基于CT图像的腹腔镜超声引导I^(125)粒子植入治疗胰腺癌术前规划

Preoperative planning of laparoscopic ultrasound-guided I^(125) implantation in treatment of pancreatic cancer based on CT images

目的提出基于CT图像的腹腔镜超声引导I^(125)粒子植入治疗胰腺癌的术前规划方法,并评价该治疗方法的可行性。方法将1例胰腺癌患者的术前CT图像导入本实验室自主研发的治疗计划系统(TPS)中,获得肿瘤和周围器官的重建图像。借助基于肿瘤表面的虚拟手术导板,选择进针点位置,进而规划出粒子植入的针道及粒子数量,并评估辐射剂量。结果共规划21条针道,拟植入45颗粒子。术前规划中肿瘤的剂量参数指标D90为12 481cGy,V100为92.83%,可满足临床剂量要求;而周边正常胰腺组织的D90为0,V100仅为0.40%。结论理论上,腹腔镜超声引导I^(125)粒子植入治疗胰腺癌能保证粒子精准植入并达到肿瘤局部控制效果。

Objective To propose a novel preoperative planning method for laparoscopic ultrasound-guided implantation of I125 seeds in treating pancreatic cancer based on CT images, and to evaluate the feasibility of this treatment. Methods CT images of a pancreatic cancer patient were transmitted into the treatment planning system （TPS） developed by our laboratory, to obtain three-dimensional representations of the tumor and surrounding organs. All the positions of puncture were selected with the aid of virtual template, then possible needle paths and the number of necessary I125 seeds were planned, and the radiation dose was evaluated. Results A total of 21 needle paths with 45 seeds implantation into the tumor were planned. In the preoperative planning, the dosage parameters D90 and V100 of the tumor were 12 481 cGy and 92.83%, which was relatively eligible for the clinic requirement, whereas of suurounding non-tumor pancreatic tissue was 0 and 0.40%, respecyively. Conclusion Laparoscopic ultrasound-guided implantation of I125 seeds can be considered as a useful method for treating pancreatic cancer with accurate implantation of 125I seeds and satisfying effect of local control for the tumor in theory.