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3D打印技术,英文名称为three-dimensional printing technology,是指运用计算机将目标物体数字化,然后通过3D打印机将某些特定材料采用分层加工、叠加成型的打印方式来快速构成物体的技术。该技术能简便快捷地制造出某些结构复杂的物体,大大提高了生产效率和精确度,同时节省了生产材料和人力资源。3D打印技术因其个体化制作、精确度高、操作简单等特点,在肿瘤放疗领域被广泛应用,如在乳腺癌的放疗中应用3D打印的组织补偿物来改善胸壁皮肤剂量等。相信3D打印技术与放疗的结合会使放疗的精确度和疗效得到显著提升。笔者就3D打印技术在肿瘤放疗中的应用及前景综述如下。
3D打印技术在放疗中的应用与进展
Application and progress of 3D printing technology in radiotherapy
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摘要: 随着3D打印技术的发展和成熟,其在医学领域被广泛应用,尤其在骨科、口腔颌面外科等方面取得了突破性进展。而在肿瘤的放疗领域,创新性地将3D打印技术与放疗技术相结合并应用于临床,可大大提高放疗的精确度和临床疗效,为肿瘤的精确放疗提供有力保障。Abstract: With its rapid development, 3D printing technology has been widely used and achieved breakthrough progress in the medical field, especially in orthopedics, oral and maxillofacial surgery, organ transplantation, and other aspects. As a major cancer treatment, radiation therapy combined with 3D printing technology provides a powerful guarantee for the precise radiotherapy of tumors. This review presents the application and prospects of 3D printing technology in tumor radiotherapy.
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Key words:
- Printing, three-dimensional /
- Neoplasms /
- Radiotherapy
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[1] Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018[J]. CA Cancer J Clin, 2018, 68(1): 7−30. DOI: 10.3322/caac.21442. [2] 中国抗癌协会乳腺癌专业委员会. 中国抗癌协会乳腺癌诊治指南与规范(2017年版)[J]. 中国癌症杂志, 2017, 27(9): 695−759. DOI: 10.19401/j.cnki.1007−3639.2017.09.004.
China Cancer Association Breast Cancer Professional Committee. Guidelines and Guidelines for the Diagnosis and Treatment of Breast Cancer by the China Anti-Cancer Association(2017)[J]. China Oncol, 2017, 27(9): 695−759. DOI: 10.19401/j.cnki.1007−3639.2017.09.004.[3] Butson MJ, Cheung T, Yu P, et al. Effects on skin dose from unwanted air gaps under bolus in photon beam radiotherapy[J]. Radiat Meas, 2000, 32(3): 201−204. DOI: 10.1016/s1350−4487(99)00276−0. [4] Kong M, Holloway L. An investigation of central axis depth dose distribution perturbation due to an air gap between patient and bolus for electron beams[J]. Australas Phys Eng Sci Med, 2007, 30(2): 111−119. DOI: 10.1007/bf03178415. [5] Khan Y, Villarreal-Barajas JE, Udowicz M, et al. Clinical and Dosimetric Implications of Air Gaps Between Bolus and Skin Surface During Radiation Therapy[J]. J Cancer Ther, 2013, 4(7): 1251−1255. DOI: 10.4236/jct.2013.47147. [6] Sharma SC, Johnson MW. Surface dose perturbation due to air gap between patient and bolus for electron beams[J]. Med Phys, 1993, 20(2): 377−378. DOI: 10.1118/1.597079. [7] Vyas V, Palmer L, Mudge R, et al. On bolus for megavoltage photon and electron radiation therapy[J]. Med Dosim, 2013, 38(3): 268−273. DOI: 10.1016/j.meddos.2013.02.007. [8] Su SQ, Moran K, Robar JL. Design and production of 3D printed bolus for electron radiation therapy[J/OL]. J Appl Clin Med Phys, 2014, 15(4): 194−211[2019-02-22]. https://aapm.onlinelibrary.wiley.com/doi/full/10.1120/jacmp.v15i4.4831. DOI: 10.1120/jacmp.v15i4.4831. [9] 王峻峰, 李定宇, 黄章玲, 等. Merkel细胞癌电子线放疗中3D打印补偿物的模拟应用[J]. 中华放射肿瘤学杂志, 2016, 25(9): 999−1002. DOI: 10.3760/cma.j.issn.1004−4221.2016.09.022.
Wang JF, Li DY, Huang ZL, et al. Simulation and application of 3D printed compensator in electron radiation therapy for Merkel cell carcinoma[J]. Chin J Radiat Oncol, 2016, 25(9): 999−1002. DOI: 10.3760/cma.j.issn.1004−4221.2016.09.022.[10] Park JW, Yea JW. Three-dimensional customized bolus for intensity-modulated radiotherapy in a patient with Kimura's disease involving the auricle[J]. Cancer Radiother, 2016, 20(3): 205−209. DOI: 10.1016/j.canrad.2015.11.003. [11] Canters RA, Lips IM, Wendling M, et al. Clinical implementation of 3D printing in the construction of patient specific bolus for electron beam radiotherapy for non-melanoma skin cancer[J]. Radiother Oncol, 2016, 121(1): 148−153. DOI: 10.1016/j.radonc.2016.07.011. [12] 张敏, 赵波, 尹金鹏, 等. 新型3D打印组织补偿物的放疗应用研究[J]. 中华放射肿瘤学杂志, 2017, 26(2): 210−214. DOI: 10.3760/cma.j.issn.1004−4221.2017.02.018.
Zhang M, Zhao B, Yin JP, et al. Application of new three-dimensional printed tissue compensators in radiotherapy[J]. Chin J Radiat Oncol, 2017, 26(2): 210−214. DOI: 10.3760/cma.j.issn.1004−4221.2017.02.018.[13] Park SY, Choi CH, Park JM, et al. A Patient-Specific Polylactic Acid Bolus Made by A 3D Printer for Breast Cancer Radiation Therapy[J/OL]. PLoS One, 2016, 11(12): e0168063[2019-02-22]. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0168063. DOI: 10.1371/journal.pone.0168063. [14] 侯彦杰, 于江平, 王永强, 等. 3D打印胸壁硅胶bolus制作及临床前研究[J]. 中华放射肿瘤学杂志, 2018, 27(9): 835−838. DOI: 10.3760/cma.j.issn.1004−4221.2018.09.010.
Hou YJ, Yu JP, Wang YQ, et al. Fabrication and pre-clinical application of patient-specific 3D silicone rubber bolus for chest wall[J]. Chin J Radiat Oncol, 2018, 27(9): 835−838. DOI: 10.3760/cma.j.issn.1004−4221.2018.09.010.[15] Lindegaard JC, Madsen ML, Traberg A, et al. Individualised 3D printed vaginal template for MRI guided brachytherapy in locally advanced cervical cancer[J]. Radiother Oncol, 2016, 118(1): 173−175. DOI: 10.1016/j.radonc.2015.12.012. [16] Sethi R, Cunha A, Mellis K, et al. Clinical applications of custom-made vaginal cylinders constructed using three-dimensional printing technology[J]. J Contemp Brachytherapy, 2016, 8(3): 208−214. DOI: 10.5114/jcb.2016.60679. [17] 于浪, 连欣, 晏俊芳, 等. 3D打印技术在CT引导宫颈癌术后阴道残端肿瘤近距离治疗中应用[J]. 中华放射肿瘤学杂志, 2016, 25(9): 965−967. DOI: 10.3760/cma.j.issn.1004−4221.2016.09.013.
Yu L, Lian X, Yan JF, et al. Application of 3D printing technology in brachytherapy for vaginal stump tumor after CT-guided cervical carcinoma surgery[J]. Chin J Radiat Oncol, 2016, 25(9): 965−967. DOI: 10.3760/cma.j.issn.1004−4221.2016.09.013.[18] 王云龙, 李昕迪, 赵钰哲. 3D打印技术在阴道癌放射治疗中的应用研究[J]. 中国数字医学, 2018, 13(6): 64−65, 71. DOI: 10.3969/j.issn.1673−7571.2018.06.022.
Wang YL, Li XD, Zhao YZ. Study on the Application of 3D Printing Technology in the Treatment of Vaginal Cancer[J]. China Digit Med, 2018, 13(6): 64−65, 71. DOI: 10.3969/j.issn.1673−7571.2018.06.022.[19] Kaanders JHAM, Fleming TJ, Ang KK, et al. Devices valuable in head and neck radiotherapy[J]. Int J Radiat Oncol Biol Phys, 1992, 23(3): 639−645. DOI: 10.1016/0360−3016(92)90023−B. [20] Nayar S, Brett R, Clayton N, et al. The effect of a radiation positioning stent (RPS) in the reduction of radiation dosage to the opposing jaw and maintenance of mouth opening after radiation therapy[J]. Eur J Prosthodont Restor Dent, 2016, 24(2): 71−77. [21] 涂文勇, 丁继平, 胡海生, 等. 口腔放疗用上下分隔型支架及其制作方法: 中国, CN104043205A[P]. 2014-09-17.
Tu WY, Ding JP, Hu HS, et al. Stent with upper and lower separation for oral radiotherapy and its manufacturing method: CN, CN104043205A[P]. 2014-09-17.[22] 丁继平, 涂文勇, 胡海生, 等. 3D打印口腔支架对舌癌术后调强放疗危及器官的剂量学影响[J]. 中华肿瘤防治杂志, 2015, 22(15): 1221−1225.
Ding JP, Tu WY, Hu HS, et al. Influence on normal tissue dosimetry in intensity-modulated radiotherapy of post-operative lingual carcinoma patients with 3D intraoral stent[J]. Chin J Cancer Prev Treat, 2015, 22(15): 1221−1225.[23] 丁继平, 涂文勇, 胡海生, 等. 基于3D打印技术的个体化口腔放疗支架的设计[J]. 中国医疗器械杂志, 2017, 41(6): 458−459, 468. DOI: 10.3969/j.issn.1671−7104.2017.06.018.
Ding JP, Tu WY, Hu HS, et al. Design of Individualized Oral Radiotherapy Stent Based on 3D Printing Technique[J]. Chin J Med Instrument, 2017, 41(6): 458−459, 468. DOI: 10.3969/j.issn.1671−7104.2017.06.018.[24] Wilke CT, Zaid M, Chung C, et al. Design and fabrication of a 3D-printed oral stent for head and neck radiotherapy from routine diagnostic imaging[J/OL]. 3D Print Med, 2017, 3(1): 12 [2019-02-22]. https://threedmedprint.biomedcentral.com/articles/10.1186/s41205-017-0021-4. DOI: 10.1186/s41205-017-0021-4. [25] Zhao YZ, Moran K, Yewondwossen M, et al. Clinical applications of 3-dimensional printing in radiation therapy[J]. Med Dosim, 2017, 42(2): 150−155. DOI: 10.1016/j.meddos.2017.03.001. [26] 赵家成, 李多杰, 段诗苗, 等. 头颈肩面罩在鼻咽癌调强放疗中的固定效果与精度比较[J]. 中华全科医学, 2012, 10(3): 363, 412.
Zhao JC, Li DJ, Duan SM, et al. The Fix Effects and Accuracy of the Head, Neck and Shoulder Mask in Intensity-modulated Radiotherapy of Nasopharyngeal Carcinoma[J]. Chin J Gen Pract, 2012, 10(3): 363, 412.[27] 吴少雄, 温志祥, 何晓华, 等. 一种新型三维头颈放疗固定装置的研制及临床验证[J]. 癌症, 2002, 21(11): 1265−1266. DOI: 10.3321/j.issn:1000−467X.2002.11.024.
Wu SX, Wen ZX, He XH, et al. Development and clinical verification of a new type of three-dimensional head and neck radiotherapy fixation device[J]. Chin J Cancer, 2002, 21(11): 1265−1266. DOI: 10.3321/j.issn:1000−467X.2002.11.024.[28] Sato K, Takeda K, Dobashi S, et al. Evaluation of the Positional Accuracy and Dosimetric Properties of a Three-dimensional Printed Device for Head and Neck Immobilization[J]. Jpn J Radiol Technol, 2017, 73(1): 57−65. DOI: 10.6009/jjrt.2017_JSRT_73.1.57. [29] Haefner MF, Giesel FL, Mattke M, et al. 3D-Printed masks as a new approach for immobilization in radiotherapy—a study of positioning accuracy[J/OL]. Oncotarget, 2018, 9(5): 6490−6498 [2019-02-22]. http://www.oncotarget.com/index.php?journal=oncotarget&page=article&op=view&path[]=24032&path[]=75562. DOI: 10.18632/oncotarget.24032. [30] 吉喆, 姜玉良, 郭福新, 等. 3D打印模板联合CT引导下放射性粒子植入治疗椎旁/腹膜后恶性肿瘤的剂量学验证观察[J]. 中华医学杂志, 2017, 97(13): 996−1000. DOI: 10.3760/cma.j.issn.0376−2491.2017.13.007.
Ji Z, Jiang YL, Guo FX, et al. Dosimetry verification of radioactive seed implantation with 3D printing template and CT guidance for paravertebral/retroperitoneal malignant tumor[J]. Nat Med J China, 2017, 97(13): 996−1000. DOI: 10.3760/cma.j.issn.0376−2491.2017.13.007.[31] 王皓, 王俊杰, 姜玉良, 等. 3D打印模板联合CT引导125I粒子治疗盆腔复发直肠癌的剂量学分析[J]. 中华医学杂志, 2016, 96(47): 3782−3786. DOI: 10.3760/cma.j.issn.0376−2491.2016.47.003.
Wang H, Wang JJ, Jiang YL, et al. CT guidance 125I seed implantation for pelvic recurrent rectal cancer assisted by 3D printing individual non-coplanar template[J]. Nat Med J China, 2016, 96(47): 3782−3786. DOI: 10.3760/cma.j.issn.0376−2491.2016.47.003.[32] 姜玉良, 王皓, 吉喆, 等. CT引导辅助3D打印个体化非共面模板指导125I粒子治疗盆腔复发肿瘤剂量学研究[J]. 中华放射肿瘤学杂志, 2016, 25(9): 959−964. DOI: 10.3760/cma.j.issn.1004−4221.2016.09.012.
Jiang YL, Wang H, Ji Z, et al. Computed tomography image-guided and personalized 3D printed template-assisted 125-iodine seed implantation for recurrent pelvic tumor: a dosimetric study[J]. Chin J Radiat Oncol, 2016, 25(9): 959−964. DOI: 10.3760/cma.j.issn.1004−4221.2016.09.012.[33] 孙海涛, 姚丽红, 王俊杰, 等. 3D打印非共面模板引导125I粒子组织间近距离治疗盆腔肿瘤个体化设计[J]. 中华放射医学与防护杂志, 2017, 37(7): 485−489. DOI: 10.3760/cma.j.issn.0254−5098.2017.07.002.
Sun HT, Yao LH, Wang JJ, et al. 3D-printing non-coplanar template assisted 125I seed implantation for pelvic tumor: individual template design method[J]. Chin J Radiol Med Prot, 2017, 37(7): 485−489. DOI: 10.3760/cma.j.issn.0254−5098.2017.07.002.[34] 郭福新, 姜玉良, 吉喆, 等. 3D打印非共面模板辅助CT引导125Ⅰ粒子植入治疗锁骨上复发转移癌的剂量学研究[J]. 北京大学学报: 医学版, 2017, 49(3): 506−511. DOI: 10.3969/j.issn.1671−167X.2017.03.022.
Guo FX, Jiang YL, Ji Z, et al. 3D printed template-assisted and computed tomography image-guided 125-iodine seed implantation for supraclavicular metastatic tumor: a dosimetric study[J]. J Peking Univ: Health Sci, 2017, 49(3): 506−511. DOI: 10.3969/j.issn.1671−167X.2017.03.022.[35] 姜玉良, 吉喆, 郭福新, 等. CT引导3D打印非共面模板辅助125I粒子治疗头颈部复发转移癌不良反应研究[J]. 中华放射医学与防护杂志, 2017, 37(7): 495−499. DOI: 10.3760/cma.j.issn.0254−5098.2017.07.004.
Jiang YL, Ji Z, Guo FX, et al. Side effect of radioactive 125I seed implantation for recurrent malignant tumor of head and neck assisted by 3D-printing individual guide plate[J]. Chin J Radiol Med Prot, 2017, 37(7): 495−499. DOI: 10.3760/cma.j.issn.0254−5098.2017.07.004.[36] 吉喆, 姜玉良, 郭福新, 等. 3D打印非共面模板辅助CT引导放射性粒子植入治疗胸部恶性肿瘤剂量学评估[J]. 中华放射肿瘤学杂志, 2017, 26(7): 754−758. DOI: 10.3760/cma.j.issn.1004−4221.2017.07.007.
Ji Z, Jiang YL, Guo FX, et al. Dosimetric assessment of CT-guided radioactive seed implantation assisted by 3D printing non-coplanar template in treatment of chest malignant tumor[J]. Chin J Radiat Oncol, 2017, 26(7): 754−758. DOI: 10.3760/cma.j.issn.1004−4221.2017.07.007.[37] Wang JJ, Zhang FJ, Guo JH, et al. Expert consensus workshop report: Guideline for three-dimensional printing template-assisted computed tomography-guided 125I seeds interstitial implantation brachytherapy[J]. J Cancer Res Ther, 2017, 13(4): 607−612. DOI: 10.4103/jcrt.JCRT_412_17. [38] 王俊杰, 柴树德, 郑广钧, 等. 3D打印模板辅助CT引导放射性125I粒子植入治疗肿瘤专家共识[J]. 中华放射医学与防护杂志, 2017, 37(3): 161−170. DOI: 10.3760/cma.j.issn.0254−5098.2017.03.001.
Wang JJ, Chai SD, Zheng GJ, et al. Expert consensus on 3D-printing template assisted CT-guided radioactive 125I seed implantation brachytherapy[J]. Chin J Radiol Med Prot, 2017, 37(3): 161−170. DOI: 10.3760/cma.j.issn.0254−5098.2017.03.001.[39] Huang MW, Zhang JG, Zheng L, et al. Accuracy evaluation of a 3D-printed individual template for needle guidance in head and neck brachytherapy[J]. J Radiat Res, 2016, 57(6): 662−667. DOI: 10.1093/jrr/rrw033. [40] Ji Z, Jiang YL, Guo FX, et al. Dosimetry verification of radioactive seed implantation for malignant tumors assisted by 3D printing individual templates and CT guidance[J]. Appl Radiat Isot, 2017, 124: 68−74. DOI: 10.1016/j.apradiso.2016.12.009. [41] Han T, Yang XD, Xu Y, et al. Therapeutic value of 3-D printing template-assisted 125I-seed implantation in the treatment of malignant liver tumors[J/OL]. Onco Targets Ther, 2017, 10: 3277−3283[2019-02-22]. https://www.dovepress.com/therapeutic-value-of-3-d-printing-template-assisted-125i-seed-implanta-peer-reviewed-article-OTT. DOI: 10.2147/OTT.S134290. [42] Jiang YL, Ji Z, Guo FX, et al. Side effects of CT-guided implantation of 125I seeds for recurrent malignant tumors of the head and neck assisted by 3D printing non co-planar template[J/OL]. Radiat Oncol, 2018, 13(1): 18[2019-02-22]. https://ro-journal.biomedcentral.com/articles/10.1186/s13014-018-0959-4. DOI: 10.1186/s13014-018-0959-4.
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