Title共面模板辅助CT引导下125Ⅰ粒子植入治疗脊柱转移瘤疗效分析
Other TitlesCo-planar template assisted CT guidance on the treatment of spinal metastases with 125Ⅰ seed implantation
Authors冯震
郑广钧
杨景魁
张圣杰
柴树德
王俊杰
Affiliation300211,天津医科大学第二医院胸外科
100191,北京大学第三医院肿瘤放疗科
Keywords脊柱转移瘤
125Ⅰ粒子
CT
共面模板
Spinal epidural metastases
125Ⅰ seed
CT
Co-planar template( CPT)
Issue Date2017
Publisher中华放射医学与防护杂志
Citation中华放射医学与防护杂志. 2017, 37(10), 763-766,788.
Abstract目的 探讨共面模板(co-planar template,CPT)辅助CT下植入125Ⅰ放射性粒子近距离治疗脊柱转移瘤质量控制与近期疗效.方法 12例原发肿瘤经病理学明确诊断,影像学改变符合脊柱转移瘤特征,患者共有16个病灶.处方剂量(prescribed dose,PD)80 Gy,粒子活度(1.48×107~2.59×107)Bq(0.4~0.7 mCi),CPT辅助CT引导下将植入针按术前计划穿刺并种植放射性125Ⅰ粒子.术后即刻扫描观察粒子分布情况,剂量评估.随访复查CT判定瘤体直径变化,进行疗效评估.随访时间为3~29个月.同时给予疼痛分级,评判疼痛改善情况.结果 16个病灶全部穿刺成功植入粒子.植入后剂量验证显示肿瘤靶区接受的平均照射剂量(209.21±37.16)Gy,D90为(115.29±7.87)Gy,D100为(76.59±5.53)Gy,V90为(99.30±0.51)%,V100为(98.06±1.15)%,适形指数(CI)0.981±0.012,靶区外体积指数(EI)0.012±0.007.脊髓接受的平均照射剂量为(30.47±4.83)Gy.靶区和脊髓接受的平均照射剂量与术前计划比较,差异无统计学意义(P>0.05).术后3个月病灶完全缓解(CR)18.8%(3/16),部分缓解(PR)62.5%(10/16),疾病进展(PD)6.25%(1/16),疾病稳定(SD)6.25%(1/16),有效率(CR+PR)81.3%;疼痛完全缓解3例,部分缓解7例,轻度缓解2例;生存期11~39个月,中位生存期24个月.所有患者脊髓无放射性损伤发生.结论 应用CPT辅助CT引导可以按照术前计划控制粒子植入的位置和放射剂量,达到治疗肿瘤、并发症少、患者可耐受的目的.
Objective To explore the quality control and the short-term curative efficacy of 125Ⅰ radioactive seeds implantation in the treatment of spinal metastases by using co-planar template ( CPT ) assisted CT guidance. Methods Totally 12 cases of primary tumor were diagnosed by pathology, imaging changes for 16 lesions were consistent with the characteristics of spinal metastatic tumor. The prescription dose (PD) was 80 Gy, seed activity was 1. 48 × 107 -2. 59 × 107Bq(0. 4 -0. 7 mCi). According to preoperative plan, spinal metastases were treated with CPT assisted CT guided 125Ⅰ radioactive seeds implantation. The distribution of seeds was observed immediately after operation and the dose was assessed. Patients were followed up by CT to determine the change of tumor diameter and evaluate the efficacy. Follow-up time ranged from 3 to 29 months. And the improvement of pain was evaluated by pain grading. Results All of the 16 spinal metastases lesions were successfully implanted by the preoperative planning. After the implantation, quality verification showed the average dose of target region was (209. 21 ± 37. 16) Gy, D90 ( 115. 29 ± 7. 87 ) Gy, D100 ( 76. 59 ± 5. 53 ) Gy, V90 ( 99. 30 ± 0. 51 )%, V100 ( 98. 06 ± 1. 15 )%, conformal index (CI) 0. 981 ± 0. 012, external index (EI) 0. 012 ± 0. 007. And the average dose of the spinal cord was ( 30. 47 ± 4. 83 ) Gy. There was no significant difference in the mean dose between the target area and the spinal cord and the preoperative plan ( P>0. 05 ) . 3 months after surgery, among 16 spinal metastases lesions, complete response ( CR ) was 18. 8% ( 3/16 ) , PR ( partial response ) rate 62. 5% (10/16), PD(progressive disease) rate 6. 25%(1/16),SD(stable disease) rate 6. 25%(1/16), effective rate ( CR + PR ) 81. 3%. The were 3 cases in pain complete remission, 7 cases in partial remission, 2 cases in mild remission. The survival time range from 11 to 39 months. The median survival time was 24 months. No radiation damage of spinal cord was found. Conclusions CT guided CPT can be used to control the position and radiation dose of the seeds implantation before the operation, so as to achieve the objective of treating tumor with fewer complications and improvement of patients′tolerance.
URIhttp://hdl.handle.net/20.500.11897/498471
ISSN0254-5098
DOI10.3760/cma.j.issn.0254-5098.2017.10.008
Indexed中国科学引文数据库(CSCD)
Appears in Collections:第三医院

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