模板辅助CT引导放射性粒子植入治疗胰腺癌的临床应用价值

Clinical application value of template-assisted CT-guided radioactive seed implantation for pancreatic carcinoma

目的探讨放射性粒子植入胰腺癌治疗中，共面模板辅助CT引导的临床应用价值。 方法回顾性分析2015年1月至2016年12月上海交通大学医学院附属瑞金医院卢湾分院放射介入科，22例行CT引导下放射性125I粒子植入治疗的中晚期胰腺癌患者的临床资料。其中10例为共面模板辅助粒子植入，12例为非模板辅助粒子植入。所有患者进行术前计划、术后剂量学验证。采用配对t检验比较手术前后90%靶体积的最小吸收剂量（D90）、最小周边剂量（MPD）及100%、150%、200%处方剂量覆盖的靶区体积占靶区总体积的百分比（分别为V100、V150、V200），并比较两组患者手术操作时间的差异。 结果22例患者均成功完成治疗，未发生与手术相关的严重并发症。共面模板辅助粒子植入组平均植入粒子26粒，非共面模板辅助粒子植入组平均植入粒子23粒。共面模板辅助粒子植入组和非共面模板辅助粒子植入组V100术前计划分别为（94.45±1.32）%、（93.27±1.37）%，术后植入分别为（89.31±2.58）%、（85.25±4.35）%，术后植入均较术前计划减小，差异有统计学意义（t值分别为5.563、5.827，P〈0.05）；术前计划D90分别为（152.41±6.78）、（153.30±7.79）Gy，术后植入分别为（147.32±7.12）、（149.25±4.86）Gy，术后植入较术前计划减少（t值分别为2.097、1.929，P值均〉0.05）；V150术前计划分别为（58.61±14.11）%、（62.45±6.49）%，术后植入分别为（57.83±7.74）%、（63.97±7.75）%，模板组较术前减小、非模板组较术前增大（t值分别为0.149、－0.574，P值均〉0.05）；术前计划MPD分别为（82.12±7.81）、（83.43±4.86）Gy，术后植入分别为（87.64±10.60）、（87.12±7.66）Gy；术前计划V200分别为（29.04±10.64）%、（36.11±7.22）%，术后植入分别为（34.12±7.67）%、（39.42±7.18）%；术后MPD（t值分别为－1.356、－1.426）、V200（t值分别为－1.713、－1.241）均较术前增大，但各指标手术前后比较差异均无统计学意义（P〉0.05）。手术操作时间，共面模板辅助粒子植入组为（44.3±12.4）min，非模板辅助粒子植入组为（60.0±12.8）min，两组比较差异有统计学意义（P〈0.05）。 结论使用模板辅助粒子植入可以更精确地达到术前规划的优化，且缩短了手术操作时间，提高了患者的耐受度。

ObjectiveTo investigate the clinical value of coplanar template-assisted CT guided radioactive seeds implantation in the treatment of pancreatic carcinoma. MethodsA total of 22 advanced pancreatic carcinoma patients underwent CT guided radioactive seeds implantation were retrospectively analyzed. Ten patients were treated with coplanar template-assisted with an average age of （65±10） years （48 to 77 years）. Tweleve patients were treated without coplanar template assist with an average age of （68±13） years （47 to 84 years）. The preoperative planning designs and postoperative dosimetry verifications were performed for all patients. The dose related parameters including D90, MPD, V100, V150 and V200 were compared between pre and post operation by t test. The operating time were also evaluated between the two groups. ResultsOverall the 22 patients were treated successfully without serious surgery-related complications. An average of 26 seeds were implanted in the coplanar template assisted implantation group, and 23 seeds were implanted in the non template-assisted implantation group. Preoperative V100 in coplanar template group and non template group were （94.45±1.32） % and （93.27±1.37） % separately. Postoperative V100 in both groups were （89.31±2.58） % and （85.25±4.35） % separately. Postoperative D90 in both groups were （147.32±7.12） Gy and （149.25±4.86） Gy separately. Postoperative V150 in both groups were （57.83±7.74） % and （63.97±7.75） % separately. Preoperative D90 in both groups were （152.41±6.78） Gy and （153.30±7.79） Gy separately. Preoperative V150 in both groups were （58.61±14.11） % and （62.45±6.49） % separately. Postoperative MPD in both groups were （87.64±10.60） Gy and （87.12±7.66） Gy separately. Postoperative V200 in both groups were （34.12±7.67） %, （39.42±7.18） % separately. Preoperative MPD in both groups were （82.12±7.81） Gy and （83.43±4.86） Gy separately. Preoperative V200 in both groups were （29.04±10.64） %, （36.11±7.22） % separately. Compared with preoperative plans, the mean value of D90 and V100 decreased while the mean value of MPD and V200 increased in postoperative verifications in both coplanar template assist CT guided radioactive seeds implantation group and non template-assisted group. However, there was no significant difference between pre and post operation except for V100 （P〈0.05）. The operating time of coplanar template assist group and non template-assisted group were （44.3±12.4） min and （60.0±12.8） min respectively. The difference of operating time between two groups were statistically significant （P〈0.05）. ConclusionCompared with the treatment without template assist, coplanar template-assisted brachytherapy could be more accurate in preoperative plans optimization, and shorten the operation time and improve the patients＇ tolerance.