| 张永侠,袁香坤,苗珺珺,等.3D打印模板应用于局部晚期宫颈癌后装放疗的剂量学研究[J].中华放射医学与防护杂志,2020,40(7):519-523.Zhang Yongxia,Yuan Xiangkun,Miao Junjun,et al.Dosimetric analysis of 3D-printed minimally invasive-guided template in the brachytherapy treatment of locally advanced cervical cancer[J].Chin J Radiol Med Prot,2020,40(7):519-523 |
| 3D打印模板应用于局部晚期宫颈癌后装放疗的剂量学研究 |
| Dosimetric analysis of 3D-printed minimally invasive-guided template in the brachytherapy treatment of locally advanced cervical cancer |
| 投稿时间：2020-02-16 |
| DOI：10.3760/cma.j.issn.0254-5098.2020.07.005 |
| 中文关键词: 宫颈癌 3D打印 腔内 插植 剂量学 |
| 英文关键词:Cervical cancer 3D-printed Intracavitary Interstitial Dosimetry |
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| 中文摘要: |
| 目的 局部晚期宫颈癌后装放疗应用3D打印微创导向模板的剂量学研究。方法 本研究为前瞻性研究，选取2016年5月-2019年8月就诊河北省沧州中西医结合医院的局部晚期宫颈癌患者共68例，均为偏心性或外照射后仍有巨大肿块（肿瘤直径>5 cm）残存的患者，外照射采用调强放疗，后装治疗方法为腔内联合组织间插植放疗，高危临床靶区（high-risk clinical target area，HR-CTV）剂量为6 Gy/次，1次/周，共5次。68例患者采用随机数表法分为两组，其中模板组35例采用3D打印微创导向模板辅助置入宫腔管并植入插植针；自由插植组33例徒手进行宫腔管的置入及插植针的植入。所有患者均于CT引导下调整宫腔管、插植针位置及深度，将最终CT图像传入后装治疗计划系统，勾画靶区及危及器官，制定治疗计划，实施治疗。结果 共制定340次后装放疗计划，其中模板组175次、自由插植组165次。模板组较自由插植组的HR-CTV的D90（包绕90%靶区体积的剂量）、中危临床靶区（intermediate-risk clinical target volume，IR-CTV）的D90均明显增高（t=3.63、2.45，P<0.05），膀胱、直肠及乙状结肠的D2 cm3均显著降低（t=-2.81、-2.54、-2.33，P<0.05）。同时，模板组每次后装治疗平均扫描CT次数为（1.78±0.53）次，每次治疗从宫腔管及插植针植入至调整达满意位置的平均消耗时间为（11.35±3.98）min，每次治疗使用插植针的针数平均为（5.21±1.37）枚。而自由插植组分别为（3.56±0.88）次，（30.67±5.83）min，（7.48±2.79）枚，两组比较差异均具有统计学意义（t=-2.26、-4.53、-3.21，P<0.05）。结论 对于偏心性或巨大肿块的局部晚期宫颈癌患者，腔内联合组织间插植治疗应用3D打印微创导向模板剂量学优势明显，操作简便，用时短。 |
| 英文摘要: |
| Objective To investigate the dosimetry advantage of 3D-printed minimally invasive guided template used in local advanced cervical cancer intracavitary combined with interstitial radiotherapy. Methods A total of 68 cases with locally advanced cervical cancer who were admitted to Hebei Cangzhou Hospital of intergrated traditional Chinese medicine and western medicine from May 2016 to August 2019 were selected. All the patients had eccentric tumor or large tumor (tumor diameter >5 cm) after radiotherapy. Intensity modulated radiotherapy was used for external radiotherapy, and intracavitary combined with interstitial radiotherapy was used for brachytherapy. The prescription dose of high-risk clinical target volume (HR-CTV) is 6 Gy/fraction, once a week, five fractions in total. Sixty-eight patients were randomly divided into two groups, 35 cases in the template group who received minimally invasive 3D printing guided template assisted intrauterine tube implantation and insertion needle implantation, and 33 patients in the free implantation group who received free hand intrauterine tube implantation and insertion needle implantation. The position and depth of the insertion needle were adjusted by CT-guidance, and the final CT image was transmitted to the Oncentra Brachy treatment planning system, then the target volume and organs at risk were delineated for planning and treatment. Results A total of 340 brchytherapy plans were made, including 175 in the template group and 165 in the free implantation group. The D90 values of the HR-CTV and intermediate-risk clinical target volume (IR-CTV) in the template group were increased (t=3.63, 2.45, P<0.05), and D2 cm3 values (dose of 2 cm3 of organ at risk) of bladder, rectum and sigmoid colon were significantly decreased (t=-2.81, -2.54, -2.33, P<0.05). At the same time, the average CT scanning times of each treatment in the template group was (1.78±0.53) times, the average duration of each treatment was (11.35±3.98) min, and the average number of needles used in each implant treatment was (5.21±1.37). The result of free implantation group was higher than that of the template group. The differences were statistically significant (t=-2.26, -4.53, -3.21, P<0.05). Conclusions For localized advanced cervical cancer patients with eccentric or large tumors, the 3D printed minimally invasive guided template for intracavitary and interstitial implantation has obvious dosimetry advantages, and the operation is simpler and the duration is shorter. |
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