(group B).Dosimetric verification was performed after implantation.Pre-and postoperative D_(90),V_(90),V_(100),V_(150) were calculated.The operating time were also compared between the two groups.The median follow-up time for these groups was 8.1 and 6.6 months,respectively.CT scans were performed 1-3 months after the implantation,and the response evaluation criteria in solid tumors(RECIST)v1.1 was adopted for the efficacy evaluation.The primary outcomes measured were overall survival(OS)and the occurrence of adverse events.Kaplan-Meier survival curves were used to calculate survival rates,which were compared using the log-rank test.Cox and logistic regression analyses were used to estimate the hazard ratios(HRs)and 95%confidence intervals(CIs)for the association between variables and outcomes.Results:^(125)I seed implantation was successfully performed in both groups.After implantation,there was no statistically significant difference in the mean D_(90),V_(90),V_(100) and V_(150) between group A and group B compared to preoperative values(all P>0.05),which were(145.18±5.00)Gy vs(135.14±4.21)Gy,(96.37±0.71)%vs(95.25±0.81)%,(94.47±0.92)%vs(92.84±1.08)%,(75.89±2.17)%vs(76.10±1.77)%,respectively,and(136.15±1.58)Gy vs(134.96±1.49)Gy,(96.20±0.35)%vs(96.59±0.31)%,(93.80±0.40)%vs(93.93±0.40)%,(74.49±0.96)%vs(74.22±0.49)%,respectively.The operating time for group A was(42.1±7.1)minutes(all puncture needles were implanted simultaneously in one puncture),which was shorter than group B's(57.6

关 键 词：胰腺癌 近距离放射治疗 放射性同位素 碘-125粒子 3D打印模板 预后 

分 类 号：R4[医药卫生—临床医学]