3D打印阴道柱插植在宫颈癌自适应近距离治疗的剂量学研究  

Dosimetric analysis of 3D-printed vaginal cylinder template-guided interstitial adaptive brachytherapy for cervical cancer

作　　者：杨翠萍 荣玲[1] 许磊[1] 孙岚[1] 吴伯恒 徐子豪 白永瑞[1] 曹鸿斌[1] Yang Cuiping;Rong Ling;Xu Lei;Sun Lan;Wu Boheng;Xu Zihao;Bai Yongrui;Cao Hongbin(Department of Radiation Oncology,Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院放射诊疗科,上海200127

出　　处：《中华放射肿瘤学杂志》2025年第3期265-274,共10页Chinese Journal of Radiation Oncology

基　　金：上海市科技计划项目(21ZR1438500,23ZR1438900)。

摘　　要：目的探索个体化3D打印阴道柱插植近距离治疗用于局部晚期宫颈癌的优势,为临床自适应近距离放疗提供参考。方法回顾性分析2021年9月至2023年8月上海交通大学医学院附属仁济医院收治的20例局部中晚期宫颈癌患者的临床资料,患者中位年龄54岁(范围为32~69岁),其中腺癌3例、鳞癌17例。根据治疗方法不同分为腔内治疗组(腔内组,10例)和个体化3D打印阴道柱插植治疗组(插植组,10例)。为插植组的患者设计预计划(插植组预计划)。运用剂量体积直方图评估靶区和危及器官的剂量分布。采用Mann-Whitney检验比较两组间数据差异,Kruskal-Wallis检验进行三种计划(腔内计划、插植计划、插植组预计划)数据的比较。结果插植计划、插植组预计划和腔内计划的高危临床靶区的平均D_(90rel)(即90%体积的靶区受到照射的剂量占处方剂量的百分比)分别为100.47%、104.66%和85.91%,适形指数分别为0.66、0.72和0.68。三种计划的膀胱、直肠和乙状结肠的D_(0.01 cm^(3))、D_(2 cm^(3))、D_(5 cm^(3))差异没有统计学意义(P>0.05),插植计划的小肠D_(2 cm^(3))在单次6 Gy和7 Gy处方时分别为169.51 cGy和111.93 cGy,优于腔内计划6 Gy处方时的343.07 cGy(P<0.01)。结论个体化3D打印阴道柱插植近距离治疗的靶区剂量更优,能根据肿瘤体积和位置变化自适应调整插植计划,操作更安全、高效。ObjectiveTo explore the advantages of individualized 3D-printed vaginal cylinder template-guided interstitial brachytherapy(3D-p-VC-ISBT)in locally advanced cervical cancer,aiming to provide reference for clinical adaptive brachytherapy.MethodsClinical data of 20 patients with locally advanced cervical cancer admitted to Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine from September,2021 to August,2023 were retrospectively analyzed.The median age was 54 years old(32-69 years).Among them,3 patients were diagnosed with adenocarcinoma and 17 cases of squamous cell carcinoma.According to the treatment method,all patients were divided into intracavitary brachytherapy group(ICBT-plan group,n=10)and 3D-p-VC-ISBT group(3D-p-VC-ISBT treatment-plan group,n=10).A pretreatment plan was designed for each patient undergoing 3D-p-VC-ISBT.The pretreatment plans were formed as the pretreatment-plan group.Dose volume histogram was used to evaluate dose distribution of the targets and organs at risk(OAR).Comparison between two groups was analyzed by Mann-Whitney test and comparison among three treatment plans(ICBT,3D-p-VC-ISBT treatment-plan and 3D-p-VC-ISBT pretreatment-plan)was analyzed by Kruskal-Wallis test.ResultsThe mean D 90rel(representing the dose received by 90%volume of the target area divided by the prescription dose)of high-risk clinical target volume(HR-CTV)in 3D-p-VC-ISBT,pretreatment-plan and ICBT-plan groups were 100.47%,104.66%and 85.91%,respectively.The conformity indexes were 0.66,0.72 and 0.68,respectively.There was no significant difference in D_(0.01 cm^(3)),D_(2 cm^(3))and D_(5 cm^(3))of bladder,rectum and sigmoid colon among the three groups(all P>0.05).For the 3D-p-VC-ISBT treatment-plan group,the D_(2 cm^(3))values of the small intestine at 6 Gy and 7 Gy prescription doses were 169.51 cGy and 111.93 cGy respectively,which were superior to those of the ICBT-plan group(343.07 cGy at 6 Gy prescription,P<0.01).ConclusionsIndividualized 3D-p-VC-ISBT is superior to ICBT in terms of

关 键 词：宫颈肿瘤 近距离放射疗法 组织间插植近距离放射疗法 自适应近距离治疗 个体化3D打印阴道柱 剂量分布 

分 类 号：R73[医药卫生—肿瘤]