| 石树远,郑广钧,张圣杰,吕金爽,冯震,柴树德,王俊杰.CT引导共面模板辅助125Ⅰ粒子植入治疗转移或复发胸壁恶性肿瘤[J].中华放射医学与防护杂志,2017,37(7):539-542 |
| CT引导共面模板辅助125Ⅰ粒子植入治疗转移或复发胸壁恶性肿瘤 |
| CT guided coplanar template assisted in the treatment of metastatic or recurrent chest wall malignant tumor with 125Ⅰ seed implantation |
| 投稿时间：2017-03-29 |
| DOI：10.3760/cma.j.issn.0254-5098.2017.07.013 |
| 中文关键词: 共面模板 放射性粒子 胸壁肿瘤 转移性肿瘤 复发性肿瘤 |
| 英文关键词:Coplanar template Radioactive seeds Chest wall malignant tumor Metastatic tumor Recurrent tumor |
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| 中文摘要: |
| 目的 探讨CT引导共面模板（coplanar template，CPT） 辅助放射性 125Ⅰ粒子植入治疗转移或复发胸壁恶性肿瘤的剂量准确性及疗效。方法 回顾性分析2005年7月至2015年7月31例转移或复发胸壁恶性肿瘤患者接受CT引导CPT辅助放射性 125Ⅰ粒子植入治疗资料。术前制定治疗计划，处方剂量（PD）110 Gy，术中在CT引导下应用CPT辅助进行放射性 125Ⅰ粒子植入。术后立即扫描CT观察粒子位置分布，进行剂量验证。比较手术前后D90、D100、V90、V100及粒子数量之间的差异。术后定期复查胸CT，与术前比较肿瘤变化，按照实体肿瘤疗效评价标准（1.1版）判定疗效，随访至2016年7月。结果 全部患者顺利完成粒子植入治疗，手术前后D90、D100、V90、V100及粒子数量差异无统计学意义（P>0.05）。适形指数（conformal index，CI）为0.951±0.13，靶区外体积指数（external index）为6.5%±0.9%。术后6个月，完全缓解（CR）25.8%（8/31），部分缓解（PR）51.6%（16/31），肿瘤稳定（SD）6.5%（2/31），肿瘤进展（PD）16.1% （5/31），有效率（CR+PR）77.4%，局部控制率83.9%（26/31）。随访过程中有13例患者出现皮肤色素沉着，未予特殊处理。结论 CT引导下应用CPT辅助放射性 125Ⅰ粒子植入治疗胸壁恶性肿瘤可保障术前计划在术中得到执行，从而有效地进行质量控制，而且安全、有效。 |
| 英文摘要: |
| Objective To evaluate the dosimetry accuracy and clinical efficacy of 125Ⅰ radioactive seed implantation using coplanar template (CPT) in the treatment of metastatic or recurrent chest wall tumor. Methods Thirty-one patients with metastasis or recurrence of chest wall tumor, who had been diagnosed with pathology between July 2005 and July 2015, were retrospectively studied. All patients underwent CPT-assisted 125Ⅰ radioactive seed implantation. Brachytherapy radiation treatment planning system (BTPS) was used to make preoperative plans, and the prescribed dose (PD) was 110 Gy. CPT was used to assist CT guided 125Ⅰ radioactive seeds implantation. Dose evaluation was performed immediately after implantation. The difference of dose parameters was compared between preoperation and postoperation, including D90, D100, V90, V100 and the numbers of seeds. Postoperative chest CT was conducted regularly to assess the treatment efficacy based on the response evaluation criteria in solid tumors (RECIST Version 1.1). The patients were followed up till July 2016. Results All patients went through implantation procedure successfully and there was no significant statistical difference between preoperative and postoperative dose parameters (P>0.05). The conformal index(CI) was 0.951±0.13,external index(EI) was 6.5%±0.9%. Six months after implantation, CR, PR, SD and PD were 25.8% (8/31), 51.6% (16/31), 6.5% (2/31) and 16.1% (5/31),respectively. The effective rate was 77.4%, and local control rate was 83.9% (26/31). Skin pigmentation occurred in 13 patients during the follow-up period, without any special treatment. Conclusions The auxiliary of CPT in the treatment of metastatic or recurrent chest wall tumor under the guiding of CT could achieve quality control, safety and effectiveness. |
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