3D打印技术引导宫颈癌个体化近距离放疗应用研究

目的腔内近距离放疗是宫颈癌根治性放疗的重要方法,但临床上宫颈癌腔内近距离放疗剂量分布不理想,本研究旨在探讨3D打印技术在宫颈癌个体化腔内近距离放射治疗中的指导价值。方法选取2014-06-01-2014-12-31初治宫颈癌患者25例,应用3.0T MRI进行平扫+增强检查,提取患者MR增强检查的DICOM格式文件,使用医学影像算法平台和三维医学影像数据处理平台3D-DOCTOR对数据进行后处理,使用热塑性塑料进行3D打印重塑出3D模型。采用3D模型指导医务人员进行宫颈癌三维腔内近距离放射治疗;采用体积剂量直方图分析内外照射的HR-CTV D90、膀胱D2cc、乙状结肠D2cc和直肠D2cc,采用EQD2进行等效生物剂量计算。观察宫颈癌放疗的近期疗效及毒副作用。结果成功打印出25例宫颈癌患者的3D模型,肿瘤大小、位置及与周围正常组织的关系显示良好;在3D模型指导下,25例完成125例次腔内近距离放射治疗。HR-CTV D90、膀胱D2cc、乙状结肠D2cc和直肠D2cc的EQD2分别为(75.26±6.31)、(67.84±8.75)、(47.36±7.62)和(62.45±8.68)Gy;21例患者达到完全缓解,4例达到部分缓解,有效率84.00%,没有2度以上毒副作用。结论 3D打印模型能够很好地显示肿瘤大小、位置及与周围正常组织的关系,有效指导医生进行宫颈癌个体化近距离放射治疗。

Clinical observation of 3D printing-guided three-dimensional brachytherapy for cervical cancer

OBJECTIVE Intracavity brachytherapy is an important method for radical radiotherapy of cervical cancer,but the dose distribution of intracavity brachytherapy for cervical cancer is not unsatisfactory clinically.The objective of this study was to investigate the guidance value of 3D printing in brachytherapy for cervical cancer.METHODS Totally 25 cases of patients with cervical cancer who received initial treatment between January 2014 and June 2014 were selected.All the patients received three-dimensional conformal radiotherapy+3D printing-guided individualized brachytherapy.3D printing-guide brachytherapy method:3.0 TMRI was used for scanning+enhancement examination,DICOM-formatted files of MR enhancement examination were extracted.Medical imaging tool kit and three-dimensional medical image data processing platform(3D-DOCTOR)were used for post-processing of data and thermoplastics were used for 3D printing and reshaping of 3D models.3D model was used to guide the three-dimensional brachytherapy for cervical cancer.Dosevolume histogram(DVH)was used to analyze internal and external irradiated HRCTVD90,bladder D2cc,sigmoid colon D2cc and rectum D2cc.EQD2 was used to calculate biological equivalent dose.At the same time,local control was followed up and RTOG/EORTC was used to evaluate the related side effects.RESULTS 3D models of 25 patients with cervical cancer were successfully printed out.The tumor size,location and relationship with the surrounding normal tissue were well developed.Twenty-five patients underwent 125 times of source applicator.EQD 2 of HR-CTV D90,bladder D2cc,sigmoid colon D2cc and rectum D2cc were(75.26±6.31),(67.84±8.75),(47.36±7.62)and(62.45±8.68)Gy,respectively.In 25 cases of patients during 3 months of follow-up,21 cases achieved complete remission,4 cases of partial relief.All of the patients have not above 2 degrees toxic and side reaction.CONCLUSIONS 3D printing model can well display the tumor size,location and relationship with the surrounding normal tissues and effectively guide doctors to conduct individualized brachytherapy for cervical cancer.It can obtain good curative effect and less toxic and adverse effects,which is worth further clinical practice.