AIM: To explore the feasibility of computed tomography (CT)-guided percutaneous ethanol injection (PEI) using a disposable curved needle for treatment of malignant liver neoplasms and their metastases in retroperitone...AIM: To explore the feasibility of computed tomography (CT)-guided percutaneous ethanol injection (PEI) using a disposable curved needle for treatment of malignant liver neoplasms and their metastases in retroperitoneal lymph nodes. METHODS: CT-cjuided PEI was conducted using a disposable curved needle in 26 malignant liver tumors smaller than 5 cm in diameter and 5 lymph node metastases of liver cancer in the retroperitoneal space. The disposable curved needle was composed of a straight trocar (21G) and styler, a disposable curved tip (25 G) and a fine styler. For the tumors found in deep sites and difficult to reach, or for hepatic masses inaccessible to the injection using a straight needle because of portal vein and bile ducts, the straight trocar was used at first to reach the side of the tumor. Then, the disposable curved needle was used via the trocar. When the needle reached the tumor center, appropriate amount of ethanol was injected. For relatively large malignant liver tumors,multi-point injection was carried out for a better distribution of the ethanol injected throughout the masses. The curvedneedle was also used for treatment of the metastasis in retroperitoneal lymph nodes blocked by blood vessels and inaccessible by the straight needle.RESULTS: All of the 26 liver tumors received 2 or more times of successful PEI, through which ethanol was distributed throughout the whole tumor mass. Effect of the treatment was monitored by contrast-enhanced multi-phase CT and magnetic resonance imaging (MRi) examinations three months later. Of the 18 lesions whose diameters were smaller than 3 cm, the necrotic change across the whole mass and that in most areas were observed in 15 and 3 tumors,respectively. Among the 8 tumors sizing up to 3 cm, 5 were completely necrotic and 3 largely necrotic. Levels of tumor seromarkers were significantly reduced in some of the cases.In 5 patients with metastases of liver cancer in retroperitoneal lymph nodes who received 1 to 3 times of PEI, all the foci treated were completely necrotic and smaller demonstrated by dynamic contrast-enhanced CT or MRI 3 months later. CONCLUSION: CT-guided PEI using a disposable curved needle is effective, time-saving and convenient, providing an alternative therapy for the treatment of malignant liver tumors and their retroperitoneal lymph node metastases.展开更多
文摘目的:探讨颈椎、胸椎及腰椎肿瘤在锥形束CT(cone beam CT,CBCT)影像引导下的调强放射治疗(image guided radiation therapy,IGRT)六自由度摆位误差分析。方法:收集2013年5月至2014年6月在北京大学第三医院行脊柱恶性肿瘤放疗的患者30例,其中颈椎肿瘤10例,胸椎肿瘤10例,腰椎肿瘤10例。采用瑞典医科达(ELEKTA)公司AXESSE直线加速器CBCT引导,用Hexa PODTMevoRT床从平移和旋转六自由度方向在线校正摆位误差,CT模拟定位获取治疗计划参考图像(层厚3 mm,120 k V,200 m As)。每次治疗前行千伏级(k V级)CBCT扫描(100 k V,36.6 m As,s20射野准直器),CBCT图像采用骨窗模式与计划参考图像自动匹配,并经高资质医师和物理师共同确认,误差校正后再次行CBCT扫描,将两次图像与计划参考图像分别进行匹配验证。本研究共收集838次摆位校正前、后匹配结果,分别记录患者平移摆位误差左右方向X(lateral)、进出方向Y(lngitudinal)、升降方向Z(vertical)、旋转误差俯仰方向RX(pitch)、滚动方向RY(roll)及左右旋转方向RZ(yaw)匹配结果。应用SPSS13.0统计软件,对Hexa PODTMevoRT床校正前后位移误差数据行配对t检验。结果:椎体肿瘤摆位误差(绝对值)中,3个平移X、Y和Z方向摆位误差结果分别为颈椎(1.71±0.10)mm、(1.81±0.11)mm和(1.94±0.09)mm;胸椎(3.17±0.19)mm、(4.26±0.28)mm和(2.18±0.12)mm;腰椎(2.69±0.24)mm、(3.33±0.26)mm和(2.86±0.21)mm。患者摆位后首次CBCT获得摆位误差数据与误差纠正后(动床后)再次CBCT验证后获得残余误差数据3个平移X、Y和Z方向分别为颈椎(0.5±2.4)mm、(0.01±2.4)mm和(2.4±1.4)mm,胸椎(1.17±0.11)mm、(0.26±0.30)mm和(0.08±0.12)mm,腰椎(1.09±0.24)mm、(2.03±1.26)mm和(0.06±0.51)mm。进行配对t检验结果:颈椎及胸椎平移3个方向误差纠正前后差异均有统计学意义;腰椎仅是升降Z方向平移误差纠正前后差异统计学有意义(t=-3.518,P<0.001)。3个旋转RX、RY和RZ方向摆位误差分别为颈椎肿瘤0.67°±0.04°、1.06°±0.06°和0.78°±0.05°,胸椎0.62°±0.05°、0.75°±0.06°和0.84°±0.06°,腰椎0.59°±0.06°、0.80°±0.07°和0.73°±0.06°;误差纠正后(动床后)再次CBCT验证后获得残余误差数据3个旋转方向RX、RY和RZ方向分别为颈椎肿瘤0.27°±0.14°、1.20°±0.04°和0.28°±0.05°,胸椎0.02°±0.20°、0.05°±0.26°和0.64°±0.16°,腰椎0.09°±0.26°、0.50°±0.05°和0.03°±0.16°,误差纠正前后颈椎和腰椎旋转3个方向差异均具有统计学意义,胸椎仅是滚动方向RY方向差异有统计学意义(t=7.106,P<0.001)。30例患者疼痛均有缓解,未发现放疗副反应。结论:IGRT下Hexa PODTMevoRT床对脊柱肿瘤放射治疗的摆位误差纠正有明显作用,建议采用在线校正脊柱肿瘤放射治疗摆位误差。
基金Supported by the National Natural Science Foundation of China,No.30070233
文摘AIM: To explore the feasibility of computed tomography (CT)-guided percutaneous ethanol injection (PEI) using a disposable curved needle for treatment of malignant liver neoplasms and their metastases in retroperitoneal lymph nodes. METHODS: CT-cjuided PEI was conducted using a disposable curved needle in 26 malignant liver tumors smaller than 5 cm in diameter and 5 lymph node metastases of liver cancer in the retroperitoneal space. The disposable curved needle was composed of a straight trocar (21G) and styler, a disposable curved tip (25 G) and a fine styler. For the tumors found in deep sites and difficult to reach, or for hepatic masses inaccessible to the injection using a straight needle because of portal vein and bile ducts, the straight trocar was used at first to reach the side of the tumor. Then, the disposable curved needle was used via the trocar. When the needle reached the tumor center, appropriate amount of ethanol was injected. For relatively large malignant liver tumors,multi-point injection was carried out for a better distribution of the ethanol injected throughout the masses. The curvedneedle was also used for treatment of the metastasis in retroperitoneal lymph nodes blocked by blood vessels and inaccessible by the straight needle.RESULTS: All of the 26 liver tumors received 2 or more times of successful PEI, through which ethanol was distributed throughout the whole tumor mass. Effect of the treatment was monitored by contrast-enhanced multi-phase CT and magnetic resonance imaging (MRi) examinations three months later. Of the 18 lesions whose diameters were smaller than 3 cm, the necrotic change across the whole mass and that in most areas were observed in 15 and 3 tumors,respectively. Among the 8 tumors sizing up to 3 cm, 5 were completely necrotic and 3 largely necrotic. Levels of tumor seromarkers were significantly reduced in some of the cases.In 5 patients with metastases of liver cancer in retroperitoneal lymph nodes who received 1 to 3 times of PEI, all the foci treated were completely necrotic and smaller demonstrated by dynamic contrast-enhanced CT or MRI 3 months later. CONCLUSION: CT-guided PEI using a disposable curved needle is effective, time-saving and convenient, providing an alternative therapy for the treatment of malignant liver tumors and their retroperitoneal lymph node metastases.
