CT引导下3D打印模板与徒手^(125)I粒子植入治疗肺癌的剂量学对比研究

Dosimetry comparison study between 3D print template and free-hand guided of precision ^(125)I seeds implantation for treating lung cancer

目的比较肺癌3D打印模板引导^(125)I粒子植入与徒手穿刺植入的剂量学差异,研究3D打印模板执行术前计划的准确性。方法对2018年10月-2019年5月于新疆医科大学附属肿瘤医院行放射性粒子植入的39例肺癌患者行回顾性分析,其中3D打印模板辅助粒子植入13例(模板组),徒手穿刺植入26例(徒手穿刺组),术前均应用近距离治疗计划系统(BTPS)设计术前计划。模板组在3D打印模板辅助下植入粒子,徒手穿刺组按术前计划在CT引导下徒手穿刺植入粒子。术后两组均应用BTPS行术后计划,分别比较两组手术前后D_(90)差异。结果模板组13个病灶术前和术后D_(90)分别为(135.37±24.14)Gy和(139.21±26.81)Gy,差异无统计学意义(t=-1.039,P=0.306);徒手穿刺组26个病灶术前和术后D90分别为(132.37±21.15)Gy和(128.36±32.42)Gy,差异无统计学意义(t=0.890,P=0.424)。模板组手术前后D_(90)差值ΔD_(90)为(4.1±2.3)Gy,徒手穿刺组手术前后D90差值ΔD_(90)为(11.3±6.3)Gy,差异有统计学意义(Z=-3.5,P=0.011)。结论3D打印模板引导粒子植入术后剂量参数与术前计划有较好的一致性,为3D打印技术的推广和普及提供临床实践依据。

Objective To compare the dose difference of^(125)I seed implantation on lung cancer between 3D print template guided operation and traditional implantation and to study the accuracy of seed implantation according preplan guided by 3D print template.Methods A total of 39 patients underwent^(125)I seed implantation from Oct 2018 to May 2019 in the Hospital were analyzed retrospectively.In which,13 patients underwent seed implantation guided by 3D print template named template group and 26 patients underwent free-hand implantation named free-hand group.The preplan was designed by BTPS.The template group was implanted with seed assisted by 3D printing template,and the free-hand group was implanted with seed guided by CT according to the preplan.BTPS was used for postplan in both groups,and the minimum absorption dose of 90%target volume(D90)difference between the two groups before and after operation was compared.Results The mean D90 pre-and post-operation in the template group were(135.37±24.14)Gy and(139.21±26.81)Gy respectively.The difference was not statistically significant(t=-1.039,P=0.306).The mean D90 pre-and post-operation in the free-hand group were(132.37±21.15)Gy and(128.36±32.42)Gy respectively.The difference was also not statistically significant(t=0.890,P=0.424).The difference of D90 in the two groups were(4.1±2.3)Gy and(11.3±6.3)Gy respectively.The difference was statistically significant(Z=-3.5,P=0.011).Con⁃clusion The dose parameters of 3D template guided seed implantation between the postplan and preplan are nearly consistent,which provides a theoretical basis for the popularization of 3D printing technology.