薄层CT对125I粒子植入治疗非小细胞肺癌的质量控制和保证的意义

薄层CT对125I粒子植入治疗非小细胞肺癌的质量控制和保证的意义

王琳¹,李小东²,张遵城¹,郑广钧¹,郭永涛¹,张雪宁¹,戴越¹

1. 天津医科大学第二医院
2. 天津医科大学第二医院放射治疗科

收稿日期:2013-12-18 修回日期:2014-02-27 出版日期:2014-04-15 发布日期:2014-04-15
通讯作者: 王琳

The Significance of Thin-Section CT in Quality Assurance and Control of Non-Small Cell Lung Cancer Therapy through

Received:2013-12-18 Revised:2014-02-27 Published:2014-04-15 Online:2014-04-15

王琳1 ,李小东2 ,张遵城1 ,郑广钧1 ,郭永涛1 ,张雪宁1 ,戴越1 . 薄层CT对125I粒子植入治疗非小细胞肺癌的质量控制和保证的意义[J]. .

摘要/Abstract

摘要：

【摘要】目的探讨薄层CT扫描在125 I粒子植入治疗非小细胞肺癌（NSCLC）各个环节中的临床价值。方法确诊的137例NSCLC患者，植入前CT扫描进行靶区勾画，应用治疗计划系统（TPS）制定植入方案；CT引导植入，并在植入过程中逐层扫描已植入粒子，进行实时位置验证和修正；植入后CT扫描协助进行放射剂量学验证，必要时调整粒子的分布和数量，使剂量分布符合有效和微创的原则；定期随访和疗效评价也需要CT检查。结果剂量-体积直方图（DVH）均显示靶区放射剂量分布能满足处方剂量要求，周围危及器官的平均照射剂量明显低于正常组织耐受剂量；137例患者中129例（94%）植入粒子数与TPS计划的植入方案一致；植入治疗后6个月CT扫描显示局部控制总有效率为91.9%，1年和2年生存率分别为91.2%和50.4%；无治疗相关的严重并发症。结论薄层CT应用于125 I粒子植入治疗NSCLC过程的各环节，尤其是在粒子植入的质量保证和质量控制方面具有重要的、不可替代的临床价值。

关键词: 非小细胞肺癌, 125I粒子, 近距离放射疗法, 断层摄影术, 质量保证, 质量控制

Abstract: [Abstract] Objective:To explore the clinical value of the thin-section CT scanning in all links of 125I seed implantation in treating non-small cell lung cancer.Methods:137 patients comfired NSCLC,the preoperative target was delineated by CT scanning,and the implantation plan was accomplished according to the TPS; Intraoperative 125I seeds were implanted under guidance of CT, and then seeds were scanned by CT layer-by-layer to validate and correct position in real time ;Postimplantation dosimetry was validated with help of CT scanning.If necessary, seed distribution and seed number were adjusted to make dose distribution conform with the principle of available and micro-invasive; Following up and evaluating termly also needed to be accomplished by CT scanning. Results: The DVHs showed the dose line in targets could meet the requirement of prescription dose, the surrounding organs at risk were within the scope of its tolerance dose.129 patients in all 137 patients implantation seeds were the same to seeds of TPS planning,the coincidence rate was 94%.CT scanning showed the local control efficient rate was91.9% after 6 months.The 1-year and 2-year survival rates were 91.2% and 50.4% respectively.During treatment none of them had serious operation-related complication. Conclusion:The thin-section CT was applied in all key links of 125I seed implantation in treating non-small cell lung cancer, especially the clinical value was significant and irreplaceable in quality assurance and quality control of seed implantation treatment.

Key words: non-small cell lung cancer, 125 Iodine seeds, brachytherapy, tomography, quality assurance, quality control

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