CT引导下3D共面模板辅助^(125)I放射性粒子植入近距离治疗纵隔淋巴结转移

Clinical Application of 3D Printing Coplanar Template Assist CT-guided RadioactiveSeed Implantation for Mediastinal Lymph Node Metastasis

目的:对比性分析CT引导下3D共面模板与非模板辅助^(125)I放射性粒子植入近距离治疗纵隔淋巴结转移瘤的方法和临床价值。方法:回顾性分析23例^(125)I放射性粒子治疗的纵隔淋巴结转移瘤患者的临床资料,其中13例为3D共面模板辅助放射性粒子植入,年龄23～77岁,平均(64±10)岁;10例为非模板辅助放射性粒子植入,年龄55～84岁,平均(68±13)岁。所有患者进行术前计划、术中优化及术后剂量学验证。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)。并比较两组手术操作时间的差异及并发症的情况。结果:23例患者均成功完成治疗,未发生与手术相关的严重并发症。3D共面模板辅助放射性粒子植入组平均植入放射性粒子30粒,非3D共面模板辅助放射性粒子植入组平均植入放射性粒子23粒。3D共面模板辅助放射性粒子植入组和非模板辅助放射性粒子植入组V100术前计划分别为(97.16±2.74)%、(95.44±1.37)%,术后分别为(95.66±2.58)%、(90.40±3.56)%,术后均较术前计划减小,差异有统计学意义(t值分别为5.563、5.827,P <0.05)。两组D90、MPD、V150、V200手术前后比较差异均无统计学意义(P> 0.05)。手术操作时间,3D共面模板辅助放射性粒子植入组为(49.04±1.75)min,非模板辅助放射性粒子植入组为(66.13±1.77)min,两组比较差异有统计学意义(P<0.0001)。结论:使用3D共面模板辅助放射性粒子植入治疗纵隔淋巴结转移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。

Purpose: To compared the methods and clinical value of 3D coplanar template assist and nontemplate assist CT-guided 125 I seed implantation in brachytherapy of mediastinal lymph node metastasis. Methods:A total of 23 mediastinal lymph node metastasis patients underwent CT guided radioactive seeds implantation were retrospectively analyzed. Thirteen patients with an average age of(64±10.0) years(23-77 years) were treated with coplanar template assist brachytherapy. Ten patients with an average age of(68±13) years(55-84 years) were treated without coplanar template assist brachytherapy. 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.Results: Overall the 23 patients were treated successfully without serious surgery-related complications. An average of 30 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(97.16±2.74)% and(95.44±1.37)%, respectively. Postoperative V100 in both groups were(95.66±2.58)% and(90.40±3.56)%,respectively. The postoperative V100 was significantly lower than preoperative V100 in both groups(P<0.05). Compared with preoperative plans, the mean value of D90, MPD, V150, V200 in postoperative verifications did not show significant difference in both groups(P>0.05). The operating time of coplanar template assist group and non-template assist group were(49.04±1.75)min and(66.13±1.77)min respectively. The difference of operating time between two groups were with statistical significant(P < 0.05). Conclusion: Compared with the treatment without template assist, 3 D coplanar template assist brachytherapy is with more accuracy in preoperative plans optimization,shorter operation time and better patients’ tolerance.