3D打印个体化施源器在宫颈癌治疗中的探索

Exploration of 3D printing individualized applicator in treatment of cervical cancer

目的研究3D打印技术在个体化宫颈癌近距离放射治疗中运用的可行性。方法选择2019年6月至12月在福建省肿瘤医院行近距离放射治疗的ⅡB-ⅢB期宫颈癌患者20例,年龄44~76岁,中位年龄56岁;鳞癌19例,腺癌1例。将其分为3D打印组和常规插入组。根据带有导向模板的CT图像,勾画高危靶区(HRCTV)、中危靶区(IRCTV)及膀胱、直肠、乙状结肠等危及器官。于Nucletron Oncentra计划系统中设计相应的插植针道及针数、驻留点及驻留时间,逆向优化后形成预计划。两组处方剂量HRCTV为700 cGy。分别评估3D打印组和常规插入组靶区、危及器官的剂量学参数的差异。结果 HRCTV D90在3D打印组、常规插入组分别为(699.85±3.61) cGy、(703.00±2.59) cGy,二者差异有统计学意义(P<0.05)。而HRCTV D_(100)、IRCTV D90、IRCTV D_(100)两组比较,差异无统计学意义(P>0.05)。膀胱、直肠、乙状结肠的D_(5cc)、D_(2cc)、D_(1cc)、D_(0.1cc)两组比较,差异无统计学意义(P>0.05)。结论宫颈癌近距离治疗中,3D打印组与常规插入组比较,在剂量分布上合理,差异无显著性,但该方法操作简单、方便,也是一种可行的治疗方式。

Objectives To probe the feasibility of three-dimensional(3D) printing in application of personalized brachytherapy for cervical cancer.Methods From June to December 2019,20 patients with cervical cancer(19 of squamous cell carcinoma and 1 of adenocarcinoma) of stageⅡB-ⅢB performed brachytherapy were enrolled,which aged 44-76 years old with median age of 56 years old.All of them were divided into 3D printing group and conventional implantation group.According to CT image with guide template,high-risk clinical target volume(HRCTV),intermediate-risk clinical target volume(IRCTV) and organ of risk(ORA),including bladder,rectum,and sigmoid colon,were outlined.The corresponding implantation needle path and number of needles,dwell point and dwell time were designed in Nucletron Oncentra planning system,and pre-plan was formed after reverse optimization.The prescribed HRCTV of 2 groups was 700 cGy.The differences in dosimetry parameters of target volume and ORA between 2 groups were evaluated.Results The HRCTV D90in 3D printing group(699.85 cGy±3.61 cGy) was statistically significantly lower than in conventional implantation group(703.00 cGy±2.59 cGy.P<0.05).There was no statistically significant difference between 2 groups in HRCTV D_(100),IRCTV D90,and IRCTV D_(100)(P>0.05).There was no statistically significant difference between 2 groups of D_(5cc),D_(2cc),D_(1cc),D_(0.1cc)in bladder,rectum,and sigmoid colon(P>0.05).Conclusion It is demonstrated that in brachytherapy of cervical cancer,the dose distribution of 3D printing group is reasonable and similar with conventional implantation group,but 3D printing is simple and convenient,which is a feasible treatment method.