3D打印非共面模板辅助CT引导放射性125I粒子植入治疗技术流程与QC的专家共识

Expert consensus on work flow and quality control of CT-guided 125Iseed permanent interstitial brachytherapy assisted by 3D-printing non-coplanar templates

放射性粒子组织间永久植入（简称粒子植入）治疗肿瘤属于近距离治疗范畴, 它具有靶区局部剂量高,周围正常组织剂量低的特点,同时粒子植入治疗需要在穿刺引导下进行,它又具有创伤小、恢复快的优势,已成为早期前列腺癌标准治疗手段之一.粒子植入治疗需要借助超声、CT、MRI等影像引导和辅助导航引导系统来实现粒子在肿瘤靶体积内精准分布,确保术后与术前计划高度一致.如何实现粒子在靶体积内精准适形剂量分布,图像引导结合模板辅助是实现粒子植入的关键.经直肠超声引导结合经会阴部模板辅助粒子植入治疗前列腺癌已十分成熟,而其他部位肿瘤粒子植入引导技术标准尚没有达成共识.本文主要基于3D打印非共面模板辅助CT引导技术建立起的规范和共识,内容包括粒子剂量学、适应证、技术流程.粒子治疗是非常有效的局部治疗手段,但鉴于目前尚缺少大规模循证医学证据,需要多中心、前瞻、随机研究的高水平文章以提高循证医学等级.

Permanent radioactive seed implantation belongs to the interstitial brachytherapy which delivers a high dose to the target volume and low doses to the surrounding normal tissues.Seed implantations are under puncture guidance which leads to minimal injury and rapid recovery, thus becoming the standard therapy for early-stage prostate carcinoma.Radioactive seed implantations require the guidance by ultrasound, CT, and MRI assisted by the navigator system to ensure accurate seed distribution in the target volume and a high degree of consistency with preoperative planning.To realize a conformal and precise dose distribution in the target volume, image guidance with template assistance is the key.125Iseed implantation under ultrasound guidance with transperineal template assistance has become a very successful therapy for prostate carcinoma, but no criteria are available for its use in other carcinomas.Here we review the consensus on the 125Iseed implantation therapy under CT-guidance assisted by 3D-printing non co-planar template （3D-PNCT）, including radiation physics and dosimetry, indications, and 3D-PNCT work flow.Despite the effectiveness of 125Iseed implantation as a local therapy for solid tumors, there is still a compelling need for prospective, randomized, multi-center clinical trials to get high-level evidence to confirm the role of 125Iseed implantation in the comprehensive treatment of cancer.