3D打印技术在宫颈癌近距离放射治疗中的应用

doi:10.12280/gjfckx.20220751

摘要/Abstract

摘要：

近距离放射治疗是宫颈癌患者根治性放射治疗中必不可少的一部分，然而传统近距离放射治疗的施源器对部分术后残端复发或偏心性或大体积宫颈癌患者存在置入困难、不能适应个体化的局部病灶、剂量分布不理想等问题，继而影响疗效及预后。3D打印技术可以为患者设计个体化的施源器。3D打印技术与近距离放射治疗相结合，可以提高放射治疗的准确性。目前3D打印技术在宫颈癌近距离放射治疗中的应用主要包括构建宫颈癌模型，进行术前规划，显示肿瘤形状以及肿瘤与周围组织的解剖关系。同时还包括制作个性化施源器，减少空气间隙发生，以实现精确剂量分布。此外还包括设计平行/斜行插植针道施源器，优化针道和靶区剂量分布。综述宫颈癌近距离放射治疗中3D打印技术在上述领域的应用现状，讨论开发3D打印所需材料、系统建立及图像引导所面临的挑战。

关键词: 宫颈肿瘤, 打印, 三维, 近距离放射疗法, 放射治疗剂量, 施源器

Abstract:

Brachytherapy is an essential part of radical radiotherapy of cervical cancer. However, traditional brachytherapy applicators are difficult to be placed, cannot be adapted to individualized local lesions, and have unsatisfactory dose distribution for some patients with recurrent postoperative stumps or eccentric or large cervical cancer, which then affects the efficacy and prognosis. Personalized radiotherapy products can be designed for each patient by utilizing 3D printing technology. Combination of 3D printing technology and brachytherapy can effectively improve accuracy of radiotherapy. The application of 3D printing technology in cervical cancer brachytherapy mainly includes the construction of cervical cancer model to preoperative planning and display tumor shape as well as anatomic relationship between tumor and surrounding tissues. It also includes the production of personalized applicator to reduce the occurrence of air gaps to achieve precise dose distribution. In addition, the design of parallel/oblique needle channel applicator and the optimization of needle channel and target dose distribution are also included. Applications of 3D printing technology in brachytherapy of cervical cancer have been summarized in the afore-mentioned areas. At the same time, the challenges in the development of 3D printing materials, system establishment and image guidance have been discussed.

Key words: Uterine cervical neoplasms, Printing, three-dimensional, Brachytherapy, Radiotherapy dosage, Applicator

秦瑶, 李杰慧. 3D打印技术在宫颈癌近距离放射治疗中的应用[J]. 国际妇产科学杂志, 2023, 50(2): 201-205.

QIN Yao, LI Jie-hui. Application of 3D Printing Technique Combined with Brachytherapy in Cervical Cancer[J]. Journal of International Obstetrics and Gynecology, 2023, 50(2): 201-205.

图/表 2

参考文献 31

[1]	Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries[J]. CA Cancer J Clin, 2021, 71(3):209-249. doi: 10.3322/caac.21660. doi: 10.3322/caac.21660
[2]	Abu-Rustum NR, Yashar CM, Bean S, et al. NCCN Guidelines Insights: Cervical Cancer, Version 1.2020: Featured Updates to the NCCN Guidelines[J]. JNCCN, 2020, 18(6):660-666. doi: 10.6004/jnccn.2020.0027. doi: 10.6004/jnccn.2020.0027
[3]	Harkenrider MM, Alite F, Silva SR, et al. Image-Based Brachytherapy for the Treatment of Cervical Cancer[J]. Int J Radiat Oncol Biol Phys, 2015, 92(4):921-934. doi: 10.1016/j.ijrobp.2015.03.010. doi: 10.1016/j.ijrobp.2015.03.010
[4]	Serban M, Kirisits C, de Leeuw A, et al. Ring Versus Ovoids and Intracavitary Versus Intracavitary-Interstitial Applicators in Cervical Cancer Brachytherapy: Results From the EMBRACE I Study[J]. Int J Radiat Oncol Biol Phys, 2020, 106(5):1052-1062. doi: 10.1016/j.ijrobp.2019.12.019. doi: 10.1016/j.ijrobp.2019.12.019
[5]	Tambas M, Tavli B, Bilici N, et al. Computed Tomography-Guided Optimization of Needle Insertion for Combined Intracavitary/Interstitial Brachytherapy With Utrecht Applicator in Locally Advanced Cervical Cancer[J]. Pract Radiat Oncol, 2021, 11(4):272-281. doi: 10.1016/j.prro.2021.01.008. doi: 10.1016/j.prro.2021.01.008
[6]	Kissel M, Fournier-Bidoz N, Henry O, et al. Venezia applicator with oblique needles improves clinical target volume coverage in distal parametrial tumor residue compared to parallel needles only[J]. J Contemp Brachytherapy, 2021, 13(1):24-31. doi: 10.5114/jcb.2021.103583. doi: 10.5114/jcb.2021.103583
[7]	Liu Y, Jiang P, Zhang H, et al. Safety and efficacy of 3D-printed templates assisted CT-guided radioactive iodine-125 seed implantation for the treatment of recurrent cervical carcinoma after external beam radiotherapy[J]. J Gynecol Oncol, 2021, 32(2):e15. doi: 10.3802/jgo.2021.32.e15. doi: 10.3802/jgo.2021.32.e15 pmid: 33300313
[8]	Hull Charles W. The Birth of 3D Printing: IRI Achievement Award Address[J]. Res Technol Management, 2015, 58(6):25-30. doi: 10.5437/08956308x5806067. doi: 10.5437/08956308x5806067
[9]	Malik HH, Darwood AR, Shaunak S, et al. Three-dimensional printing in surgery: a review of current surgical applications[J]. J Surg Res, 2015, 199(2):512-522. doi: 10.1016/j.jss.2015.06.051. doi: 10.1016/j.jss.2015.06.051 pmid: 26255224
[10]	Xue R, Lai Q, Sun S, et al. Application of Three-Dimensional Printing Technology for Improved Orbital-Maxillary-Zygomatic Reconstruction[J]. J Craniofac Surg, 2019, 30(2):e127-e131. doi: 10.1097/SCS.0000000000005031. doi: 10.1097/SCS.0000000000005031
[11]	Guo C, Zhang Y, Yang L, et al. The Application and Operation-Effect Analysis for Complex Tibial Plateau Fractures with 3D Printing Technique[J]. Int J Clin Med, 2019, 10(3):101-108. doi: 10.4236/ijcm.2019.103010. doi: 10.4236/ijcm.2019.103010
[12]	Campelo S, Subashi E, Meltsner SG, et al. Multimaterial three-dimensional printing in brachytherapy: Prototyping teaching tools for interstitial and intracavitary procedures in cervical cancers[J]. Brachytherapy, 2020, 19(6):767-776. doi: 10.1016/j.brachy.2020.07.013. doi: 10.1016/j.brachy.2020.07.013 pmid: 32893145
[13]	Bartellas M, Ryan S, Doucet G, et al. Three-Dimensional Printing of a Hemorrhagic Cervical Cancer Model for Postgraduate Gynecological Training[J]. Cureus, 2017, 9(1):e950. doi: 10.7759/cureus.950. doi: 10.7759/cureus.950
[14]	Baek MH, Kim DY, Kim N, et al. Incorporating a 3-dimensional printer into the management of early-stage cervical cancer[J]. J Surg Oncol, 2016, 114(2):150-152. doi: 10.1002/jso.24292. doi: 10.1002/jso.24292
[15]	Wang F, Wang H, Luo H, et al. Is 3D printing-gided three-dimensional brachytherapy suitable for cervical cancer: From one single research institute?[J]. Eur J Gynaecol Oncol, 2020, 41(4):591-597. doi: 10.31083/J.EJGO.2020.04.4932. doi: 10.31083/J.EJGO.2020.04.4932
[16]	王凤玫, 程惠华, 冯静, 等. 3D打印技术引导宫颈癌个体化近距离放疗应用研究[J]. 中华肿瘤防治杂志, 2020, 27(12):1003-1007. doi: 10.16073/j.cnki.cjcpt.2020.12.14. doi: 10.16073/j.cnki.cjcpt.2020.12.14
[17]	Abdollahi S, Rafat Motavali L, Miri Hakimabad SH, et al. Statistical and dosimetric analysis of air gaps in vaginal cuff brachytherapy[J]. Rad Oncol, 2017, 123(5):978-979. doi: 10.1016/S0167-8140(17)32143-6. doi: 10.1016/S0167-8140(17)32143-6
[18]	Yan J, Qin X, Zhang F, et al. Comparing multichannel cylinder and 3D-printed applicators for vaginal cuff brachytherapy with preliminary exploration of post-hysterectomy vaginal morphology[J]. J Contemp Brachyther, 2021, 13(6):641-648. doi:10.5114/jcb.2021.112115. doi: 10.5114/jcb.2021.112115 pmid: 35079250
[19]	Qin X, Zhang F, Hou X, et al. Efficacy and safety of a 3D-printed applicator for vaginal brachytherapy in patients with central pelvic-recurrent cervical cancer after primary hysterectomy[J]. Brachytherapy, 2022, 21(2):193-201. doi: 10.1016/j.brachy.2021.11.004. doi: 10.1016/j.brachy.2021.11.004
[20]	唐成琼, 刘江平, 古丽娜·库尔班, 等. 3D打印多通道施源器在宫颈癌术后患者近距离治疗中研究[J]. 中华放射肿瘤学杂志, 2022, 31(5):445-449. doi: 10.3760/cma.j.cn113030-20210712-00257. doi: 10.3760/cma.j.cn113030-20210712-00257
[21]	陶娜, 安永伟, 欧阳水根, 等. 3D打印阴道模型塞应用在宫颈癌近距离治疗中的剂量学研究[J]. 辐射研究与辐射工艺学报, 2020, 38(4):51-56. doi: 10.11889/j.1000-3436.2020.rrj.38.040302. doi: 10.11889/j.1000-3436.2020.rrj.38.040302
[22]	杨文翠, 宋丽娟, 张骞文, 等. 局部晚期宫颈癌应用3D打印阴道模型塞插植治疗的剂量学和近期疗效观察[J]. 临床肿瘤学杂志,2019, 24(10):925-929. doi: 1009-0460(2019)10-0925-05. doi: 1009-0460(2019)10-0925-05
[23]	王彬冰, 郑光浩, 张翔, 等. 经阴道3D打印个体化模板在宫颈癌后装治疗中的应用价值研究[J]. 中华放射肿瘤学杂志, 2020, 29(4):283-288. doi: 10.3760/cma.j.cn113030-20190929-00007. doi: 10.3760/cma.j.cn113030-20190929-00007
[24]	Logar H, Hudej R, Šegedin B. Development and assessment of 3D-printed individual applicators in gynecological MRI-guided brachytherapy[J]. J Contemp Brachytherapy, 2019, 11(2):128-136. doi: 10.5114/jcb.2019.84741. doi: 10.5114/jcb.2019.84741
[25]	Zhao Z, Tang X, Mao Z, et al. The design of an individualized cylindrical vaginal applicator with oblique guide holes using 3D modeling and printing technologies[J]. J Contemp Brachytherapy, 2019, 11(5):479-487. doi: 10.5114/jcb.2019.88441. doi: 10.5114/jcb.2019.88441
[26]	刘影, 郭昕, 韩东梅, 等. 宫颈残端癌应用3D打印施源器实施个体化自适应近距离放疗1例报道[J]. 中国实验诊断学, 2020, 24(9):1560-1562. doi: 10.3969/j.issn.1007-4287.2020.09.047. doi: 10.3969/j.issn.1007-4287.2020.09.047
[27]	Haie-Meder C, Pötter R, Van Limbergen E, et al. Recommendations from Gynaecological (GYN) GEC-ESTRO Working Group (I): concepts and terms in 3D image based 3D treatment planning in cervix cancer brachytherapy with emphasis on MRI assessment of GTV and CTV[J]. Radiother Oncol, 2005, 74(3):235-245. doi: 10.1016/j.radonc.2004.12.015. doi: 10.1016/j.radonc.2004.12.015 pmid: 15763303
[28]	张永侠, 袁香坤, 苗珺珺, 等. 3D打印模板应用于局部晚期宫颈癌后装放疗的剂量学研究[J]. 中华放射医学与防护杂志, 2020, 40(7):519-523. doi: 10.3760/cma.j.issn.0254-5098.2020.07.005. doi: 10.3760/cma.j.issn.0254-5098.2020.07.005
[29]	Mazeron R, Castelnau-Marchand P, Dumas I, et al. Impact of treatment time and dose escalation on local control in locally advanced cervical cancer treated by chemoradiation and image-guided pulsed-dose rate adaptive brachytherapy[J]. Radiother Oncol, 2015, 114(2):257-263. doi: 10.1016/j.radonc.2014.11.045. doi: 10.1016/j.radonc.2014.11.045 pmid: 25497872
[30]	赵志鹏, 管薇, 赵红福, 等. 3D打印模板辅助标准化施源器在ⅢB期宫颈癌影像引导自适应近距离治疗中的应用[J]. 中华放射肿瘤学杂志, 2020, 29(8):661-665. doi: 10.3760/cma.j.cn113030-20200511-00246. doi: 10.3760/cma.j.cn113030-20200511-00246
[31]	李宁. 基于预计划的3D打印模板在宫颈癌组织间插植中的应用[D]. 长春: 吉林大学, 2019.