3D打印个体化模具在宫颈癌近距离治疗中的应用

Application of three-dimensional printed individualized brachytherapy applicators for cervical cancer

目的:通过3D打印个体化模具辅助插植,降低宫颈癌近距离治疗难度。方法:前瞻性研究2019年6月至2020年7月30例于重庆大学附属肿瘤医院行根治性放化疗宫颈鳞状细胞癌患者,随机分为15例3D打印组(试验组)和15例通用施源器组(对照组)。评估两组治疗情况、靶区适形指数(coformity index,CI)、高危临床靶区(high-risk clinical target area,HR-CTV)90%体积的最低吸收剂量(D90)、危及器官(organs-at-risk,OARs)受量及临床治疗结果。结果:试验组无子宫穿孔,对照组子宫穿孔率为8.97%(7/78)。试验组的CI为0.81±0.01,与对照组的0.61±0.01相比,差异具有统计学意义(P<0.05);试验组HR-CTV D90及膀胱的分次/总外照射等效剂量(equivalent dose in 2 Gy per fraction,EQD2)分别为6.65±0.06/91.84±1.35及3.75±0.07/71.02±1.39,与对照组的6.17±0.06/88.59±0.11及4.09±0.07/74.81±1.50相比,差异均具有统计学意义(均P<0.05)。试验组直肠及乙状结肠的受量降低,差异无统计学意义(P>0.05),试验组治疗结束后3个月完全缓解(complete response,CR)率为93.33%(14/15),与对照组的86.67%(13/15)相比,差异具有统计学意义(P<0.05)。结论:3D打印个体化模具在辅助宫颈癌近距离插植治疗中有明显的优势,操作简单、安全性高、有利于组织间插植技术推广。

Objective:To reduce the difficulty in administering brachytherapy to patients with cervical cancer using three-dimensional(3D)printed individualized applicators.Methods:This prospective study included 30 patients with cervical squamous cell carcinoma who visited the Chongqing University Cancer Hospital from June 2019 to July 2020 and received radical chemoradiotherapy.The patients were randomly assigned into a 3D printing group(clinical trial group)and a universal donor group(control group),each containing 15 participants.In both groups,treatment target was evaluated according to the conformity index(CI),fractional and total equivalent doses(equivalent dose in 2 Gy per fraction,EQD2),high-risk clinical target area(HR-CTV),90%of the lowest volume of absorbed dose(HR-CTV D90),organs-at-risk(OARs)limits,and clinical treatment result.Results:Uterine perforation was not observed in the clinical trial group;however,the rate of uterine perforation in the control group was 8.97%(7/78).The CI was 0.81±0.01 in the experimental group and 0.61±0.01 in the control group,and the difference was statistically significant(P<0.05).HR-CTV D90 and EQD2 of the bladder were(6.65±0.06)/(91.84±1.35)and(3.75±0.07)/(71.02±1.39),respectively,in the clinical trial group and(6.17±0.06)/(88.59±0.11)and(4.09±0.07)/(74.81±1.50),respectively,in the control group;the differences were statistically significant(P<0.05).The rectum and sigmoid colon were also reduced in the clinical trial group,although the difference between both groups was not statistically significant(P>0.05).The complete response(CR)rates were 93.33%(14/15)and 86.67%(13/15)in the clinical trial and control groups,respectively,3 months after completing treatment,and the difference was statistically significant(P<0.05).Conclusions:3D printed has obvious advantages in assisting in treating cervical cancer with interstitial irradiation,and it is simple to operate and highly safe and conducive to promote intertissue implantation.