摘要目的 探讨3D打印共面模板(3D-print coplanar template,3D-PCT)辅助CT引导125I粒子植入治疗非小细胞肺癌(NSCLC)的安全、有效及对剂量学的可控性.方法 选取2014年5月到2016年11月符合125I粒子植入适应证的NSCLC患者20例,其中3D-PCT辅助CT引导125I粒子植入治疗的患者10例(3D组),CT引导徒手穿刺125I粒子植入治疗的患者10例(徒手组),术前2d内行CT定位扫描,得出医学数字成像和通信(digital imaging and communications in medicine,DICOM)数据,输入治疗计划系统(brachytherapy treatment planning system,BTPS),行术前预计划.术后即刻行胸部CT扫描,术后质量验证.对比两组术前、术后剂量学参数,包括90％和100％的靶区体积所占的剂量D90和D100、100％和150％的处方剂量所占的靶区体积百分比V100和V150、适形指数(CI)、靶区外体积指数(EI)、均匀性指数(HI).结果 3D组术前与术后剂量学参数V150差异有统计学意义(t=-2.916,P＜0.05),其他剂量学参数差异无统计学意义(P＞0.05).徒手组术前与术后剂量学参数,包括粒子数、V100、EI、HI差异有统计学意义(t=-2.516、2.492、4.725、7.258,P ＜0.05),其他剂量学参数差异无统计学意义(P＞0.05).3D组术后剂量学参数和徒手组术后剂量学参数行单样本t检验,其中V100、CI、EI、HI、剂量误差率差异有统计学意义(t=2.598、2.278、4.637、4.616、-4.785,P＜0.05),两组术后V150差异无统计学意义(P＞0.05).结论 3D-PCT辅助CT引导125I近距离放射性粒子植入治疗NSCLC安全可行,剂量学可控,且在粒子空间分布方面较徒手穿刺具有一定优势.

abstractsObjective To explore the safety,effectivity and dosimetric continence of 3D-printing coplanar template(3D-PCT)combined with CT-guided 125I seed implantation in the treatment of non-small cell lung cancer(NSCLC).Methods From May 2014 to November 2016,a total of 20 NSCLC patients who were suitable for 125I seed implantation were recruited in this study.Of all the patients,10 received 125I seed implantation treatment by CT-guided combined with 3D-PCT (3D group),and the rest,by freehand puncture combined with CT-guided 125I seed implantation (free-hand group).During two days before the surgery,the patients received the CT scan.Then the digital imaging and communications in medicine (DICOM) was collected to input to the Brachytherapy Treatment Planning System (BTPS).The dose parameters including D90,D100,V100,V150,conformal index(CI),external index(EI),and homogneneity index(HI) were compared between pre-operation and post-operation.Pair t-test and single sample t-test were performed.Results V150 in 3D group between preoperation and postoperation showed statistically significant difference (t =-2.916,P ＜ 0.05),and there was no significant difference in the rest parameters(P ＞ 0.05).However,the number of seeds,V100,EI,HI in free-hand group between preoperation and postoperation showed statistically significant difference (t =-2.516,2.492,4.725,7.258,P ＜0.05),and there was no significant difference in the rest parameters(P ＞0.05).Comparison of indicuted that there was significant difference in V100,V150,CI,EI,HI and dose error rate between the 3D group and the free-hand group with single sample t test,the result showed V100,CI,EI,HI between two groups(t =2.598,2.278,4.637,4.616,-4.785,P ＜0.05),and there was no significant difference in V150 (P ＞ 0.05).Conclusions CT-guided 125I seed implantation brachytherapy combined with 3D-PCT for treatment of NSCLC safe is feasible,and dose controllable,and there is a certain advantage in the spatial distribution of seed compared with free-hand puncture.