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I期非小细胞肺癌术中I-125近距离放射治疗的剂量学和技术方面

Dosimetric and technical aspects of intraoperative I-125 brachytherapy for stage I non-small cell lung cancer.

作者信息

Johnson Mark, Colonias Athanasios, Parda David, Trombetta Mark, Gayou Olivier, Reitz Bodo, Miften Moyed

机构信息

Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, Pennsylvania 15212, USA.

出版信息

Phys Med Biol. 2007 Mar 7;52(5):1237-45. doi: 10.1088/0031-9155/52/5/002. Epub 2007 Jan 31.

DOI:10.1088/0031-9155/52/5/002
PMID:17301451
Abstract

Initial treatment outcome data from our institution for stage I non-small cell lung cancer (NSCLC) patients have shown that sublobar resection in combination with iodine-125 (I-125) brachytherapy is associated with recurrence rates of 2.0%, compared to 18.6% with sublobar resection alone. In this work, the technical and dosimetric aspects required to execute this procedure from the radiation oncology perspective as well as an analysis of the dose distributions of patients treated with this technique are presented. In this treatment technique, I-125 seeds in vicryl suture are embedded into vicryl mesh and surgically inserted providing a 2.0 cm margin on each side of the resection staple line. A nomogram is developed to determine the suture spacing in the vicryl mesh, as a function of seed activity in order to deliver 120 Gy at a distance of 0.5 cm above and below the seed array. Post-operative dosimetry consists of a CT-based planning and dose volume analysis. Dose distributions, dose volume histograms and mean dose data for lung are analysed in a group of patients. Dosimetric results show significant lung sparing with only a small volume of lung irradiated for all patients with mean lung dose values ranging from 1.5 Gy to 5.4 Gy. Lung brachytherapy with I-125 at the time of sublobar resection is a highly conformal option of dose delivery for stage I NSCLC patients with compromised physiologic reserve. Patient-related toxicity clinically measured by loss of pulmonary function and radiation-induced pneumonitis have not been linked to this procedure.

摘要

我们机构针对 I 期非小细胞肺癌(NSCLC)患者的初始治疗结果数据显示,肺叶下切除联合碘 - 125(I - 125)近距离放疗的复发率为 2.0%,而单纯肺叶下切除的复发率为 18.6%。在这项工作中,从放射肿瘤学角度介绍了执行该程序所需的技术和剂量学方面,并分析了采用该技术治疗的患者的剂量分布情况。在这种治疗技术中,将 Vicryl 缝线中的 I - 125 种子嵌入 Vicryl 网中,并通过手术插入,在切除吻合线两侧各留出 2.0 厘米的边缘。开发了一个列线图,根据种子活度确定 Vicryl 网中的缝线间距,以便在种子阵列上方和下方 0.5 厘米处给予 120 Gy 的剂量。术后剂量学包括基于 CT 的计划和剂量体积分析。对一组患者的肺剂量分布、剂量体积直方图和平均剂量数据进行了分析。剂量学结果显示,所有患者的肺均得到显著保护,仅小部分肺受到照射,平均肺剂量值在 1.5 Gy 至 5.4 Gy 之间。对于生理储备受损的 I 期 NSCLC 患者,肺叶下切除时采用 I - 125 进行肺部近距离放疗是一种高度适形的剂量输送选择。通过肺功能丧失和放射性肺炎临床测量的与患者相关的毒性与该程序无关。

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