基于预计划的3D打印导板在宫颈癌近距离插植治疗中的应用  

Application of the pre-plan-based 3D-printed guide template in interstitial implantation brachytherapy of cervical cancer

作　　者：赵强 吴湘阳 穆允凤 王国庆 Zhao Qiang;Wu Xiangyang;Mu Yunfeng;Wang Guoqing(Department of Radiation Therapy,Shaanxi Provincial Cancer Hospital,Xi'an 710061,China;Department of Gynecological Oncology,Shaanxi Provincial Cancer Hospital,Xi'an 710061,China)

机构地区：[1]陕西省肿瘤医院放疗医院,西安710061 [2]陕西省肿瘤医院妇瘤病院,西安710061

出　　处：《中华放射医学与防护杂志》2024年第10期827-834,共8页Chinese Journal of Radiological Medicine and Protection

基　　金：陕西省科学技术厅一般项目-社会发展领域(2023-YBSF-049)。

摘　　要：目的:介绍一种严格基于预计划的3D打印导板的设计方法,以应用于宫颈癌近距离插植治疗,并阐明3D打印导板应用于宫颈癌近距离插植治疗中的优势。方法:回顾性选取局部晚期宫颈癌病例6例,均采用3D打印插植导板进行宫颈癌近距离插植治疗。利用插植导板的CT影像和预计划影像,通过图像配准的方法验证插植导板的机械精度。分别对比3D打印导板治疗计划和预计划、3D打印导板治疗计划和自由插植计划的剂量学差异。对比参数有:高危临床靶区的体积和D90,膀胱、直肠、小肠、乙状结肠的D2 cm 3、D1 cm 3、D0.1 cm 3。结果:利用严格基于预计划的方法设计的3D打印导板的机械精度较高,<1 mm。对于靶区D90,3D打印导板治疗计划为(713.37±143.26)cGy,比预计划的(766.62±145.97)cGy降低6.95%(z=-1.98,P<0.05),比自由插植计划的(343.56±188.72)cGy提高107.6%(z=-1.89,P<0.05)。对于其他危及器官的剂量学参数,3D打印导板计划与预计划、自由插植计划的差异均无统计学意义(P>0.05)。结论:3D打印宫颈癌插植导板的方法精度较高,在保证危及器官免受过量照射的情况下,可大幅度提升靶区受量。Objective To present a method of modeling 3D-printed guide templates(3DPGTs)strictly based on pre-plans for the interstitial implantation brachytherapy of cervical cancer,and elucidate the advantages of 3DPGTs in the interstitial implantation brachytherapy of cervical cancer.Methods This study retrospectively selected six cases of locally advanced cervical cancer treated with interstitial implantation brachytherapy using 3DPGTs.Based on the CT images of 3DPGTs and pre-plans,the mechanical precision of 3DPGTs was verified through image registration.The dosimetric differences were compared between the 3DPGT treatment plan and the pre-plan/the freehand implantation plan.The dosimetric parameters included the volume and D90 for the high-risk clinical target volume(HR-CTV),and the D2 cm3,D1 cm3,and D0.1 cm3 for the bladder,rectum,intestine,and sigmoid.Results The 3DPGTs modeled using the method strictly based on pre-plans exhibited relatively high mechanical precision,with deviations all below 1 mm.Regarding the D90 of the HR-CTV,the 3DPGT treatment plan resulted in a dose of(713.37±143.26)cGy,reduced by 6.95%(z=-1.98,P<0.05)compared to the(766.62±145.97)cGy in the pre-plan,and increased by 107.6%(z=-1.89,P<0.05)compared to the(343.56±188.72)cGy in the freehand implantation plan.For dosimetric parameters of organs at risk(OARs),no statistical differences were observed(P>0.05)between the 3DPGT treatment plan and the pre-plan/the freehand implantation plan.Conclusions The method of modeling 3DPGTs for cervical cancer proposed in this study demonstrates high accuracy.Hence,the dose for the HR-CTV can be substantially increased under the condition that the OARs are protected from over-irradiation.

关 键 词：3D打印 宫颈癌 近距离插植治疗 

分 类 号：R737.33[医药卫生—肿瘤] R730.55[医药卫生—临床医学]