| Objective:The objective of this study is to evaluate the feasibility,safety and advantages of the three-dimensional（3D）-printed individual template-guided 125I seed implantation for the treatment of head and neck cancer.Methods:A total of 40 consecutivepatients with head and neck cancer（42 targets）who received 125I interstitial brachytherapy at HeBei General Hospital during Aug.2015-Aug.2018 were enrolled.And 38 consecut-ivepatients with（40 targets）meet the inclusion criteria,including 31 male and7 female patients.Of all the 38 patients,the stage of disease:StageⅠwas 1,StageⅡwere 2,StageⅢwere 7,StageⅣwere 22,Stage unknown were6;the pathology of the primary lesions and the number were follows:squamous carcinoma:26（esophageal were 11;gum,primary lesions unknown were 3,nasopharynx,laryngeal were 2;hypopharyngeal,cervix,Parotid,tongue,upper lip,salivary gland was 1,respectively）,papillary thyroid carcinoma:4,adenocarcinoma of lung:3,adenoid cystic carcinoma:2,small cell carcinoma of lung,chordoma and schwannoma were 1 respectively.17patients received surgical excision of primary lesion,26 had a history of external beam radiotherapy,with the mean dose of 63.35±4.7Gy（6 case unknown）.Then divided the patients into two groups,18 patients（20 targets）received the operation guided by CT scans combined with the 3D-printed individual template（3D-PT）（Experimental Group）,and the rest 20 patients（20 targets）received the operation under CT guidance（Control Group）.All the per-plan were completed by the TPS according to the contrast scanning CT images,and the CT scans should be finished within 1 week before the operation.The 3D?printed individual template was printed out according to the pre-plan of Experimental Group,and the operation of Experimental Group was guided by CT scans combined with the 3D-PT.The operation of Group B was finished with the guidance of CT or ultrasound scan.The restoration and fixation of 3D printing individual template of Experimental Group was under close observation during the whole procedure course.The intraoperative complications and postoperative complications such as hemorrhage,the puncture site pain,hoarseness,cough from drinking water,skin numbnessand so on were also observed;To compare the difference of scan times and time of operation between the two groups;the verification plan was completed immediately after brachytherapy,the volume of the target,seeds number,dosimetric parameters（D90,V90,V100,V150）were calculated,the deviation of the number of seeds,target volume,and dosimetric parameters（D90,V90,V100,and V150）between pre-and post-operative plan of the two groups were compared;the quality evaluation was finished according to the British Columbia Cancer Agency（BCCA）Provincial Prostate Brachytherapy Quality Assurance Programme;the local control rate（LCR）,effective rate and complications in 3 months after operation of the two groups were compared.Result:During the operation,the incidence of bleeding in Experimental Group was 35%,and 50%in Control Group.The puncture site pain showed in3 patients and hoarseness showed in 2 patients in Control Group.The scan times and time of operation of Experimental Group were:6.0±1.3,59.7±14.8min respectively,and for Control Group were 9.0（8.0,10.0）,83.2±24.2min respectively,the scan times and time of operation of the two groups had very significant differences（P<0.05）.No statistically significant differences in the number of seeds,target volume,dosimetric parameters（D90,V90,V100,V150）existed between preoperative data and postoperative in the two groups（P>0.05）.The quality of 125I seed implantation was classified into excellent,good,moderate and poor grade,and the ratio was60%（12/20）、35%（7/20）、5%（1/20）and0（0/20）in Experimental Groupand50%（10/20）,25%（4/20）,5%（2/20）and 15%（3/20）in Control Grouprespectively.The therapeutic evaluation in 2 months were as follow:LCR was 100%（20/20）,effective rate 55%（11/20）in Experimental Groupand LCR was 100%（20/20）,effective rate 40%（8/20）in Control Group,and 3months were as follows:LCR was 95%（19/20）,effective rate75%（15/20）in Experimental Groupand LCR was 95%（19/20）,effective rate65%（12/20）in Control Group.Conclusion:1.The 3D-PT guided 125I seed implantation for the head and neck cancer is a safe and feasible guidance approach.2.Comparing the traditional operation,the application of 3D-PT can not only simplify operations,save time,reduce the CT scan time.3.3D-PT guided 125I implantation,can reduced the complicationsand meeting the pre-plan accurately.Improve the efficacy in the premise of ensuring the safety of the operation. |
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