CT引导术中实时计划对胸部肿瘤^125I粒子植入治疗的价值

The study of intraoperative real-time planning by CT-guided in 125I seed implantation for thoracic malignancie

目的探讨CT引导下计算机三维治疗计划系统（TPS）术中实时治疗计划在^125I粒子植入治疗胸部肿瘤中应用的必要性和可行性。方法对2010-2012年间31例行^125I粒子治疗的胸部肿瘤患者资料进行回顾分析，其中13例术中行TPS实时计划优化（A组），余18例未行术中实时计划（B组）。按经验间隔1cm植入粒子，所有患者处方剂量110Gy，术后均行TPS质量验证。并在B组原术中影像资料上重新模拟实时计划（C组），比较各组质量验证满意率。采用x^2检验差异。结果A、B组术后质量验证满意率分别为92％、39％（P=0．003），C组重新模拟计划后满意率为94％，也高于B组（P=0．001），但与A组相似（P=0．811）。结论术中实时治疗计划在CT引导下^125I粒子治疗胸部肿瘤可显著提高肿瘤靶区剂量满意率，具有可操作性，对胸部肿瘤粒子治疗的规范化具有重要价值。

Objective To explore the necessity and feasibility of the real-time treatment planning optimization by CT guided with 125I seed implantation brachytherapy treatment to thoracic malignancies. Methods To retrospectively analyze the data of 31 inpatients （from October 2010 to June 2012） with thoracic malignancie by CT guidance 125I brachytherapy. The real-time planning optimization were applicated to 13 cases （group A）, 18 patients undergoing experience particles implantation interval 1 cm （group B）, all the patients were prescribed dose 110 Gy and post-planning verified after surgery. Re-simulation of real- time program （group C） about the image data in group B, data analysis was x2-test by SPSS 13.0 software. Results The quality verification in two groups were 92% and 39%, the difference was statistically sifnificant （P = 0. 003 ）. The re-simulation program in group C was 94% , there was significant difference compared with group B （ P = 0. 001 ） , but with no significant difference compared with group A （ P = 0. 811 ）. Conclusions The application of intraoperative real-time planning by CT guided with ^125I seed implantation braehytherapy to thoraeic malignancies, non-equidistant layout that be the real implantedneedle trajectory based on dosimetry, can significantly improve the tumor target dose, operational, there was greatly important value to the standardization of the particle therapy of thoracic malignancies.