袁香坤, 崔芒芒, 苗珺珺, 郜蕾, 胡建伟, 田丹丹, 张永侠. 3D打印微创导向模板在术后复发性宫颈癌近距离治疗中的临床应用[J]. 中国肿瘤临床, 2018, 45(24): 1258-1262. DOI: 10.3969/j.issn.1000-8179.2018.24.030
引用本文: 袁香坤, 崔芒芒, 苗珺珺, 郜蕾, 胡建伟, 田丹丹, 张永侠. 3D打印微创导向模板在术后复发性宫颈癌近距离治疗中的临床应用[J]. 中国肿瘤临床, 2018, 45(24): 1258-1262. DOI: 10.3969/j.issn.1000-8179.2018.24.030
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Yuan Xiangkun, Cui Mangmang, Miao Junjun, Gao Lei, Hu Jianwei, Tian Dandan, Zhang Yongxia. The clinical application of 3D-printed minimally-invasiveguided template in the interstitial brachytherapy treatment of postoperative recurrent cervical cancer[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2018, 45(24): 1258-1262. DOI: 10.3969/j.issn.1000-8179.2018.24.030
Citation: Yuan Xiangkun, Cui Mangmang, Miao Junjun, Gao Lei, Hu Jianwei, Tian Dandan, Zhang Yongxia. The clinical application of 3D-printed minimally-invasiveguided template in the interstitial brachytherapy treatment of postoperative recurrent cervical cancer[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2018, 45(24): 1258-1262. DOI: 10.3969/j.issn.1000-8179.2018.24.030
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3D打印微创导向模板在术后复发性宫颈癌近距离治疗中的临床应用

The clinical application of 3D-printed minimally-invasiveguided template in the interstitial brachytherapy treatment of postoperative recurrent cervical cancer

    摘要
  • 摘要:
      目的  探讨3D打印微创导向模板在术后复发性宫颈癌三维插植后装治疗中的临床应用。
      方法  收集2017年7月至2018年4月10例就诊于河北省沧州中西医结合医院，术后复发的宫颈癌患者行个体化3D打印微创导向模板辅助下三维插植后装治疗的临床资料。根据患者具体情况选用不同阴道定位模板，行CT模拟定位，勾画靶区，设计主要导向针道空间分布，打印出3D微创导向模板。根据预设针道植入插植针，制定治疗计划，高危临床靶区（high risk-clinical target volume，HR-CTV）处方剂量为6 Gy/次，共4~6次。
      结果  10例患者共行插植治疗52次，每次插植治疗平均扫描CT次数为（1.58±0.70）次，每次插植治疗从插植针植入至插植针到达满意位置的平均消耗时间为（10.88±2.94）min，每次治疗插植针的使用针数为（5.69±1.91）根。剂量参数HR-CTV包绕90%靶区体积的剂量（D90）为（6.41±0.29）Gy，包绕膀胱、直肠、乙状结肠的2 cm3体积的剂量（D2cm3）分别为（4.75±0.37）、（3.93± 0.26）、（4.33±0.24）Gy。10例患者治疗结束3个月后进行疗效评价，8例达完全缓解（complete response，CR）、2例达部分缓解（par tial response，PR）。
      结论  3D打印微创导向模板应用于术后中心型复发性宫颈癌三维插植后装治疗，定位准确，可重复治疗，插植操作时间短，插植针数少，患者痛苦小，并发症少而轻，肿瘤缩小明显，具有良好的应用前景。

     

    Abstract:
      Objective  To investigate the application of 3D-printed minimally-invasiveguided template in the treatment of recurrent cervical cancer after surgery, assisting interstitial brachytherapy.
      Methods  From July 2017 to April 2018, a total of 10 patients admitted to Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine in Hebei province with recurrent cervical cancer after radical surgery underwent the 3D-printed customized template-assisted interstitial brachytherapy. According to the specific conditions of patients, different vaginal localization templates were selected for CT simulation localization. The main guidance needle space distribution was designed, and 3D minimally-invasive guidance templates were printed. Then, needles were inserted according to the main guide channel of the template commissioned by medical photosensitive resin. The high-risk clinical target volume (HR-CTV) of 6 Gy/ fraction was administered (4 to 6 fractions).
      Results  Overall, 10 patients were treated with implantation for a total of 52 times. Treatment with average scanning CT number for each brachytherapy was (1.58±0.70) times. The average elapsed time for each brachytherapy implant treatment, from plug implant to inserting planting needle satisfactorily with the location of the tumor, was (10.88±2.94) minutes. The mean number of metal needles used was (5.69±1.91) in each brachytherapy. The mean D90 value for high-risk clinical target volume (HR-CTV) was (6.41±0.29) Gy. The cumulative D2cm3 values for the bladder, rectum, and sigmoid colon were (4.75±0.37) Gy, (3.93±0.26) Gy, and (4.33±0.24) Gy, respectively. After 3 months of treatment, the efficacy was evaluated in 8 cases with CR and 2 cases with PR.
      Conclusions  The technology of 3D-printed minimally-invasive guided template shows the advantage of accurate location and superior repeatability in the application of interstitial brachytherapy in treating recurrent cervical cancer after operation, which involves less time and insertion needles. The patients had minor aches and few complications. The tumor shrank significantly, which indicated a bright future of the technology's clinical application.

     

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