3D打印施源器在宫颈癌近距离放疗中的应用研究

Application of 3D printed vaginal multi-channel individualized source applicator in locally advanced cervical cancer

目的比较局部晚期宫颈癌三维近距离治疗3D打印阴道多通道个体化施源管与常规施源器剂量学差异,观察疗效及毒副反应。方法50例初治局部晚期宫颈癌行近距离根治性放射治疗,其中25例患者行3D打印多通道施源器(3DP-ISBT组),25例患者采用传统施源管(ICBT组)。比较2组患者的HR-CTV剂量分布,评价危及器官的剂量分布、近期疗效与毒副反应。结果3DP-ISBT、ICBT组近距离HR-CTV D_(90)分别为(87±7)、(76±16)Gy。组间比较,3D打印多通道个体化施源管较常规施源器剂量分布更合理,且差异有统计学意义(P<0.05)。膀胱D_(2cc)3DP-ISBT组为(81±8)Gy,ICBT组为(86±17)Gy;直肠D_(2cc)3DP-ISBT组为(72±10)Gy,ICBT组为(79±14)Gy。组间比较,3D打印多通道个体化施源管患者放射性膀胱炎及放射性直肠炎发生率均低于常规施源器,且差异均有统计学意义(P<0.05)。结论3D打印个体化施源管与传统常规施源器行腔内放射治疗相比剂量分布更加合理,降低正常组织受量有明显优势,具有疗效好、毒副反应轻的特点。

Objective To compare the dosimetric differences between 3D printed vaginal multi-channel individualized source applicator and conventional source applicator in the treatment of locally advanced cervical cancer, and then to observe the short-term efficacy and the side reaction in an organ at risk. Methods 50 locally advanced cervical cancer patients who had received radical radiotherapy were randomly divided into 3DP-ISBT and ICBT groups. 25 of the group 3DP-ISBT received 3D printed multi-channel applicator interstitial brachytherapy and 25 of the group ICBT received conventional intracavitary radiotherapy. We compared the dose distribution and side reaction in the organ at risk between the two groups, and evaluated their respective short-term efficacy. Results The HR-CTV D90 in group 3DP-ISBT and ICBT was(87 ± 7) Gy and(76 ± 16) Gy,and a comparison showed that the dose distribution of 3D printed multi-channel applicator interstitial brachytherapy was more reasonable than that of conventional intracavitary radiotherapy, and the difference was statistically significant(P < 0.05). The bladder D2cc in the 3DP-ISBT group was(81 ± 8) Gy, and(86 ± 17) Gy in group ICBT. Rectal D2cc was(72 ± 10) Gy in group 3DP-ISBT and(79 ± 14) Gy in group ICBT, with the conclusion that the incidence rates of radiation cystitis and radiation proctitis in patients with 3D printed multichannel individualized applicator interstitial brachytherapy were lower than those with conventional intracavitary radiotherapy, and the differences were statistically significant(P < 0.05). Conclusion Compared with the conventional intraventricular radiotherapy, the 3D printed multi-channel individualized applicator interstitial brachytherapy is more reasonable in dose distribution and has obvious advantages in reducing the normal tissue dose, and it has the characteristics of good curative effect and light side effect.