本文關(guān)鍵詞： 宮頸癌 根治性放療 劑量學(xué)　出處：《中南大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：比較常規(guī)放療、3D-CRT、IMRT及IMAT四種治療計(jì)劃在未手術(shù)宮頸癌根治性放療中的劑量學(xué)差異及優(yōu)劣。 方法：收集14例宮頸癌患者,經(jīng)過嚴(yán)格的膀胱訓(xùn)練后,在充盈膀胱和排空直腸狀態(tài)下行定位CT及MRI掃描獲取影像學(xué)資料,并傳送至TPS工作站進(jìn)行數(shù)字影像重建后,由同一醫(yī)療組勾畫靶區(qū)和危及器官,予以PTV46Gy/23次,并由同一物理師設(shè)計(jì)完成常規(guī)放療、3D-CRT、IMRT、IMAT四種治療計(jì)劃,觀察其平面劑量分布圖和劑量體積直方圖(Dose Volume Histogram,DVH),計(jì)算并比較4種治療計(jì)劃在滿足處方劑量要求的等劑量曲線分布及PTV的最大劑量(Dmax)、最小劑量(Dmin)、平均劑量(Dmean)、適形指數(shù)(Comformal Index, CI)、均勻性指數(shù)(Homogeneity Index, HI)和危及器官(直腸、膀胱、腸管、雙側(cè)股骨頭)的受照體積和劑量。 結(jié)果： 1.比較四種不同體外照射在橫斷面、矢狀面、冠狀面的平面劑量分布圖,結(jié)果顯示IMRT和IMAT較其他兩種治療計(jì)劃在PTV46Gy時(shí)更貼近靶區(qū),減少了直腸和膀胱受照體積,而常規(guī)放療和3D-CRT中直腸和膀胱幾乎全部在靶區(qū)內(nèi)；常規(guī)放療時(shí)雙側(cè)股骨頭的部分區(qū)域受46Gy的照射,而其余三種治療計(jì)劃幾乎全部避免了46Gy的照射。 2.四種不同體外照射中,常規(guī)放療Dmax (4877.34±69.2cGy)、 Dmin (2030.54±492.11cGy)、Dmean(4595.25±115.74cGy)與另外三種體外照射3D-CRT(5036.21±31.55cGy、3816.52±192.04cGy、4809.47±20.82cGy)、IMRT(5065.02±53.84cGy、3817.43±356.17cGy、4769.66±29.14cGy)、IMAT(4971.65±117.63cGy、4415.29±213.15cGY、4754.07±72.37cGy)比較差異均有統(tǒng)計(jì)學(xué)意義(P值0.0001；而IMAT與3D-CRT、IMRT比較差異亦有統(tǒng)計(jì)學(xué)意義(P值0.0001)；后二者之間比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。 3.IMRT、IMAT的C1分別為0.64±0.1、0.65±0.17,明顯優(yōu)于常規(guī)放療(0.1±0.06)、3D-CRT(0.32±0.06),P值0.0001。 4.HI在四種不同照射計(jì)劃之間比較差異無統(tǒng)計(jì)學(xué)意義(P=0.233)。 5.常規(guī)放療的危及器宮受量明顯高于其他三種治療計(jì)劃,差異比較均有統(tǒng)計(jì)學(xué)意義(P0.05),尤其在V46、V40、V35時(shí)差異明顯；而IMRT、IMAT的危及器官保護(hù)要優(yōu)于3D-CRT(P0.05), IMRT與IMAT兩者比較除V25以外均無顯著差異(P0.05)。 6.比較IMRT和IMAT機(jī)器跳數(shù)差異有統(tǒng)計(jì)學(xué)意義(1488.86MUvs625.64MU,P0.001)。 結(jié)論： 1.對(duì)未手術(shù)宮頸癌根治性放療的四種不同體外照射計(jì)劃比較的結(jié)果顯示IMRT和IMAT在劑量學(xué)、靶區(qū)適形度、對(duì)危及器官的保護(hù)均明顯優(yōu)于常規(guī)放療和3D-CRT,說明IMRT、IMAT較常規(guī)放療和3D-CRT具有明顯的優(yōu)勢(shì),可臨床應(yīng)用于宮頸癌根治性放療。 2. IMAT與IMRT在靶區(qū)適形度、均勻性以及對(duì)危及器官的保護(hù)相當(dāng),但I(xiàn)MAT的跳數(shù)明顯小于IMRT,能明顯縮短治療時(shí)間。
[Abstract]:Objective: to compare the dosimetric differences and advantages of conventional radiotherapy with 3D-CRTIMRT and IMAT in radical radiotherapy for unoperated cervical cancer. Methods: 14 cases of cervical cancer were collected. After strict bladder training, CT and MRI scans were performed under filling bladder and emptying rectum to obtain imaging data. After transferring to TPS workstation for digital image reconstruction, the same medical group drew the target area and endangered organs, gave PTV46Gy/23 times, and designed by the same physicist to complete the routine radiotherapy. The planar dose distribution and dose volume histogram (Dose Volume Histogramma DVHs) of 3D-CRT / IMRT / IMAT were observed. Four treatment plans were calculated and compared in the distribution of isodose curve to meet the prescribed dose requirements, and the maximum dose of PTV, the minimum dose of Dmina, and the average dose of Dmean) were calculated and compared. Conformal Index, CIN, homogeneity Index, HIX, and endangering organs (rectum, bladder, intestine). The volume and dose of exposure to the bilateral femoral head. Results: 1. To compare the plane dose distribution of four kinds of external irradiation in cross section, sagittal plane and coronal plane. The results showed that IMRT and IMAT were closer to the target area during PTV46Gy than the other two treatment plans, and reduced the exposure volume of rectum and bladder. In conventional radiotherapy and 3D-CRT, the rectum and bladder were almost all in the target area. Part of the bilateral femoral head was exposed to 46Gy during conventional radiotherapy, while the other three treatment plans almost avoided 46Gy irradiation. 2.In four different kinds of irradiation in vitro, conventional radiotherapy for Dmax was 4877.34 鹵69.2 cGy and Dmin was 2030.54 鹵492.11cGy). Dmean(4595.25 鹵115.74cGy) and the other three kinds of in vitro irradiation 3D-CRT 5036.21 鹵31.55cGy. 3816.52 鹵192.04cGy 4809.47 鹵20.82cGy IMRTT 5065.02 鹵53.84cGy. 3817.43 鹵356.17cGy 4769.66 鹵29.14cGy IMATA 4971.65 鹵117.63cGy. 4415.29 鹵213.15cGYT 4754.07 鹵72.37cGy (P = 0.0001); The difference between IMAT and 3D-CRT IMRT was statistically significant (P = 0.0001). There was no significant difference between the latter two groups (P 0.05). 3. The C1 of IMAT was 0.64 鹵0.1 鹵0.17, which was significantly better than that of conventional radiotherapy (0.1 鹵0.06). 3D-CRT = 0.32 鹵0.06 (P = 0.0001). 4. There was no significant difference in HI between the four different radiation plans. 5. The quantity of pernicious uterus received by conventional radiotherapy was significantly higher than that of the other three treatment plans, and the difference was statistically significant (P 0.05), especially at V46 / V40 / V35. The organ protection of IMAT was better than that of 3D-CRT (P 0.05). There was no significant difference between IMRT and IMAT except V25. 6.Compared with IMRT and IMAT, the difference of hops was statistically significant (1488.86 MUVs 625.64 MUP 0.001). Conclusion: 1. The results of comparison of four different external irradiation plans for radical radiotherapy for unoperated cervical cancer showed that IMRT and IMAT were in dosimetry and target conformability. The protection of endangered organs was obviously superior to that of conventional radiotherapy and 3D-CRT, which indicated that IMAT had obvious advantages over conventional radiotherapy and 3D-CRT. It can be used clinically in radical radiotherapy for cervical cancer. 2.The conformability, homogeneity and protection of IMAT and IMRT in target area were similar, but the hops of IMAT were obviously smaller than that of IMRT, and the treatment time could be shortened obviously.
【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R737.33

【共引文獻(xiàn)】

相關(guān)期刊論文 前10條

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5 羅e，

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