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放射性粒子治疗肿瘤,3D打印技术可望减少“多余”剂量

2017-6-13 10:53 | 发布者:Ray 阅读(2985) 评论: 78 mhnznds

导读:文/金羊网记者 张华 通讯员 曾腾 放射性治疗肿瘤已有近一个世纪的历史,从“老式陈旧”的技术发展到今日的“精准打入,定点爆破”,新技术可谓年年有更新。近日,在广州白云国际中心召开的第十七届全国放射性 ...
文/金羊网记者 张华 通讯员 曾腾


放射性治疗肿瘤已有近一个世纪的历史,从“老式陈旧”的技术发展到今日的“精准打入,定点爆破”,新技术可谓年年有更新。近日,在广州白云国际中心召开的第十七届全国放射性粒子治疗肿瘤学术大会上,来自全球知名专家探讨放射性粒子治疗肿瘤存在的问题和未来发展方向。


粒子植入肿瘤内,持续有效灭肿瘤


与体表的放疗不同,放射性粒子(碘—125)近距离治疗肿瘤其特点,首先粒子植入体内后,由内向外定点照射,并不是均匀放疗,越靠近肿瘤位置,放射剂量量越大。而且粒子的半衰期为59.6天(需要60天才能放射一半左右的剂量),可在体内持续照射,从而抑制肿瘤细胞自我修复。


现代医院肿瘤科白海山主任指出,粒子植入治疗恶性肿瘤,最开始在国外广泛运用于男性前列腺癌的治疗,而且主要用于早期的前列腺癌治疗。后来越来越多的肿瘤被证明适用粒子植入疗法,比如女性的子宫颈癌、乳腺癌,再比如肝癌、肺癌以及其他恶性肿瘤的肝、肺转移等。


其实,放射性粒子治疗肿瘤的效果也比较明显。 据大会主席、中国抗癌协会肿瘤微创专业委员侯任主委、中山大学肿瘤防治中心介入科主任、张福君教授介绍,中山大学附属肿瘤医院在每年有300-400例病人采用这种方法治疗。由于副作用小,治疗效果明显,植入一个月后肿瘤就能消失或者减少至少25%的体积。




肺部肿瘤3D打印导板,通过长针准确植入放射性粒子




f04da22e65021aa8c9f23e.png
3D打印导板,通过长针准确植入放射性粒子
在放射性粒子治疗肿瘤的技术上,一直存在一个关键问题。张福君说,目前粒子植入术,放多少剂量主要依靠医生临床经验,虽然放射性例子的高剂量消灭了肿瘤,但是粒子的剂量是否最合理?我们是不是粒子的用量都普遍偏多?


从杀伤肿瘤细胞的角度看,推荐靶区接受的处方剂量,超过处方剂量20%以内时会有治疗上的优势,但当剂量再高(大于处方剂量30%)时就成为“多余”剂量。粒子治疗的病灶,一般在一个月内就消失了,那还有3/4的剂量在体内,剩下的粒子就是多余剂量。这有可能会出现迟发性副作用,比如放射性肺炎。


如何解决这一问题?张福君说,除了医生不断积累临床经验外,3D打印粒子植入治疗新技术应用可能也会帮助解决这一难题。以前放粒子是全凭医生个人经验,3D打印模块技术,定位为三维立体,从平面布点到纵向深浅,再到粒子的剂量,都精确计算,能有效避开血管、神经和骨骼,从而提高布控和操作上的精准度,缩短手术时间、减少病人痛苦。


放射性粒子的植入从“准星靠经验手艺”变成“计算机辅助精准引导”,使这项技术的广泛应用可能大幅提高粒子治疗的有效性和安全性。可以说,消灭肿瘤需要多大的辐射剂量,植入物要放置在哪个位置上才能最为有效的消灭肿瘤,事先都可以进行精确的计算并制定方案。


据记者了解,目前中山大学附属肿瘤医院已经近30位患者采用3D打印粒子植入治疗。张福君说,如果3D打印使得粒子治疗同质化、统一化、标准化,如果能够很好地科学推广,将使粒子技术真正成熟起来,进入肿瘤治疗的主流行列。


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