Fractionated High-Dose-Rate Stereotactic Brachytherapy in the Management of Malignant Gliomas

惡性膠質細胞瘤之立體定位分次高劑量率近接治療

陳文政(Wen-Cheng Chen) ； 葉健一(Jami Yeh) ； 湯國政(Simon G. Tang) ； 魏國珍(Kuo-Chen Wei) ； 賬承能(Chen-Nen Chang) ； 黃英強(Y. C. Huang)

《放射治療與腫瘤學》 2卷2期 (1995/06) Pp. 115-121

https://doi.org/10.6316/TRO/199502(2)115

摘要

高劑量率立體定位近接治療技術已成功被引進，用於治療惡性膠質細胞瘤之病患。首先，先將CRW鐵環固定於病人頭上，戴上電腦斷層定位框後，病人接受電腦斷層掃描。電腦斷層影像經由光碟片傳送至三度空間治療計劃軟體(BrainSCAN)。先前之治療計劃，經由導管數目、位置及各導管內射源停留的位置及時間的決定而產生。最主要的目標是使標的體積內達到最均勻的劑量，而在標的體積外的劑量快速遞減。一旦決定好治療計劃，病人再送至開刀房。依據先前的治療計劃，腦神經外科醫師使用手鑽在頭殼上打一個小洞，再將導管置入預定位置中。藉著互相垂直方向照得的X光片，可以驗證真王導管及先前治療計劃導管位置的差異。經過適當地調整射源位置及停留時問以彌補導管位置的誤差，再將病人以MicroSelectron後荷治療機施行治療。根據我們的初步經驗，已開始進行第一/二相的研究試驗。

關鍵字

膠質細胞瘤 ； 近接治療 ； 高劑量率 ； 立體定位

並列摘要

A stereotactic high-dose-rate brachytherapy technique has recently been implemented for the treatment of malignant gliomas. A Cosman-Roberts-Wells (CRW) base ring is attached to the patient's skull with a CT localization frame attached to the base ring. The patient undergoes a contrast enhanced CT scanning. The CT images are transferred to the three-dimensional stereotactic brachytherapy treatment planning system (Brain-SCAN) through optical disc. Then the pre-plan is generated to determine the number of catheters, the location of each catheter, the source positions in each catheter and the implant time. The goal is to provide a steep dose fall off outside the target volume while providing the best possible dose homogeneity within the target volume. Once the plan is approved, the patient is taken to the operation room. According to the pre-plan data, neurosurgeons make a small hole by twist-drill on the skull and then place the catheters into the desired location. Later on, the real positions of catheters in the brain are verified by orthogonal radiographics and compare with the preplanned positions. After adjusting the implant time and position of each seed to compromise the position deviation of catheters, the patient is treated with MicroSelectron unit. High activity Ir-192 source is afterloaded into the catheters by remote-control system. Based on our preliminary experience, a phase I/II clinical study has been initiated.

並列關鍵字

Glioma ； Brachytherapy ； High-dose-rate ； Stereotactic