CAJ | 학술논문

目的评价个体化模板辅助技术在颅底区恶性肿瘤永久性组织间近距离治疗中应用的可行性.方法选择2010年8月至2012年6月在北京大学口腔医院口腔颌面外科接受125I粒子永久性植入治疗的颅底区复发性恶性肿瘤患者20例.植入前行头颈部CT扫描获得Dicom数据,导入组织间近距离治疗计划系统进行预计划和模拟针道设计,然后将含有模拟针道信息的图像文件导入Mimics软件和Geomagic软件进行个体化模板数字建模,最后利用医用光敏树脂经快速成型技术制作个体化模板.粒子植入过程中,应用个体化模板控制针的插植和粒子的植入,并CT扫描验证插植针空间位置分布.粒子植入后CT扫描进行粒子空间分布和实际剂量验证.粒子植入过程中和植入后72 h内观察并记录并发症.结果 20例颅底区复发恶性肿瘤患者应用个体化模板技术,均顺利完成了125I粒子植入.个体化模板同时具有预计划插植针道信息和患者面部特征信息,插植针定位和定向准确.125I粒子平均植入70颗(20 ～ 172颗),空间分布均匀,无移位和脱落.粒子平均活度0.7 mCi/颗(0.6～0.8 mCi/颗,1 Ci=3.7×1010Bq),平均D90=181.6 Gy(127.4～279.6Gy),平均V100为98.2％(94.6％～100％),平均V150为43.2％(24.3％～52.2％),危及器官的平均受照剂量为31.6 Gy(24.6 ～47.3 Gy).未观察到严重并发症.结论应用个体化模板辅助颅底区永久性组织间近距离治疗,方法安全可行,具有插植针定位、定向准确的特点,可明显提高治疗的精确性,避免插植操作的盲目性.
목적 평개개체화모판보조기술재로저구악성종류영구성조직간근거리치료중응용적가행성.방법 선택2010년8월지2012년6월재북경대학구강의원구강합면외과접수125I입자영구성식입치료적로저구복발성악성종류환자20례.식입전행두경부CT소묘획득Dicom수거,도입조직간근거리치료계화계통진행예계화화모의침도설계,연후장함유모의침도신식적도상문건도입Mimics연건화Geomagic연건진행개체화모판수자건모,최후이용의용광민수지경쾌속성형기술제작개체화모판.입자식입과정중,응용개체화모판공제침적삽식화입자적식입,병CT소묘험증삽식침공간위치분포.입자식입후CT소묘진행입자공간분포화실제제량험증.입자식입과정중화식입후72 h내관찰병기록병발증.결과 20례로저구복발악성종류환자응용개체화모판기술,균순리완성료125I입자식입.개체화모판동시구유예계화삽식침도신식화환자면부특정신식,삽식침정위화정향준학.125I입자평균식입70과(20 ～ 172과),공간분포균균,무이위화탈락.입자평균활도0.7 mCi/과(0.6～0.8 mCi/과,1 Ci=3.7×1010Bq),평균D90=181.6 Gy(127.4～279.6Gy),평균V100위98.2％(94.6％～100％),평균V150위43.2％(24.3％～52.2％),위급기관적평균수조제량위31.6 Gy(24.6 ～47.3 Gy).미관찰도엄중병발증.결론 응용개체화모판보조로저구영구성조직간근거리치료,방법안전가행,구유삽식침정위、정향준학적특점,가명현제고치료적정학성,피면삽식조작적맹목성.
Objective To evaluate the feasibility of individual template assisting permanent interstitial brachytherapy for skull base region.Methods From August 2010 to June 2012,20 patients with recurrent malignancies of skull base region received 125I seed permanent implantation.Before implanting,all patients underwent CT scan,the data were stored in Dicom format and imported into brachytherapy treatment planning system (BTPS).The preplan were finished by BTPS.Then,the digital model based on virtual needle and skin CT slices was reconstructed by Mimics and Geomagic.According to the digital model,the individual template was made from medical light-cured resin using rapid forming machine.During implanting,needles were inserted under the individual template assistance and 125I seeds were implanted according to preplan.After implanting,implantation quality was evaluated by 2D and 3D CT images and BTPS.The needles and seed distribution were observed.The actual dose distribution of target volumes D90,V100 and V150 was calculated.The complications were recorded within 72 hours.Results Interstitial implantation of 20 patients were performed successfully and efficiently under the individual template assistance without serious complications.Because of containing the virtual needle positioning and face surface feature information at the same time,the individual template significantly improved precision of needle location and orientation.The actuarial median number of 125I seeds implanted was 70 (range,20-172),and actuarial median D90,V100 and V150 was 181.6 Gy (127.4-279.6 Gy),98.2％ (94.6％-100％),43.2％ (24.3％-52.2％),respectively.The seed distribution and dosimetric quality were well controlled.Conclusions The method of individual template assisting permanent interstitial brachytherapy for skull base region is feasible,which can improve the accuracy of needle position placement.