中华放射医学与防护杂志

曲昂,彭冉,姜玉良,江萍,吉喆,郭福新,孙海涛,范京红,李卫燕,王俊杰.3D打印共面坐标模板辅助¹²⁵I放射性粒子植入治疗盆壁复发宫颈癌的剂量学研究[J].中华放射医学与防护杂志,2018,38(10):756-760

3D打印共面坐标模板辅助¹²⁵I放射性粒子植入治疗盆壁复发宫颈癌的剂量学研究

Dosimetric study of ¹²⁵I seed implantation by 3D-printing coplanar template for pelvic wall recurrent cervical cancer after radiotherapy

投稿时间：2018-03-11

DOI：10.3760/cma.j.issn.0254-5098.2018.10.007

中文关键词: 盆壁复发宫颈癌 ¹²⁵I放射性粒子剂量学 3D打印共面坐标模板

英文关键词:Pelvic wall recurrent cervical cancer ¹²⁵I radioactive seed Dosimetry 3D-printing coplanar coordinate template

基金项目:

作者	单位	E-mail
曲昂	100191 北京大学第三医院肿瘤放疗科
彭冉	100191 北京大学第三医院肿瘤放疗科
姜玉良	100191 北京大学第三医院肿瘤放疗科
江萍	100191 北京大学第三医院肿瘤放疗科
吉喆	100191 北京大学第三医院肿瘤放疗科
郭福新	100191 北京大学第三医院肿瘤放疗科
孙海涛	100191 北京大学第三医院肿瘤放疗科
范京红	100191 北京大学第三医院肿瘤放疗科
李卫燕	100191 北京大学第三医院肿瘤放疗科
王俊杰	100191 北京大学第三医院肿瘤放疗科	junjiewang_edu@sina.cn

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中文摘要:

目的探讨放疗后盆壁复发宫颈癌患者采用3D打印共面坐标模板（3D-PCT）辅助¹²⁵I放射性粒子植入治疗剂量精确性实施的可行性。方法本研究为单中心的回顾性研究，选取2016年4月至2017年12月北京大学第三医院应用3D-PCT辅助¹²⁵I放射性粒子植入治疗的放疗后盆壁复发宫颈癌患者资料10例。患者年龄37~71岁，中位年龄53.5岁，KPS评分≥ 70分。所有患者均接受过盆腔放疗。病灶体积为3.5~58.0 cm³（中位31.9 cm³），处方剂量120~180 Gy，粒子活度0.55~0.67 mCi（1 Ci=3.7×10¹⁰Bq），术前计划植入粒子数目为50（12~81）颗。根据术前计划在3D-PCT引导下行放射性粒子植入术。术后实际植入粒子数目为53（10~82）颗。评估剂量学参数包括D₉₀、D₁₀₀、V₁₀₀、V₁₅₀、V₂₀₀、靶区外体积指数（EI）、适形指数（CI）和均匀性指数（HI），以及危及器官剂量D_{2 cm³}、D_{1 cm³}和D_{0.1 cm³}。术前计划与术后计划参数的比较采用相关样本非参数检验。结果术后实际植入粒子数目多于术前计划设计，差异有统计学意义（Z=-2.255，P<0.05）。术后计划与术前计划的靶区剂量学参数D₉₀、D₁₀₀、V₁₀₀、V₁₅₀、V₂₀₀、EI、CI和HI比较，差异均无统计学意义（P>0.05）。膀胱、肠道的D_{2 cm³}、D_{1 cm³}和D_{0.1 cm³}、直肠D_{0.1 cm³}的术后计划与术前计划剂量差异均无统计学意义（P>0.05）。直肠D_{2 cm³}和D_{1 cm³}术后计划剂量低于术前计划，差异均有统计学意义（Z=-2.100、-2.240，P<0.05）。结论 3D-PCT辅助¹²⁵I放射性粒子植入治疗盆壁复发宫颈癌，通过术中剂量优化，术后实际剂量达到术前计划设计，可以保证¹²⁵I放射性粒子植入盆壁复发宫颈癌的剂量精确实施。

英文摘要:

Objective To investigate the feasibility of 3D-printing coplanar coordinate template (3D-PCT) for guiding ¹²⁵I radioactive seed implantation in the treatment of pelvic wall recurrence of cervical cancer on ensuring the accuracy of dose. Methods From Oct 2016 to Dec 2017 in Peking University Third Hospital, totally 10 patients with pelvic wall recurrent cervical cancer after radiotherapy were treated with ¹²⁵I radioactive seed implantation assisted by 3D-PCT. The median age was 53.5 years old (37-71 years old). KPS score of the cohort were more than 70. All patients had received pelvic radiation therapy previously. The median volume of the lesion was 31.9 cm³ (3.5-58.0 cm³). The prescription dose was 120-180 Gy. The activity of seeds was 0.55-0.67 mCi(1 Ci=3.7×10¹⁰Bq), while the number of seeds was 12-81 (median 50) on preoperative plan. Radioactive seeds implantation was performed under 3D-PCT guidance according to the preoperative plan. The actual number of implanted seeds was 53(10-82). Dosimetry parameters of preoperative plan and postoperative plan including D₉₀, D₁₀₀, V₁₀₀, V₁₅₀, V₂₀₀, external index (EI), conformal index (CI), heterogeneity index (HI), and organ-at-risk doses of D_{2 cm³}, D_{1 cm³} and D_{0.1 cm³} were compared using the nonparametric test. Results The seed number of postoperative plan was more than that of preoperative plan (Z=-2.255,P<0.05), but all of the dosimetric parameters showed no significant difference (P>0.05). D_{2 cm³} and D_{1 cm³} of rectum for postoperative plan were lower than that of preoperative plan (Z=-2.100,-2.240,P<0.05), while other dose parameters of normal tisssues showed no statistically significant difference (P>0.05). Conclusions Assisted by 3D-PCT for ¹²⁵I radioactive seed implantation in pelvic wall recurrence of cervical cancer, the actual postoperative dose could meet the requirement of the preoperatie plan through the intraoperative optimization of dose. 3D-PCT could ensure the precise of delivered dose of ¹²⁵I radioactive seed implantation.

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