| 吕金爽,郑广钧,张圣杰,杨景魁,阎卫亮,石树远,冯震,朱晓雷,柴树德,王俊杰.共面模板辅助放射性粒子植入治疗纵隔4R组淋巴结转移瘤的剂量学分析[J].中华放射医学与防护杂志,2017,37(7):533-538 |
| 共面模板辅助放射性粒子植入治疗纵隔4R组淋巴结转移瘤的剂量学分析 |
| Dosimetry analysis of radioactive seed implantation supported by coplanar template for lung cancer patients with mediastinal lymph node metastases 4R |
| 投稿时间：2017-03-25 |
| DOI：10.3760/cma.j.issn.0254-5098.2017.07.012 |
| 中文关键词: CT引导 共面模板 放射性粒子 近距离治疗计划系统 纵隔淋巴结转移瘤 |
| 英文关键词:CT guided Coplanar template Radioactive seeds Brachytherapy treatment planning system Mediastinal lymph node metastasis |
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| 中文摘要: |
| 目的 评价CT引导下应用共面模板（coplanar template，CPT）对4R组纵隔淋巴结转移瘤进行 125Ⅰ放射性粒子治疗的植入前、后剂量学符合程度及对疗效的影响。方法 收集2008年1月至2014年12月在天津医科大学第二医院接受治疗的经病理学明确诊断的伴有4R组纵隔淋巴结转移的晚期肺癌患者32例，对该组患者的淋巴结转移灶行CT引导下CPT辅助 125Ⅰ放射性粒子植入治疗。术前行胸部CT扫描获得医学数据成像信息（digital imaging and communications in medicine，DICOM），导入近距离治疗计划系统（brachytherapy treatment planning system，BTPS）进行预计划，处方剂量（prescribed dose，PD）120 Gy。术中应用CPT控制针的穿刺和粒子的植入，CT扫描验证插植针及粒子空间位置分布，完成植入后即刻进行剂量评估，验证结果与术前计划的剂量参数进行配对t检验。术后定期复查胸部CT，根据术后第6 个月时复查的胸部CT，与粒子植入前进行比较，按照实体肿瘤疗效评价标准（1.1版）判定疗效。结果 全部患者完成粒子植入治疗，术后剂量评估，接受的平均照射剂量为（232.5±30.2）Gy，90%靶区体积的剂量为（150.8±16.6） Gy，100%靶区体积的剂量为（100.4±12.6） Gy，100%PD覆盖的靶区体积为（94.1±2.6）%，200%PD覆盖的靶区体积（33.0±5.7）%，适形指数（conformal index，CI）为0.75±0.06，靶区外体积指数（external index，EI）为（22.7±5.8）%，上腔静脉接受的平均照射剂量为（19.3±7.2）Gy，主动脉接受的平均照射剂量为（12.1±5.1）Gy。术后6个月判定疗效，有效率为84.37％。随访过程中未发现明显肺部放射性损伤及大血管损伤、出血等严重并发症。结论 CT引导下应用CPT辅助对4R组纵隔淋巴结转移瘤进行 125Ⅰ放射性粒子植入治疗，可以较好地在术中实现术前BTPS计划目标、避免重要血管和脏器损伤，是一种精准、有效、安全的治疗方法，对纵隔淋巴结转移瘤放射性粒子治疗的规范化和质量控制具有重要价值。 |
| 英文摘要: |
| Objective To compare the planned radiation dose and the actual dose received after 125Ⅰ radioactive seeds implantation supported by coplanar template (CPT) in lung cancer patients with mediastinal node metastases 4R, and to evaluate the clinical efficacy. Methods Totally 32 patients with lung cancer with mediastinal lymph node metastases 4R who had been diagnosed via cellular pathology studies were selected from January 2008 to December 2014. The mediastinal lymph node metastases were treated by CPT-assisted 125Ⅰ radioactive seed implantation. Digital imaging and communications in medicine(DICOM) data were acquired by chest CT scan before implantation, brachytherapy radiation treatment planning system (BTPS) was introduced to carry out the plan, and the prescribed dose(PD) was 120 Gy. CPT was used to control the precision of needle penetration and implantation of radioactive seeds. Computer tomography (CT) was used to ensure the correct position of needles and radioactive seeds. Dose evaluation was performed immediately after implantation and was compared with planned dose using paired t-test. The 6-months postoperative chest CT was conducted to evaluate treatment efficacy according to response evaluation criteria in solid tumors(RECIST Version 1.1). Results All patients went through implantation procedure successfully. Dose evaluation after implantation was as followed. The average dose received (231.9±29.6)Gy, the dose received by 90% of the target(D90) (150.8±16.6) Gy, the dose received by 100% of the target(D100) (100.4±12.6)Gy, the volume of 100%PD covering the target(V100) (94.1±2.6)%, the volume of 200%PD covering the target(V200) (33.0±5.7)%, the conformal index(CI) 0.75±0.06, the external index(EI) (22.7±5.8)%, the average dose received by the superior vena cava (19.3±7.2)Gy, and the average dose received by aorta (12.1±5.1)Gy. Efficacy was followed for 6 months after implantation and the effective rate was 84.37%. There was no serious complications (such as radioactive lung injury,major vascular injury, bleeding, and et al.) occurred in follow-up period. Conclusions CPT assisted CT guided 125Ⅰ radioactive seed implantation in treating mediastinal node metastases 4R can achieve preoperative BTPS, minimize major vascular or organ injury. It is an accurate, effective and safe treatment approach and may be of great value to standardize the procedure of radioactive seed implantation in mediastinal metastases. |
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