3D打印共面模板在胰腺癌125I粒子植入治疗中的初步应用

摘要

目的 评估3D打印共面模板在胰腺癌125I粒子植入治疗中的临床应用价值.方法 回顾性分析2016年1月至2017年6月行3D打印共面模板引导胰腺癌125I粒子植入治疗患者10例.术前根据CT扫描结果和治疗计划系统,制备3D打印共面模板,术中在该模板引导下进行穿刺和植入粒子,术后对剂量学参数进行验证.观察治疗前后90％靶区体积的剂量(D90)、90％处方剂量的靶区体积(V90)、100％处方剂量的靶区体积(V100)、150％处方剂量的靶区体积(V150).评估3D打印共面模板引导下胰腺癌125I粒子植入穿刺定位的成功率,治疗后剂量学参数与术前计划的吻合度和并发症发生率.结果 10例胰腺癌患者在共面模板引导下均成功穿刺和植入125I粒子.术后剂量学参数D90符合术前计划,治疗前后D90差异较小且无统计学意义(P＞0.05),术后V90、V100和V150分别为(94.3±2.4)％、(90.4±4.1)％和(62.1±13.4)％,符合治疗剂量学要求.1例患者术后出现局部血肿.结论 3D打印共面模板是一种安全、有效的引导工具,有助于胰腺癌125I粒子精准植入,可使术后剂量参数符合术前计划要求.%Objective To investigate the clinical application value of 3D printing coplanar template in treating pancreatic cancer with 125I seed implantation.Methods Clinical data of 10 patients with pancreatic cancer,who received 3D printing coplanar template-guided 125I seed implantation during the period from January 2016 to June 2017,were retrospectively analyzed.According to preoperative CT scan results and treatment planning system findings,a 3D coplanar template was designed and printed,guided by which percutaneous puncture and 125I seed implantation were conducted.Dosimetric verification was performed after 125I seed implantation.Both preoperative and postoperative 90％ dose of target volume (D90),90％ target volume of prescription dose (V90),100％ target volume of prescription dose (V100) and 150％ target volume of prescription dose (V150) were calculated.The success rate of puncture location of 3D printing coplanar template-guided 125I seed implantation was calculated.The coincidence between preoperative dosimetric plan and postoperative dosimetric parameter was assessed,and the complications were recorded.Results Under the guidance of 3D coplanar template,percutaneous puncture and 125I seed implantation were successfully accomplished in all 10 patients with pancreatic cancer.The postoperative dosimetric parameter D90 was consistent with preoperative planning.No statistically significant difference in D90 existed between preoperative value and postoperative one (P＞0.05).The postoperative V90,V100 and V150 were (94.3±2.4)％,(90.4±4.1)％ and (62.1±13.4)％ respectively,which were compliance with therapeutic dosimetry requirements.Local hematoma occurred in one patient after the treatment.Conclusion 3D printing coplanar template appears to be a safe and effective guiding tool,it is very helpful for precise implantation of 125I seeds in treating pancreatic cancer,and with the help of 3D printing coplanar template the postoperative dose parameters will be able to meet the preoperative planning requirements.