Liu Shi-Feng, Lu Jian, Wang Hong, Han Yan, Wang De-Feng, Yang Li-Li, Li Zi-Xiang, Hu Xiao-Kun
Center for Interventional Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
Department of Radiology, Zhongda Hospital, Southeast University, Nanjing, Jiangsu, China.
J Cancer Res Ther. 2019;15(4):818-824. doi: 10.4103/jcrt.JCRT_70_19.
To investigate the feasibility and safety of computed tomography-magnetic resonance imaging (CT-MRI) fusion-guided iodine-125 seed implantation for a single malignant brain tumor.
From November 2015 to October 2016, 12 patients with a single malignant brain tumor were treated with permanent iodine-125 seeds implantation. CT-MRI fusion images were used to make the preoperative treatment plan, intraoperative dose optimization, postoperative verification, and tumor response follow-up. The dosimetry parameters of CT-MRI image fusion plans were compared between preprocedures and postprocedures, including plan target volume, V100 (the percentage of the target volume covered by the prescription dose [PD]), D90 (the dose that covers 90% of the target volume), and V200 (the percentage volume of the brain tumor receiving 200% of the PD). Adverse events were graded by the Common Terminology Criteria for Adverse Events. Clinical and radiological follow-ups were performed at a 3-month interval.
All the interstitial implantations were completed successfully under the guidance of CT-MRI image fusion. The dosimetry parameters of CT-MRI image fusion postplans did not differ significantly from those of preplans (P > 0.05). No higher than Grade 2 adverse events were observed during the follow-up. Tumor control was achieved in 10 of 12 patients (83.33%). The median overall survival time was 15.05 ± 3.35 months (95% confidence interval 12.99-17.26).
CT-MRI image fusion is feasible for the design, optimization, and verification of treatment planning. CT-MRI fusion-based brachytherapy may improve dosimetry of brain tumor while sparing the normal structures, potentially impacting disease control, treatment-related toxicity, and long-term survival.
探讨计算机断层扫描-磁共振成像（CT-MRI）融合引导下碘-125粒子植入治疗单发恶性脑肿瘤的可行性和安全性。
2015年11月至2016年10月，对12例单发恶性脑肿瘤患者行永久性碘-125粒子植入治疗。利用CT-MRI融合图像进行术前治疗计划制定、术中剂量优化、术后验证及肿瘤反应随访。比较术前和术后CT-MRI图像融合计划的剂量学参数，包括计划靶体积、V100（处方剂量[PD]覆盖的靶体积百分比）、D90（覆盖90%靶体积的剂量）和V200（接受200%PD的脑肿瘤体积百分比）。不良事件按照不良事件通用术语标准进行分级。每3个月进行一次临床和影像学随访。
所有间质植入均在CT-MRI图像融合引导下成功完成。CT-MRI图像融合后计划的剂量学参数与术前计划相比差异无统计学意义（P>0.05）。随访期间未观察到高于2级的不良事件。12例患者中有10例（83.33%）实现了肿瘤控制。中位总生存时间为15.05±3.35个月（95%置信区间12.99-17.26）。
CT-MRI图像融合在治疗计划的设计、优化和验证方面是可行的。基于CT-MRI融合的近距离放射治疗可能在保护正常结构的同时改善脑肿瘤的剂量学，对疾病控制、治疗相关毒性和长期生存可能产生影响。
