共面模板辅助^(125)I粒子植入治疗肺癌术后局部复发的剂量学研究

Dosimetric study of coplanar template-assisted and CT-guided ^(125)I seed implantation in the treatment of local recurrence of lung cancers

目的评价通用共面模板(以下简称通用模板)辅助CT引导下对肺癌术后局部复发进行^(125)I放射性粒子治疗的植入前、植入后剂量学符合程度及对疗效的影响。方法收集自2009年1月至2015年12月在天津医科大学第二医院接受通用模板辅助^(125)I放射性粒子植入治疗的非小细胞肺癌术后局部复发患者38例。术前进行预计划,处方剂量110 Gy。术中验证结果与术前计划的剂量参数匹配周边剂量(MPD)、90%靶体积的最小吸收剂量(D90)、100%靶体积的最小吸收剂量(D100)、适形指数(CI)、靶区外体积指数(EI)和均匀性指数(HI)进行配对t检验。术后第6个月按照实体肿瘤疗效评价标准(1.1版)判定疗效。结果全部患者完成粒子植入治疗,术前计划、术后质量验证剂量:MPD为(222.7±26.2)、(227.7±29.8)Gy,D90(130.8±13.6)、(134.8±12.8)Gy,D100(106.4±10.6)、(110.7±11.8)Gy,CI(0.75±0.06)、(0.74±0.04),EI(22.7±5.8)%、(24.3±4.8)%,HI(36.8±4.7)%、(37.2±5.3)%,心脏平均照射剂量为(19.3±7.2)、(21.3±6.8)Gy(P>0.05),中位随访时间为22.5个月(8~98个月)。中位生存期21个月(95%CI 7.4~34.6),2年总生存(OS),无进展生存(PFS)和局部控制(LC)的发生率分别为47.4%、39.5%和83.5%。结论通用模板辅助CT引导下^(125)I放射性粒子植入治疗非小细胞肺癌术后局部复发可以较好地在术中实现术前TPS计划目标,取得良好疗效,是一种微创、精准、安全、有效的治疗方法。

Objective To evaluate the pre-and post-implantation dosimetric consistency and efficacy of CT-guided ^(125)I radioactive seed implantation for the treatment of the local recurrence of lung cancers under the assistance of a universal coplanar template(also referred to as the universal template).Methods This study involved 38 patients with a local recurrence of non-small cell lung cancers who received universal template-assisted ^(125)I radioactive seed implantation in the Second Hospital of Tianjin Medical University from Jan 2009 to Dec 2015.Preoperative planning was carried out before implantation,and the prescription dose was 110 Gy.The paired T-test was adopted for cooperation between intraoperative verification result and pre-plan values of the dosimetric parameters including minimum peripheral dose(MPD),the minimum prescription doses delivered to 90%and 100%of the target volume(D90 and D100),conformity index(CI),external index(EI),and homogeneity index(HI).The efficacy was evaluated at the 6th month after implantation according to the RECIST 1.1(Response Evaluation Criteria in Solid Tumors).Results All patients successively received the seed implantation.The pre-plan and post-implant dosimetric parameters were as follows:MPD(222.7±26.2),(227.74±29.8)Gy;D90(130.8±13.6),(134.8±12.8)Gy;D100(106.4±10.6),(110.7±11.8)Gy,CI(0.75±0.06),(0.74±0.04),EI(22.7±5.8)%,(24.3±4.8)%;HI(36.8±4.7)%,(37.2±5.3)%,the mean irradiation dose of hearts(19.3±7.2),(21.3±6.8)Gy(P>0.05).The median follow-up period was 22.5 months(8-98 months).The median survival was 21 months(95%CI,7.4-34.6),and the 2-year overall survival(OS),progression-free survival(PFS),and local control(LC)rate were 47.4%,39.5%,and 83.5%,respectively.Conclusions The universal template-assisted and CT-guided ^(125)I radioactive seed implantation in the treatment of postoperative local recurrence of non-small cell lung cancers can achieve the goal of the preoperative TPS planning during the operation and achieve good efficacy.It is a minimally invasive,accurate,safe and effective therapy.