3D打印非共面模版引导125I粒子植入治疗头颈部肿瘤个体化设计与应用

3D-printing non-coplanar template assisted 125I seed implantation for head and neck tumor:individualized template design and application

目的对比3D打印非共面模板引导125I粒子植入治疗头颈部肿瘤的术前、术后计划的物理剂量学参数,探索头颈部肿瘤放射性粒子植入治疗用个体化模板设计方法的安全性、可行性、精确性。方法2016年1月-2016年12月于北京大学第三医院接受3D打印模板辅助CT引导放射性125I粒子植入的头颈部复发/转移恶性肿瘤的患者42例。处方剂量110~160Gy,设计制作3D打印非共面模板42块,对比术前、术后物理剂量学参数,包括D90、最小周边剂量(mPD)、V100、V150、V200、适形指数(CI)、靶区外体积指数(EI)、均匀性指数(HI)。结果为42例患者设计、制作的42块导板术中就位良好,与术前计划相比,术后D90、V100、CI、EI、HI均相近(P=0.490、0.407、0.893、0.143、0.079),mPD、V150、V200不同(P=0.036、0.007、0.000)。结论术后验证的主要剂量学指标较好地达到了术前计划要求,有良好的治疗精确性,可以满足临床需求。

Objective To compare the dosimetric data between preoperative plans and postoperative verification in computed tomography(CT)-guided and 3D-printing non-coplanar template-assisted 125I seed implantation for head and neck tumor,aiming to explore the safety,feasibility and accuracy of the individualized template design method.Methods A total of 42 patients with recurrent/metastatic malignant head and neck tumor admitted toPeking University Third Hospitalfrom January to December 2016 were recruited in this study.A prescribed dose of 110-160Gy was adopted.3D-printing non-coplanar templates were designed for 42 cases.The dosimetric parameters including D90,minimum peripheral dose(mPD),V100,V150,V200,conformal index(CI),external index(EI)and homogeneity index(HI)were statistically compared before and after surgery.Results All templates were properly implanted intraoperatively.Compared with preoperative planning,postoperative D90,V100,CI,EI and HI did not significantly differ(P=0.490,0.407,0.893,0.143 and 0.079),whereas mPD,V150 and V200 significantly differed(P=0.036,0.007 and 0.000).Conclusion After postoperative verification,the main dosimetric parameters have high therapeutic accuracy and properly match with preoperative planning,which can meet clinical requirements.