本文選題：全腦放療　切入點(diǎn)：海馬保護(hù)　出處：《鄭州大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景與目的腦轉(zhuǎn)移瘤(Brain metastases,BM)是成人最常見(jiàn)的顱腦腫瘤,發(fā)病率接近于10/10萬(wàn)。BM的實(shí)際發(fā)病率可能比文獻(xiàn)中報(bào)道出來(lái)的還要高,其數(shù)量與日俱增。惡性腫瘤進(jìn)展到BM多提示預(yù)后不良,其頭痛、頭暈、惡心、嘔吐、乏力等癥狀嚴(yán)重降低患者生存質(zhì)量。全腦放療(Whole-brain radiotherapy,WBRT)是BM的標(biāo)準(zhǔn)治療方式之一,其臨床應(yīng)用仍在迅速發(fā)展。WBRT后導(dǎo)致的神經(jīng)認(rèn)知功能(Neurocognitive function,NCF)損傷逐漸引起臨床重視。大量臨床前研究顯示,NCF的減退與放療后海馬(Hippocampal,HP)損傷有關(guān)。海馬保護(hù)性全腦放療(Hippocampal-sparing whole-brain radiotherapy,HS-WBRT)可以保護(hù)HP,從而避免NCF障礙。螺旋斷層放射治療(Helical tomotherapy,TOMO)的發(fā)展使HS-WBRT成為可能,避免BM患者在放療后出現(xiàn)NCF的損傷。本研究將BM患者分為兩組:WBRT組,用傳統(tǒng)三維適形放療(Three dimensional conformal radiotherapy,3D-CRT)兩野對(duì)穿,不保護(hù)HP;HS-WBRT組,用TOMO技術(shù)保護(hù)HP。統(tǒng)計(jì)兩組計(jì)劃的參數(shù)及放療后的NCF評(píng)分,通過(guò)對(duì)比來(lái)探討海馬保護(hù)技術(shù)在WBRT中的可行性,以及保護(hù)HP能夠減輕放療后的NCF損傷的可能性。方法選取鄭州大學(xué)第一附屬醫(yī)院2015年8月至2016年8月期間收治的43例BM患者為研究對(duì)象,22例行WBRT;另外21例行HS-WBRT。統(tǒng)計(jì)兩組的計(jì)劃參數(shù)數(shù)值及NCF評(píng)分。采用SPSS 21.0軟件對(duì)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)處理:兩組計(jì)劃之間的劑量學(xué)、NCF評(píng)分對(duì)比:用W檢驗(yàn)法(Shapiro-Wilk,W test)檢驗(yàn)兩組數(shù)據(jù)的正態(tài)性,Levene法檢驗(yàn)方差齊性:第一,兩組數(shù)據(jù)均服從正態(tài)分布,且符合方差齊性,則應(yīng)用t檢驗(yàn);第二,兩組數(shù)據(jù)服從正態(tài)分布,但方差不齊時(shí),用矯正的t檢驗(yàn),即?檢驗(yàn);兩組數(shù)據(jù)不服從正態(tài)分布時(shí),采用Wilcoxon秩和檢驗(yàn)。組內(nèi)治療前后NCF評(píng)分對(duì)比:數(shù)據(jù)符合正態(tài)性、方差齊性,用配對(duì)t檢驗(yàn);否則應(yīng)用秩和檢驗(yàn)。檢驗(yàn)標(biāo)準(zhǔn):P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果兩組之間計(jì)劃靶區(qū)體積(Planning target volume,PTV)的比較,無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);HI比較:3D-CRT組、TOMO組分別為0.12±0.02、0.36±0.03,對(duì)比有統(tǒng)計(jì)學(xué)意義(P0.05),3D-CRT在靶區(qū)劑量均勻性上優(yōu)于TOMO。兩組之間Dmean(左HP P=0.00;左HP P=0.00)和D max(左HP P=0.00;左HP P=0.00)的比較,具有統(tǒng)計(jì)學(xué)意義(P0.05);在HP受量上TOMO明顯小于3D-CRT組,左HP的Dmean、Dmax分別降至處方劑量的20.14%、35.39%,右HP的Dmean、Dmax降至降至處方劑量的19.92%、35.14%。NCF評(píng)分對(duì)比結(jié)果:兩組治療前和治療后1個(gè)月的NCF評(píng)分的比較均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);兩組間治療后3個(gè)月和治療后6個(gè)月的對(duì)比有統(tǒng)計(jì)學(xué)意義(P0.05)。TOMO組,治療前與治療后比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);3D-CRT組,治療前和治療后1個(gè)月的比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);治療前和治療后3個(gè)月、治療后6個(gè)月的NCF評(píng)分對(duì)比有統(tǒng)計(jì)學(xué)意義(P0.05)。TOMO組NCF評(píng)分優(yōu)于3D-CRT組。未觀察到3級(jí)及以上毒副反應(yīng)。結(jié)論HS-WBRT治療BM是可行的。TOMO能降低HP受量,在一定程度上避免NCF受損;但是在HI上,與3D-CRT相比,TOMO并無(wú)優(yōu)勢(shì)。
[Abstract]:Background and objective brain metastases (brain metastases) are the most common craniocerebral tumors in adults. The actual incidence of brain tumors close to 10/10 million BM may be higher than that reported in the literature. The number of brain metastases is increasing. The progression of malignant tumors to BM indicates poor prognosis. The symptoms of headache, dizziness, nausea, vomiting, fatigue and other symptoms seriously reduce the quality of life of patients. Whole-brain radiation therapy is one of the standard treatments for BM. Its clinical application is still developing rapidly. The neurocognitive function NCFs induced by WBRT have attracted more and more attention. A large number of preclinical studies have shown that the decrease of NCF is related to Hippocampal HPP damage after radiotherapy. Hippocampal-sparing is associated with Hippocampal-sparing. HS-WBRT) can protect whole-brain from NCF disorders. The development of helical radiation therapy makes HS-WBRT possible. In this study, BM patients were divided into two groups: WBRT group. Conventional three-dimensional conformal radiotherapy was used to treat with three dimensional conformal radiotherapytic 3D-CRTRT without protecting HPS-WBRT. The TOMO technique was used to protect HP. the parameters of the two groups and the NCF scores after radiotherapy were counted, and the feasibility of hippocampal protection in WBRT was discussed by comparison. Methods 43 patients with BM admitted from August 2015 to August 2016 in the first affiliated Hospital of Zhengzhou University were selected as study subjects: 22 patients were treated with NCF and 21 patients were treated with HS-WBRT.These patients were treated with HS-WBRT.Methods from August 2015 to August 2016, 43 patients with BM were selected as study subjects, 22 with WBRT and 21 with HS-WBRT. Taking into account the planned parameter values and NCF scores of the two groups. The data were processed statistically with SPSS 21.0 software. The dosimetry scores of the two groups were compared. The normal Levene method was used to test the homogeneity of variance between the two groups of data by using the W test method. If both groups of data are subject to normal distribution and conformance to homogeneity of variance, t test is applied. Second, when two groups of data take normal distribution, but the variance is uneven, the corrected t test is used, that is? Wilcoxon rank sum test was used when the two groups of data were not subject to normal distribution. The NCF scores before and after treatment were compared: the data were consistent with normality and homogeneity of variance, and matched t test was used. Otherwise, the rank sum test was used. The test standard: 0. 05 was statistically significant. Results the planned target volume target volume PTV was compared between the two groups. No statistical significance was found in the HI comparison between the TOMO group and the 3D-CRT group (0.12 鹵0.02 鹵0.36 鹵0.03, respectively). The comparison between the two groups in the dose uniformity of the target area was better than that of TOMO.The Dmean (left HP P0. 00; left HP P0. 00) and D max( left HP P0. 00C; left HP P0. 00C) were compared between the two groups. The TOMO of HP was significantly lower than that of 3D-CRT group. Dmean Dmax of left HP decreased to 20.14 ~ 35.39 of prescription dose, Dmean Dmax of right HP decreased to 19.92 ~ 35.14% of prescription dose: there was no significant difference in NCF score between two groups before treatment and one month after treatment (P 0.05). There were significant differences between months after treatment and 6 months after treatment in the TOMO group. There was no significant difference before and after treatment in P0.05D CRT group, there was no significant difference before treatment and 1 month after treatment, there was no significant difference before and after treatment, and there was no significant difference before treatment and 3 months after treatment. Six months after treatment, there was significant difference in the NCF score between the two groups. The NCF score of the tomo group was better than that of the 3D-CRT group. No toxic and adverse reactions were observed in the 3rd grade group or above. Conclusion HS-WBRT treatment with BM can reduce the level of HP and avoid NCF damage to a certain extent. In HI, however, TOMO has no advantage over 3 D-CRT.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R739.4;R730.55

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