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  本文選題：前列腺癌　切入點(diǎn)：PET-CT　出處：《廣西醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討PET-CT在前列腺癌精確大分割放療中生物靶區(qū)勾畫的應(yīng)用,以及3D超聲對前列腺定位和保護(hù)膀胱、直腸的作用。方法:收集初次放療的局限期中高危前列腺癌患者10例,分為A、B兩組。放療前行PSA檢查、前列腺穿刺組織病理確診為前列腺腺癌。A、B兩組患者放療前同時行定位CT和3D超聲檢查、盆腔增強(qiáng)MRI檢查,A組患者加做使用18F-FDG(18氟-脫氧葡萄糖)和11C-CH(11C-膽堿)兩種造影劑的PET-CT檢查。A組患者參考定位CT、3D超聲、MRI和PET-CT勾畫GTVPET、CTV、RPV、CTVnd、PTV;B組患者僅參考定位CT、3D超聲和MRI勾畫CTV、RPV、CTVnd、PTV。放療前使用3D超聲和CBCT兩種引導(dǎo)方式定位,記錄二組誤差數(shù)據(jù),最后將CBCT獲得的位移誤差傳至加速器進(jìn)行修正及移床,然后實(shí)施放療。觀察放療過程中患者出現(xiàn)的各種急性毒副反應(yīng)(如直腸、膀胱、血液學(xué)等),記錄患者初診時、放療前和放療后1月的血清PSA數(shù)值以及影像資料,評價(jià)近期療效。結(jié)果:A組患者CTV體積為71.10±15.78cm3,B組CTV體積為68.45±14.51cm3,P0.05,兩組體積差別沒有統(tǒng)計(jì)學(xué)意義。A組GTVPET體積為6.83±8.05cm3,僅占A組CTV體積的9.6%。A組CTV生物有效劑量(BED)為119.74±1.78Gy,B組CTV的BED為129.20±2.70Gy,A組GTVPET的BED為139.92±3.45Gy。A組CTV的的BED小于B組CTV,而A組GTVPET的的BED大于B組CTV,兩組差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。A、B兩組患者膀胱、直腸的計(jì)劃和實(shí)際受照劑量體積均在正常限制范圍內(nèi)。3D超聲引導(dǎo)獲得的位移誤差在左右方向和上下方向與CBCT引導(dǎo)獲得的位移誤差相似,P0.05,沒有統(tǒng)計(jì)學(xué)差異。超聲引導(dǎo)獲得的位移誤差在前后方向上是3.4±1.4mm,大于CBCT獲得的1.0±0.8mm,P0.01,差異有統(tǒng)計(jì)學(xué)意義。使用3D超聲引導(dǎo)前列腺的同時,可測得膀胱、鄰近直腸體積,確保每次放療時膀胱和直腸的實(shí)際體積與定位時體積大致相等。放療過程中A組有2例患者出現(xiàn)1級骨髓抑制,有1例出現(xiàn)2級泌尿道癥狀,有2例出現(xiàn)1級直腸反應(yīng);B組有1例患者出現(xiàn)1級骨髓抑制,有1例患者出現(xiàn)1級直腸反應(yīng),兩組患者均未出現(xiàn)其他嚴(yán)重早期不良反應(yīng)。從PSA變化趨勢圖可以看出,A、B兩組患者經(jīng)放射治療后PSA均明顯下降,A組患者PSA下降趨勢比B組PSA下降趨勢顯著。結(jié)論:1.PET-CT可應(yīng)用于前列腺癌精確大分割放療中生物靶區(qū)的勾畫,能夠提高局部病灶(DIL)劑量,同時減少臨床靶區(qū)劑量,早期副反應(yīng)和普通大分割放療類似。2.3D超聲可應(yīng)用于引導(dǎo)前列腺癌實(shí)行精確放療,同時能在引導(dǎo)過程中確保膀胱和直腸的實(shí)際體積與定位時體積大致相等。
[Abstract]:Objective: to investigate the application of PET-CT in the mapping of biological target area in prostate cancer with accurate large fractionation radiotherapy, and the role of 3D ultrasound in prostate localization and protection of bladder and rectum. Methods: ten patients with high risk prostate cancer in local stage of initial radiotherapy were collected. The patients were divided into two groups: PSA examination before radiotherapy and localization CT and 3D ultrasound examination before radiotherapy. Pelvic Enhancement MRI in Group A: PET-CT examination with 18F-FDG ~ (18 Fluorodeoxyglucose) and 11C-CHN _ (11C- choline). Group A. patients in Group A with reference location CTV 3D Ultrasound MRI and PET-CT to draw CTVndPTVB only reference CTT 3D Ultrasound and MRI. Before radiotherapy, 3D ultrasound and CBCT were used to guide the localization. Two sets of error data were recorded, and then the displacement errors obtained by CBCT were transmitted to the accelerator to correct and move the bed, then radiotherapy was performed. All kinds of acute side effects (such as rectum, bladder, bladder) were observed during radiotherapy. Hematology, recording the serum PSA values and imaging data of patients at first visit, before radiotherapy and January after radiotherapy. Results the volume of CTV in group B was 68.45 鹵14.51 cm ~ (-3) P 0.05, the volume of GTVPET in group A was 6.83 鹵8.05 cm ~ (3), the BED of CTV in group A was 129.20 鹵2.70 Gy. The BED of GTVPET in group A was 139.92 鹵3.45Gy.A, the BED of CTV in group A was lower than that of group B, while the BED of group A was larger than that of group B, and the difference between the two groups was statistically significant. The displacement error obtained by 3D ultrasound guidance is similar to that obtained by CBCT guidance in the direction of left and right, which is similar to that obtained by CBCT guidance (P 0.05). There is no statistical difference in ultrasonic guidance. The displacement error was 3.4 鹵1.4mm in front and back direction, which was higher than that obtained by CBCT (1.0 鹵0.8mm P0.01), the difference was statistically significant. The volume of bladder and rectum was measured to make sure that the actual volume of bladder and rectum was approximately equal to that of localization. In group A, there were 2 patients with grade 1 bone marrow depression and 1 patient with grade 2 urinary tract symptoms during radiotherapy. There were 2 patients with grade 1 rectal reaction in group B, 1 patient with grade 1 bone marrow depression and 1 patient with grade 1 rectal reaction. There were no other serious early adverse reactions in both groups. It can be seen from the trend map of PSA changes in both groups that the PSA of both groups decreased significantly after radiotherapy. The decrease trend of PSA in group A is significantly higher than that in group B. conclusion: 1. PET-CT. It can be used to delineate the biological target area in prostate cancer with accurate large fraction radiotherapy. It can increase the dose of local lesion and reduce the dose of clinical target area. The early side effects are similar to those of conventional large segment radiotherapy. 2.3D ultrasound can be used to guide prostate cancer to carry out accurate radiotherapy. It can also ensure that the actual volume of bladder and rectum is approximately equal to that of localization.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.25

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