CT引导三维打印个体化模板辅助^(192)Ir插植治疗非小细胞肺癌的剂量学研究  

Dosimetric study of ^(192)Iridium implantation assisted by CT guided three-dimensional printing individualized template in the treatment of non-small cell lung cancer

作　　者：陈仁金 庞皓文 张怀文[2] 石翔翔 CHEN Renjin;PANG Haowen;ZHANG Huaiwen;SHI Xiangxiang(Department of Oncology,Affiliated Hospital of Southwest Medical University,Luzhou,Sichuan 646000,China;Department of Radiation Oncology,Jiangxi Cancer Hospital,Nanchang,Jiangri330029,China)

机构地区：[1]西南医科大学附属医院肿瘤科,四川泸州646000 [2]江西省肿瘤医院放疗技术科,江西南昌330029

出　　处：《中华肿瘤防治杂志》2024年第23期1444-1450,共7页Chinese Journal of Cancer Prevention and Treatment

基　　金：四川省医学科研课题计划(S21004);古蔺县人民医院-西南医科大学附属医院科技战略合作项目(2022GLXNYDFY05);核医学与分子影像四川省重点实验室开放课题(HYX20002)。

摘　　要：目的对比三维打印个体化模板辅助^(192)Ir插植技术与自由插植技术在非小细胞肺癌(NSCLC)立体定向近距离消融(SABT)中的剂量学差异。方法回顾性分析2022-01-01-12-31西南医科大学附属医院肿瘤科收治的60例行SABT的NSCLC患者临床资料。男35例,女25例;年龄42~86岁,中位年龄58岁。按治疗时是否使用插植模板将患者分为2组:模板辅助组30例,采用CT引导下三维医学影像处理软件建模个体化三维打印模板辅助植入插植针;自由插植组30例,在CT引导下徒手植入插植针。患者均在CT引导下调整插植针的位置和深度,将满足临床要求的CT图像输出到Oncentra后装治疗计划系统,勾画靶区及危及器官,完成近距离放疗计划后实施近距离插植放疗。分别评估模板辅助组和自由插植组靶区、危及器官的剂量学参数,以及在插植操作过程中的CT扫描次数、插植时间和针数的差异。数据通过两独立样本t检验或秩和检验进行比较,评估2种技术对于SABT的临床使用效果。结果模板辅助组的靶区剂量学参数100%靶区体积接受剂量(D_(100))、90%靶区体积接受剂量(D_(90))、150%处方剂量覆盖的计划靶区体积(V_(150))和100%处方剂量覆盖的计划靶区体积(V_(100))分别为(2015.92±392.60)cGy、(3166.29±392.66)cGy、(70.21±10.21)%和(92.03±5.70)%,自由插植组分别为(1770.18±282.78)cGy、(2894.92±310.09)cGy、(65.10±9.16)%和(87.50±5.40)%,2组差异有统计学意义,t值分别为2.782、2.971、2.063和3.160,均P<0.05。各危及器官剂量学参数心脏最大剂量(D_(max))、全肺平均剂量(D_(mean))和20%处方剂量覆盖的计划靶区体积(V_(20))、脊髓D_(max)和食管D_(max)的差异均无统计学意义,P>0.05。肿瘤靶区的适形度和均匀性均明显提高,t值分别为2.16和2.51,均P<0.05。同时,模板辅助组每次插植平均CT扫描次数为(4.40±1.63)次,每次从第1根插植针入针时间至所有插植针均达到满意位置的平Objective To compare the dosimetric differences between three-dimensional printed individualized template-assisted ^(192)Ir implantation technique and free-hand implantation technique in stereotactic ablative brachytherapy(SABT)for non-small cell lung cancer(NSCLC).Methods A retrospective analysis of clinical data of 60 patients with NSCLC undergoing SABT in the Department of Oncology,Affiliated Hospital of Southwest Medical University from January 1 to December 31,2022,There were 35 males and 25 female patients,aged 42 to 86 years with a median age of 58 years.Patients were divided into two groups based on whether template assistance was used during treatment,30 patients underwent personalized three-dimensional printed template-assisted implantation of interstitial needles under CT guidance(template-assisted group),while 30 patients underwent manual implantation of interstitial needles under CT guidance(freehand group).All patients had the position and depth of the interstitial needles adjusted under CT guidancer and CT images meeting clinical requirements were output to the Oncentra brachytherapy treatment planning system.The target area and organs at risk were delineated,and after completing the brachytherapy plan,the interstitial brachytherapy was performed.Dose-volume parameters of the target area and organs at risk,as well as the differences in the number of CT scans,implantation time,and number of needles during the implantation process,were evaluated between the templateassisted group and the free-hand group.Data were compared by using independeit sample t-tests or rank sum tests to assest the clinical efficacy of the two techniques for SABT.Results The target area dosimetric parameters for the template-assisted group,including the dose received by 100%of the target volume(D_(100)),90%of the target volume(D_(90)),150%of the prescription dose(V_(150)),and 100%of the prescription dose(V_(100))were(2015.92±392.60)cGy,(3166.29±392.66)cGy,(70.21±10.21)%,and(92.03±5.70)%,respectively,which were higher than

关 键 词：三维打印 模板 ^(192)Ir插植 非小细胞肺癌 立体定向近距离消融 剂量学 

分 类 号：R734.2[医药卫生—肿瘤]