实用医学杂志 ›› 2020, Vol. 36 ›› Issue (21): 2971-2975.doi: 10.3969/j.issn.1006⁃5725.2020.21.017

• 临床研究 • 上一篇    下一篇

125I粒子植入术后脊髓靶区勾画方法的研究

王静1 张萍1 张坤1 王义涛2 董俊峰2 杨健1   

  1. 1沧州市人民医院精准放疗中心(河北沧州061000);2 黄骅市开发区博爱医院(河北沧州062600)
  • 出版日期:2020-11-10 发布日期:2020-11-30
  • 通讯作者: 杨健E⁃mail:345647102@qq.com

Study on the method of drawing the target area of spinal cord after 125I seed implantation

WANG Jing*,ZHANG Ping,ZHANG Kun,WANG Yitao,DONG Junfeng,YANG Jian.#br#   

  1. *Precision Radiotherapy Center of Cang⁃zhou People′s Hospital,Cangzhou 061000,China
  • Online:2020-11-10 Published:2020-11-30
  • Contact: YANG Jian E⁃mail:345647102@qq.com

摘要:

目的 研究放射性125I 粒子植入术后正常脊髓组织的靶区勾画方法。方法 选取5 名健康体检者胸及腹部CT 图像,层厚0.5 cm,载人计算机三维治疗计划系统(The 3D treatment planning system,TPS),在第12胸椎处逐层勾画分别模拟直径为4 cm、高3 cm(A组)、直径为5 cm、高4 cm(B组)和直径为6 cm、高5 cm(C组)距离脊髓1.0 cm的圆柱形肿瘤以及长4 cm、宽4 cm、高4 cm(D组)和长5 cm、宽5 cm、高5 cm(E组),以及长6 cm、宽6 cm、高6 cm(F组)距离脊髓1.0 cm,且肿瘤的高与脊髓平行。按照中间稀疏、周边密集的布源规则,处方剂量为135 Gy,行使术前计划。然后分别勾画GTV上下-1.0、-0.5、0.0、0.5、1.0、1.5、2、2.5、3.0 cm为正常脊髓组织靶区,然后计算正常脊髓组织所受到的平均剂量(Mean)、最大点剂量(Max)及D2c(c 2 cm3脊髓组织所接受的剂量)。结果 肿瘤越大,相同处方剂量时,使用粒子数目越多,脊髓受量D2cc、最大点剂量、平均剂量越高。A、B、C、D、E、F组正常脊髓组织靶区勾画长度与其受到的最大点剂量无关,随着正常脊髓组织靶区勾画长度的增加脊髓受到的平均剂量逐渐减少,A、B、C、D、E、F组正常脊髓组织靶区勾画小于GTV层面时,D2cc随着正常脊髓组织靶区勾画长度缩短而减小,大于等于GTV层面时,D2cc不再随正常脊髓组织靶区勾画长度的增加而变化,且与肿瘤形状、肿瘤大小不相关,且脊髓勾画长度小于肿瘤靶区层面1.0 cm于其勾画长度大于等于肿瘤靶区层面相比差异有统计学意义(P < 0.05)。结论 放射性125I 粒子植入术后正常脊髓组织靶区勾画长度大于或等于GTV 层面时,脊髓组织受量与肿瘤大小,肿瘤形状无关,为统一放射性125I粒子植入术后正常脊髓组织靶区勾画的范围,推荐放射性125I粒子植入术后正常脊髓组织靶区勾画长度为肿瘤靶区上下1.0 cm。

关键词: 靶区勾画, 脊髓, 125I粒子, 计算机三维治疗计划系统

Abstract:

Objective To study the target delineation method of normal spinal cord tissue after implanta⁃tion of 125I radioactive particles. Methods The CT images of chest and abdomen of 5 healthy people were selected.The slice thickness was 0.5 cm,and the 3D treatment planning system was used. At the 12th thoracic vertebrae,the cylindrical tumors with the diameter of 4 cm,3 cm high(group A),5 cm in diameter and 4 cm in height(group B),6 cm in diameter and 5 cm in height(Group C)and 1.0 cm in length,width and height(Group D),5 cm in length,5 cm in width and 5 cm in height(Group E),and 6 cm in length,6 cm in width and 6 cm inheight(Group F)and 1.0 cm in length,width and height were respectively depicted at the 12th thoracic vertebraeThe tumor is a triangular pyramid. According to the rule of sparse in the middle and dense in the periphery,theprescription dose was 135 Gy,and the preoperative plan was carried out. Then the target areas of normal spinalcord tissue were delineated as -1.0,-0.5,0,0.5,1.0,1.5,2,2.5,3.0 cm,respectively. The mean,Max andD2cc of GTV were calculated. Results The particles used the dose of D2cc and the maximum point increases with thesize of the tumor. In group A,B,C,D,E and F,the length of the target area which was delineated normal spinalcord tissue,was not related to the maximum dose received by the spinal cord. With the increase of the length of thetarget area of normal spinal cord tissue,the average dose received by the spinal cord decreased gradually. In groupA,B,C,D,E and F,when the target area of normal spinal cord tissue was less than the GTV layer,the D2ccdecreased with the reduction of the target area of normal spinal cord tissue,greater than or equal to the GTV layerIn face time,D2cc did not change with the increase of target length in normal spinal cord,and was not related totumor shape and size. There was a significant difference in the length of spinal cord sketch between the tumor targetlevel and the tumor target level(P < 0.05). Conclusion When the target area of normal spinal cord tissue afterimplantation of 125I radioactive particles was longer than or equal to the GTV level ,the amount of spinal cordtissue received has nothing to do with tumor size and tumor shape. It is recommended that the target length of normalspinal cord tissue after implantation of 125I radioactive particles be the visible level of all tumor targets.【Key words】target delineation spinal cord 125I particle the 3D treatment planning system

Key words: target delineation, spinal cord, 125I particle, the 3D treatment planning system