基于个体化解剖模型的胰腺导管腺癌肿瘤消融激光剂量学优化。
Optimization of laser dosimetry based on patient-specific anatomical models for the ablation of pancreatic ductal adenocarcinoma tumor.
机构信息
Department of Mechanical Engineering, Politecnico di Milano, 20156, Milan, Italy.
Operative Endoscopy Department, Fondazione Policlinico Universitario Campus Biomedico, Rome, Italy.
出版信息
Sci Rep. 2023 Jul 8;13(1):11053. doi: 10.1038/s41598-023-37859-7.
Laser-induced thermotherapy has shown promising potential for the treatment of unresectable primary pancreatic ductal adenocarcinoma tumors. Nevertheless, heterogeneous tumor environment and complex thermal interaction phenomena that are established under hyperthermic conditions can lead to under/over estimation of laser thermotherapy efficacy. Using numerical modeling, this paper presents an optimized laser setting for Nd:YAG laser delivered by a bare optical fiber (300 µm in diameter) at 1064 nm working in continuous mode within a power range of 2-10 W. For the thermal analysis, patient-specific 3D models were used, consisting of tumors in different portions of the pancreas. The optimized laser power and time for ablating the tumor completely and producing thermal toxic effects on the possible residual tumor cells beyond the tumor margins were found to be 5 W for 550 s, 7 W for 550 s, and 8 W for 550 s for the pancreatic tail, body, and head tumors, respectively. Based on the results, during the laser irradiation at the optimized doses, thermal injury was not evident either in the 15 mm lateral distances from the optical fiber or in the nearby healthy organs. The present computational-based predictions are also in line with the previous ex vivo and in vivo studies, hence, they can assist in the estimation of the therapeutic outcome of laser ablation for pancreatic neoplasms prior to clinical trials.
激光热疗在治疗不可切除的原发性胰腺导管腺癌肿瘤方面显示出了有前途的潜力。然而,在高温条件下建立的异质肿瘤环境和复杂的热相互作用现象可能导致激光热疗效果的低估/高估。本文通过数值模拟,针对 1064nm 连续工作模式下、功率范围为 2-10W 的裸光纤(直径 300μm)传输的 Nd:YAG 激光,提出了一种优化的激光设置。对于热分析,使用了患者特定的三维模型,其中包括胰腺不同部位的肿瘤。研究发现,要完全消融肿瘤并对肿瘤边缘以外可能残留的肿瘤细胞产生热毒性效应,优化的激光功率和时间分别为胰腺尾部肿瘤 5W 照射 550s、7W 照射 550s、8W 照射 550s;胰腺体部肿瘤 5W 照射 550s、7W 照射 550s、8W 照射 550s;胰腺头部肿瘤 5W 照射 550s、7W 照射 550s、8W 照射 550s。基于这些结果,在优化剂量的激光照射下,光纤 15mm 侧方距离或附近的健康器官均未出现明显的热损伤。基于计算的预测结果与之前的离体和体内研究一致,因此,它们可以在临床试验前协助估计激光消融治疗胰腺肿瘤的治疗效果。