CT引导3D打印非共面模板辅助125Ⅰ粒子治疗头颈部复发转移癌不良反应研究

Side effect of radioactive 125I seed implantation for recurrent malignant tumor of head and neck assisted by 3D-printing individual guide plate

目的 探讨3D打印非共面模板辅助放射性粒子植入治疗头颈部复发/转移恶性肿瘤技术的安全性。方法 回顾性分析2016年1—12月于本院接受3D打印模板辅助CT引导放射性125Ⅰ粒子植入治疗的头颈部复发/转移恶性肿瘤患者共42例。其中头颈部肿瘤原位或瘤床复发26例，头颈部淋巴结转移16例。肿瘤体积为2.4~102.8 cm3（中位体积大小为28.6 cm3）。处方剂量给予110~160 Gy，选择粒子活度为0.34~0.70 mCi，中位活度为0.6 mCi（1 Ci=3.7×1010Bq）。粒子数目为10~126枚（中位为34枚）。插入粒子植入针为4~31根（中位针数11根）。所有患者行术前计划设计、3D打印模板制作、穿刺及粒子植入，术后验证，并随访。对皮肤、黏膜、血液和脊髓等不良反应进行统计分析。结果 所有病例手术顺利。随访时间为4~14个月，中位随访8.5个月。1例出现可疑治疗相关Ⅲ度神经反应。余病例均无3级以上不良反应。皮肤Ⅰ度反应3例（3/42），黏膜Ⅰ度反应1例、Ⅱ度反应2例。口干均未加重。皮肤反应与皮肤所受剂量（D0.1 cm3）相关，D0.1 cm3≥60 Gy和D0.1 cm3 〈60 Gy的皮肤不良反应差异有统计学意义（χ2=7.067，P=0.032）。均未出现血液毒性反应和脊髓损伤，也未发现粒子移位。结论 3D打印非共面模板辅助放射性粒子植入头颈部复发转移肿瘤，无明显相关不良反应，且操作简便，剂量精准。

Objective To investigate the acute side effect of 3D printing individual non-coplanar template for 125Ⅰ seed implantation in head and neck recurrent/ metastatic carcinoma. Methods Between January 2016 and December 2016, 42 patients of local recurrent malignant tumor of head and neck received 3D printing guide plate assist radioactive seeds implantations, and included in the study. The tumor volume ranged from 2.4 to 102.8 cm3 （median 28.6 cm3）. The prescribed dose is 110-160 Gy, and the seeds activity were 0.34 to 0.70 mCi（1 Ci=3.7×1010Bq）. All patients carried out preoperative planning design, individual guide plate production, seed implantation, postoperative dose assessment, and follow-up. The side effects of skin, mucous membrane, blood and spinal cord were statistically analyzed. Results All patients were operated successfully. The follow-up time was 4-14 months （median 8.5 months）. There were no adverse reactions at grade three or above. Three patients had grade one skin reaction. One patient experienced grade one mucosal reaction, two experienced grade two mucosal reactions. The skin response was correlated with the dose of the skin （χ2=7.067, P=0.032）. No hematologic toxicity or radiation myelopathy was observed and no seed displacement was found. Conclusions 3D-printing guide plate can provide good accuracy for positioning and direction. For local recurrent malignant tumor of head and neck, there were no obvious adverse reactions and the operation was simple and the dosage was accurate.