CT-fluoroscopy guided interstitial brachytherapy with image-based treatment planning for unresectable locally recurrent rectal carcinoma.
CT-fluoroscopy guided interstitial brachytherapy with image-based treatment planning for unresectable locally recurrent rectal carcinoma.
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DOI：
10.1016/j.brachy.2004.09.007
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发表时间：
2004-01-01
期刊：
影响因子：
1.9
通讯作者：
Nakano, Takashi
中科院分区：
文献类型：
--
作者：
Sakurai, Hideyuki;Mitsuhashi, Norio;Nakano, Takashi
目的：本研究旨在制定高剂量率（HDR）适形间质近距离放疗，结合ct -透视引导和ct为基础的治疗方案，治疗局部复发性直肠癌。方法和材料：在螺旋CT扫描仪引导下，近距离置针，提供连续透视重建。视频监视器同时放置在CT龙门附近，使操作人员能够看到针的插入过程。最终的CT图像通过在线系统传输到治疗计划计算机，重建植入针和器官轮廓。规划靶体积剂量归一化并进行几何优化。患者接受近距离放疗，剂量为5gy，每日两次，总剂量为30-50 Gy，伴或不伴外放射治疗。18例患者接受了这种手术。结果：每例患者成功放置10 ~ 36根针，平均17.3根。CT透视的平均时间为357秒。插针无意外，但有2例患者在拔针后出现腓骨神经不完全性麻痹，但均逐渐恢复。基于ct的治疗计划比传统x线片的投影重建更快、更准确。剂量-体积直方图分析显示，剂量与靶区呈适形分布，避免了正常结构。结论：CT透视引导在近距离治疗中确保了置针的安全性和准确性。适形高剂量率（HDR）间质近距离放射治疗是一种值得考虑的治疗局部复发直肠癌的方法。
PURPOSE: The aim of the study is to develop high-dose-rate (HDR) conformal interstitial brachytherapy by means of combined CT-fluoroscopy guidance with CT-based treatment planning for locally recurrent rectal carcinoma.METHODS AND MATERIALS: Brachytherapy needle insertion was guided with a helical CT scanner providing continuous fluoroscopy reconstruction. A video monitor placed adjacent to the CT gantry simultaneously allowed the operator to see the process of needle insertion. Final CT images were transferred by an online system to the treatment-planning computer, which reconstructed the implant needles and organ contours. The doses in planning target volume were normalized and geometrically optimized. The patients received a brachytherapy dose at 5 Gy twice daily with a hypofractionated accelerated schedule at a total dose of 30-50 Gy with or without external radiation therapy. Eighteen patients were treated with this procedure.RESULTS: Ten to thirty-six needles (average, 17.3) were successfully placed to the planning target volume in each patient. The average time for CT fluoroscopy was 357 seconds for each procedure. No accident was seen at needle insertion, but 2 patients developed incomplete peroneal nerve palsy after needle removal, but gradually recovered. CT-based treatment planning was faster and more accurate than projection reconstruction with conventional radiograms. Analysis of the dose volume histogram showed conformal dose distribution to the target, while avoiding normal structures.CONCLUSION: CT fluoroscopy guidance ensures safety and increases the accuracy of needle placement in brachytherapy. Conformal high-dose-rate (HDR) interstitial brachytherapy with CT-based treatment planning is a method worth considering for locally recurrent rectal cancer.