Objective: To investigate the advantages of adjustable angle needle path template compared with CT-guided 125I seeds free-hand implantation in the treatment of non-small cell lung carcinoma. Methods: This randomized controlled trial involved the retrospective analysis of the clinical data of 45 patients with non-small cell lung carcinoma who underwent 125I seeds implantation at the Shandong Cancer Hospital, Shaanxi Provincial Tumor Hospital and The Third Affiliated Hospital of Shandong First Medical University from May 2018 to January 2023. Patients were divided into the template (n=21) and free-hand (n=24) groups, according to the modality used. The template group comprised 16 males and 5 females, aged (66±12) years, while the free-hand group comprised 16 males and 8 females, aged (62±8) years. The dose distribution, implant quality, intraoperative computed tomography (CT) scan times, and 125I seed reseeding numbers after implantation were compared between the two groups to evaluate the potential advantages of adjustable angle needle path template-assisted implantation over free-hand 125I implantation. Results: Statistical comparison revealed no significant differences in age (t=1.16, P=0.253), tumor volume [(71±26) vs. (71±22) cm3, t=0.21, P=0.837), or any other baseline characteristics between the template and free-hand groups. Overall, 45 patients successfully completed the operation. In the template group, the mean values of the D90 (dose that was delivered to 90% of the target volume), V100 (the target volume receiving 100% of the prescription dose), coverage index (CI), relative dose homogeneity index (HI), and external volume index (EI) pre-and post-implantation were (131.0±2.1) vs. (131.1±5.5) Gy, 90.0%±0.4% vs. 91.0%±2.8%, 0.83±0.07 vs. 0.82±0.05, 41%±11% vs. 37%± 13%, and 4.3%(2.9%, 14.0%) vs.8.8%(5.2%,14.6%), respectively. None of these parameters showed any significant difference (all P>0.05). In the free-hand group, the mean value of D90 pre- and post-implantation was (131.4±2.9) vs.(128.6±8.6) Gy, showing no significant difference (P>0.05), the mean values of V100, CI, HI, and EI pre-and post-implantation were 90.0%±0.5% vs. 89.0%± 3.0%, 0.84±0.04 vs. 0.71±0.09, 41%±9% vs. 34%±10%, and 7.7% (4.9%,11.0%) vs.24.2% (14.3%, 35.3%), respectively, showing significant differences (all P<0.05). The number of reseeding seeds in the template group was lower than that in the free-hand group [2.0 (0,2.5) vs. 4.0 (2.0, 7.0), Z=-3.36, P=0.001], showing a statistically significant difference. Further, the number of CT scans in the template group was significantly less than that in the free-hand group (3.9±0.5 vs. 4.6±1.2, t=-2.54, P=0.016). The incidences of adverse reactions were 23.8% (5/21) and 33.3% (8/24) (χ2=12.86, P=0.002) in the template and free-hand groups, respectively, indicating a significant difference. Conclusion: Compared with free-hand implantation, use of the adjustable angle needle path template technique can shorten the operation time, reduce the number of scans, reduce the incidence of complications, and improve treatment efficacy to a certain extent.
目的： 探讨可调角度针道模板辅助较徒手穿刺125I粒子植入治疗肺恶性肿瘤的优势。 方法： 随机对照研究。收集2018年5月至2023年1月山东省肿瘤医院、陕西省肿瘤医院、山东第一医科大学第三附属医院符合纳入标准并提供书面知情同意书的45例行放射性125I粒子治疗的中晚期肺癌患者，根据是否应用可调角度针道模板辅助将患者分为模板组（n=21）和徒手组（n=24），其中模板组男16例、女5例，年龄（66±12）岁；徒手组男16例、女8例，年龄（62±8）岁。比较两组患者放射性 125I 粒子植入治疗后剂量分布情况、粒子植入质量、术中CT扫描次数及粒子补种数量，评价可调角度针道模板辅助较徒手穿刺125I粒子植入的优势。两组符合正态分布的计量资料以x¯±s表示，组间比较采用两独立样本t检验，组内比较采用配对t检验，偏态分布计量资料用M（Q1，Q3）表示，组间比较采用秩和检验；计数资料以［例（%）］表示，组间比较采用χ2检验。以P<0.05 为差异有统计学意义。 结果： 模板组与徒手组在年龄（t=1.16，P=0.253）、肿瘤体积［（71±26）比（71±22）cm3，t=0.21，P=0.837］等基线水平比较，差异均无统计学意义（均P>0.05）。45例患者均顺利完成手术操作。模板组患者术前验证剂量参数90%靶区体积受照剂量（D90）、100%处方剂量所占体积（V100）、适形度指数（CI）、均匀性指数（HI）、靶区外体积指数（EI）与术后计划比较［（131.0±2.1）比（131.1±5.5）Gy，90.0%±0.4%比91.0%± 2.8%，0.83±0.07比0.82±0.05，41%±11%比37%±13%，4.3%（2.9%，14.0%）比8.8%（5.2%，14.6%）］，差异均无统计学意义（均P>0.05）。徒手组患者术前验证剂量参数D90与术后计划比较，差异无统计学意义［（131.4±2.9）比（128.6±8.6）Gy，P>0.05］，术前V100、CI、HI、EI与术后计划比较［90.0%±0.5%比89.0%±3.0%，0.84±0.04比0.71±0.09，41%±9%比34%± 10%，7.7%（4.9%，11.0%）比24.2%（14.3%，35.3%），差异均有统计学意义（均P<0.05）。模板组剂量植入质量评估［优85.7%（18/21）、良9.5%（2/21）、中4.8%（1/21）、差0］优于徒手组［优37.5%（9/24）、良 50.0%（12/24）、中12.5%（3/24）、差0］，差异有统计学意义（χ2=10.99，P=0.004）。模板组手术补种粒子数目少于徒手组［2.0（0，2.5）比4.0（2.0，7.0）颗，Z=-3.36，P=0.001］，差异有统计学意义。模板组手CT扫描次数要少于徒手组［（3.9±0.5）比（4.6±1.2）次，t=-2.54，P=0.016］，差异有统计学意义。模板组与徒手组的不良反应发生率分别为［23.8%（5/21）比 33.3%（8/24），χ2=12.86，P=0.002］，差异有统计学意义。 结论： 与徒手穿刺相比，可调角度针道模板辅助下的放射性125I粒子植入，剂量分布更均匀，且剂量学更加优化。而且CT扫描次数、补种粒子数较少，有效降低辐射风险，显著提高了安全性和有效性，具有很好的应用前景。.