發(fā)布時(shí)間：2018-01-08 01:30

  本文關(guān)鍵詞：腮腺癌術(shù)后兩種放療計(jì)劃的劑量學(xué)研究　出處：《吉林大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 腮腺癌 放射治療計(jì)劃 劑量學(xué)

【摘要】：目的:通過(guò)比較腮腺癌術(shù)后容積弧形調(diào)強(qiáng)放療(VMAT)和調(diào)強(qiáng)放射治療(IMRT)兩種放療技術(shù)各自的的優(yōu)劣,為腮腺癌術(shù)后患者臨床放射治療方案選擇上提供相應(yīng)的理論支持,以期選擇最優(yōu)治療方案。材料和方法:自2013年7月至2017年3月在我院放療科接受放療的腮腺癌術(shù)后患者中選取10例分別制定VMAT及IMRT兩種放療計(jì)劃進(jìn)行比較。具體放療范圍包括:術(shù)后瘤床區(qū)(GTVtb)、同側(cè)頸部淋巴引流區(qū)Ib、II區(qū)和III區(qū);以下情況需包括同側(cè)IV區(qū)和V區(qū):局部病灶T3和T4;淋巴結(jié)陽(yáng)性;腫瘤病理類型為低分化。放療劑量為瘤床區(qū)(PGTVtb):5936c Gy/212c Gy/28F;預(yù)防區(qū)(PTV):5040c Gy/180c Gy/28F。通過(guò)對(duì)比兩種放療技術(shù)靶區(qū)劑量分布情況及劑量體積直方圖(DVH),比較兩種放療技術(shù)的靶區(qū)適形度指數(shù)(CI)、均勻性指數(shù)(HI)、D95、D5和平均劑量(Dmean);危及器官(包括顳頜關(guān)節(jié)、脊髓、內(nèi)耳、對(duì)側(cè)腮腺及腦干)最大劑量(Dmax)和平均劑量(Dmean)。結(jié)果:(1)放療靶區(qū)劑量分布情況:VMAT計(jì)劃的Dmean、D95和D5均低于IMRT計(jì)劃,三項(xiàng)差異均無(wú)統(tǒng)計(jì)學(xué)意義。(2)CI方面:VMAT和IMRT二者的PGTVtb分別為0.71±0.09和0.57±0.04(P=0.018),P0.05,差異有統(tǒng)計(jì)學(xué)意義;PTV分別為0.82±0.04和0.72±0.03(P=0.003),P0.05,差異有統(tǒng)計(jì)學(xué)意義。HI方面:VMAT和IMRT二者的PGTVtb分別為1.06±0.02和1.14±0.05(P=0.017),P0.05,差異有統(tǒng)計(jì)學(xué)意義;PTV分別為1.15±0.04和1.23±0.04(P=0.028),P0.05,差異有統(tǒng)計(jì)學(xué)意義。(3)危及器官保護(hù)方面:VMAT和IMRT相比,對(duì)側(cè)腮腺Dmax、脊髓Dmax、腦干Dmax VMAT明顯低于IMRT,其中P0.05,差異有統(tǒng)計(jì)學(xué)意義;內(nèi)耳Dmean高于IMRT,其中P0.05,差異有統(tǒng)計(jì)學(xué)意義;脊髓Dmean、顳頜關(guān)節(jié)Dmean VMAT均小于IMRT,其中P0.05,該差異無(wú)統(tǒng)計(jì)學(xué)意義;對(duì)側(cè)腮腺Dmean、腦干Dmean、內(nèi)耳Dmax、顳頜關(guān)節(jié)Dmax均略高于IMRT,其中P0.05,結(jié)果不具有統(tǒng)計(jì)學(xué)意義。(4)治療時(shí)間和機(jī)器跳數(shù)方面:容積弧形調(diào)強(qiáng)治療技術(shù)與調(diào)強(qiáng)放療技術(shù)相比,治療時(shí)間和機(jī)器跳數(shù)都明顯減少,差異有統(tǒng)計(jì)學(xué)意義。結(jié)論:VMAT和IMRT均能滿足臨床劑量學(xué)需求,VMAT有更優(yōu)良的靶區(qū)CI和HI;二者均能很好保護(hù)危及器官,并且VMAT優(yōu)于IMRT;在治療時(shí)間及機(jī)器跳數(shù)方面VMAT明顯優(yōu)于IMRT,縮短治療時(shí)間,使治療更加精確。
[Abstract]:Objective: through the parotid carcinoma were compared after volumetric arc intensity-modulated radiotherapy (VMAT) and intensity-modulated radiotherapy (IMRT) for two types of radiation technology to their advantages and disadvantages, provide corresponding theoretical support for the selection of clinical treatment options for patients with parotid carcinoma after operation, in order to select the optimal treatment program. Materials and methods: from from July 2013 to March 2017 in patients receiving radiotherapy in radiotherapy department in our hospital after parotid carcinoma were selected from 10 cases were developed VMAT and IMRT two kinds of radiotherapy were compared. The specific scope includes: postoperative radiotherapy of tumor bed area (GTVtb), ipsilateral cervical lymph drainage area Ib, II area and III area; the following conditions should include the ipsilateral IV and V area: T3 and T4 positive lesion; lymph node; tumor pathological type was low differentiation. The radiation dose to the tumor bed area (PGTVtb): 5936c Gy/212c Gy/28F (PTV); prevention area: 5040c Gy/180c Gy/28F. by comparing the two kinds of technology of target dose distribution 鎯呭喌鍙?qiáng)鍓傞噺浣摽U�鐩存柟鍥�(DVH),姣旇緝涓ょ�嶆攧�枟鎶，

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