發(fā)布時(shí)間：2018-03-20 13:24

  本文選題：宮頸癌　切入點(diǎn)：腔內(nèi)放療　出處：《大連醫(yī)科大學(xué)》2014年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的：回顧性分析局部晚期宮頸癌高劑量率192Ir腔內(nèi)放療患者的臨床療效、不良反應(yīng)及預(yù)后相關(guān)因素，探討不同劑量參考點(diǎn)對(duì)劑量學(xué)的影響。 方法：抽取我科30例以A點(diǎn)作為劑量參考點(diǎn)的局部晚期宮頸癌高劑量率192Ir腔內(nèi)放療的患者，參考劑量為4-5Gy/次，8-10次，配合盆腔體外放療（45Gy）。參照國(guó)際輻射單位和測(cè)量委員會(huì)（International Commission on Radiation Unitsand Measurement，ICRU）38號(hào)報(bào)號(hào)對(duì)A點(diǎn)的明確定義。參照美國(guó)近距離治療協(xié)會(huì)（American brachytherapy society，ABS）推薦重新設(shè)置新的劑量參考點(diǎn)H點(diǎn)。根治性放療的累積總劑量將轉(zhuǎn)化為2Gy分次等效生物劑量（equivalent dose in2Gy fractions，EQD2）來(lái)進(jìn)行計(jì)算及劑量評(píng)估，并分析其臨床療效、不良反應(yīng)及預(yù)后相關(guān)因素。對(duì)以A點(diǎn)、H點(diǎn)為參考點(diǎn)的兩種治療計(jì)劃的等劑量曲線(xiàn)內(nèi)參考體積、膀胱及直腸參考點(diǎn)受量進(jìn)行比較。 結(jié)果：1.根治性放療的累積劑量、療效及預(yù)后分析：三組不同劑量分割組A點(diǎn)的累積總劑量（EBRT+ICBT）分別為76.76GyEQD2、80.09GyEQD2、86.34GyEQD2，所有患者A點(diǎn)累積劑量的平均值為83.60GyEQD2。有效率（CR+PR）為96.7%，其中CR為56.7%，PR為40.0%。3年總生存率為63.3%。本資料中膀胱、直腸（1、2級(jí)）急性反應(yīng)發(fā)生率分別10%、26.7%，不同劑量分割組膀胱、直腸急性反應(yīng)在統(tǒng)計(jì)學(xué)上無(wú)顯著差異（P0.05）。Cox單因素分析：腫瘤大小、A點(diǎn)累積劑量及參考體積對(duì)生存的影響有統(tǒng)計(jì)學(xué)意義（P0.05），多因素回歸分析：腫瘤大小、參考體積是影響3年總生存率的獨(dú)立預(yù)后因素，而A點(diǎn)累積劑量并非是影響預(yù)后的獨(dú)立因素。 2.以A點(diǎn)、H點(diǎn)為參考點(diǎn)的兩種治療計(jì)劃的劑量學(xué)比較： （1）不同患者A點(diǎn)沿Y軸方向至兩側(cè)陰道穹窿連線(xiàn)水平的距離為1.670.31cm，，波動(dòng)幅度較大（1.15-2.25cm）； （2）A點(diǎn)、H點(diǎn)距坐標(biāo)原點(diǎn)水平的垂直距離分別為1.6780.238cm、2.1560.448cm，H點(diǎn)的位置高于A點(diǎn)位置（大約0.5cm，P0.05）； （3）以A點(diǎn)、H點(diǎn)為參考點(diǎn)的等劑量曲線(xiàn)內(nèi)參考體積分別為118.88920.955cm3、125.29820.189cm3，基于H點(diǎn)的等劑量曲線(xiàn)內(nèi)參考體積要更大（P0.05）；其中，參考體積的徑線(xiàn)高度（dh）分別為6.7300.642cm、6.8900.672cm、寬度（dw）分別為5.0040.235cm、5.0890.213cm，兩組在統(tǒng)計(jì)學(xué)上均有顯著差異（P0.05），厚度（dt）分別為3.5100.227cm、3.5600.239cm，差異無(wú)統(tǒng)計(jì)學(xué)意義（P0.05）； （4）以A點(diǎn)、H點(diǎn)為參考點(diǎn)的兩種治療計(jì)劃的膀胱及直腸參考點(diǎn)劑量的比較：RP劑量分別為65.3996.250GyEQD2、67.5657.124GyEQD2；R1劑量分別為66.4927.089GyEQD2、68.1669.185GyEQD2；R2劑量分別為63.8694.954GyEQD2、65.3165.994GyEQD2； BL劑量分別為79.1857.989GyEQD2、80.7736.774GyEQD2，差異均無(wú)統(tǒng)計(jì)學(xué)意義（P0.05），且膀胱、直腸參考點(diǎn)劑量均未超過(guò)限制劑量。 結(jié)論： 1.不同劑量分割組A點(diǎn)的累積總劑量存在差異（76.76-86.34GyEQD2），且比較各劑量組臨床療效、復(fù)發(fā)或轉(zhuǎn)移、不良反應(yīng)及生存情況在統(tǒng)計(jì)學(xué)上均無(wú)顯著差異。 2.腫瘤大小、A點(diǎn)累積劑量及參考體積是影響局部晚期宮頸癌預(yù)后的相關(guān)因素，其中腫瘤大小及參考體積是影響3年總生存率的獨(dú)立預(yù)后因素，而A點(diǎn)累積劑量并非是影響預(yù)后的獨(dú)立因素。 3.A點(diǎn)的位置因?qū)m頸口解剖結(jié)構(gòu)的變化而存在眾多不確定性，導(dǎo)致A點(diǎn)劑量不能真正反映腫瘤實(shí)際受照射劑量，因此分析A點(diǎn)的累積劑量與療效、復(fù)發(fā)或轉(zhuǎn)移、不良反應(yīng)及生存情況之間是無(wú)顯著相關(guān)性的。 4.H點(diǎn)較A點(diǎn)的重復(fù)性好、可信度高；以H點(diǎn)為參考點(diǎn)的等劑量曲線(xiàn)內(nèi)參考體積要更大，對(duì)靶區(qū)的包繞更充分；同時(shí)能提高對(duì)受浸潤(rùn)宮旁組織的覆蓋，且不會(huì)增加膀胱及直腸的受量。
[Abstract]:Objective: To retrospectively analyze the clinical efficacy, adverse reactions and prognosis related factors of patients with locally advanced cervical cancer treated with high dose rate 192Ir intracavitary radiotherapy, and to explore the influence of different dose reference points on dosimetry.
Methods: a total of 30 cases in our department with A as a reference point dose of locally advanced cervical cancer with high dose rate intracavitary radiotherapy in patients with 192Ir, the reference dose of 4-5Gy/ times, 8-10 times, with the in vitro pelvic radiotherapy (45Gy). According to the International Commission on radiation units and measurements (International Commission on Radiation Unitsand Measurement, ICRU) defined No. 38 reported on A point. According to the American Brachytherapy Society (American brachytherapy, society, ABS) is recommended to set the dose reference point H. The new cumulative total dose of radiotherapy will be converted into 2Gy times of biological effective dose (equivalent dose in2Gy fractions, EQD2) to evaluate the calculation and dose. And analysis of the clinical efficacy, adverse reactions and the prognostic factors. To A points, H points for the two treatment plans of reference points to the isodose curve within the reference volume, bladder and rectum reference dose Compare.
Results: 1. radical radiotherapy cumulative dose, curative effect and prognosis analysis: the cumulative total dose of three groups of different dose group segmentation point A (EBRT+ICBT) 76.76GyEQD2,80.09GyEQD2,86.34GyEQD2 respectively, the average value of all patients with A cumulative dose of 83.60GyEQD2. efficiency (CR+PR) was 96.7%, CR for 56.7%, PR for the 40.0%.3 year survival rate of 63.3%. in the bladder, rectum (1,2) acute reaction rates were 10%, 26.7%, different dose fractionation group had no significant difference in the bladder, rectum acute reaction in Statistics (P0.05) single factor analysis: tumor size,.Cox had significant effects A cumulative dose and reference volume on survival (P0.05), multi factor regression Analysis: tumor size, reference volume were independent prognostic factors for the 3 year overall survival rate, and A cumulative dose was not independent prognostic factors.
2. the dosimetry comparison of two treatment plans with A point and H point as reference point:
(1) the distance between the A points of different patients along the Y axis to the bilateral vaginal fornix was 1.670.31cm, and the amplitude of the fluctuation was larger (1.15-2.25cm).
(2) A, the vertical distance from the distance between the H coordinate levels were 1.6780.238cm, 2.1560.448cm, H points above the A point (about 0.5cm P0.05);
(3) to A, H as a reference point to the isodose curve in the reference volume were 118.88920.955cm3125.29820.189cm3, H point isodose curve in the reference volume is greater (P0.05); based on the reference volume diameter height (DH) were 6.7300.642cm, 6.8900.672cm, width (DW) were 5.0040.235cm 5.0890.213cm, the two groups had statistically significant difference (P0.05), thickness (DT) were 3.5100.227cm, 3.5600.239cm, the difference was not statistically significant (P0.05);
(4) to A points, H points for the two treatment plans reference points in the bladder and rectum reference point dose comparison: RP dose was 65.3996.250GyEQD2,67.5657.124GyEQD2; dosage of R1 were 66.4927.089GyEQD2,68.1669.185GyEQD2; R2 dose was 63.8694.954GyEQD2,65.3165.994GyEQD2; dosage of BL was 79.1857.989GyEQD2,80.7736.774GyEQD2, there were no significant differences (P0.05), and bladder, rectum the reference point dose did not exceed the limit dose.
Conclusion:
1. there was a difference in cumulative total dose of A point in different dose group (76.76-86.34GyEQD2), and there was no significant difference in clinical efficacy, recurrence or metastasis, adverse reactions and survival between different dose groups.
2. tumor size, cumulative dose and reference volume at A point are the prognostic factors of locally advanced cervical cancer. Tumor size and reference volume are independent prognostic factors for 3 year overall survival rate, while A point cumulative dose is not an independent prognostic factor.
The positions of 3.A for cervical anatomical changes and exist many uncertainties, leading to A point dose not truly reflect the actual tumor radiation dose, therefore the analysis of cumulative dose and efficacy of A, recurrence or metastasis, and survival between the adverse reaction is no significant correlation.
The 4.H point is more repeatable and reliable than the A point. The reference volume of the isodose curve with H reference point as the reference point is larger, and the target area is more wrapped. Meanwhile, it can improve the coverage of the adjacent tissue and increase the volume of the bladder and rectum.

【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R737.33

【參考文獻(xiàn)】

相關(guān)期刊論文 前9條

1 束凱俊,游濤,嚴(yán)懷培;腔內(nèi)與體外照射治療宮頸癌的劑量分布分析[J];河南腫瘤學(xué)雜志;1999年02期

2 周蓓蓓,蔣鵬程,楊宇星,薛惠珍,沈文同;子宮頸癌高劑量率~(192)銥源腔內(nèi)放射治療的劑量學(xué)臨床意義[J];腫瘤防治雜志;2001年01期

3 田琦,何若吉,左雅芳;子宮頸癌的放射治療及影響預(yù)后因素的分析[J];實(shí)用腫瘤學(xué)雜志;2001年01期

4 傅志超;林貴山;李東石;吳建勇;王凱;程惠華;;CT引導(dǎo)下三維腔內(nèi)后裝放療在中晚期宮頸癌治療中的臨床應(yīng)用[J];實(shí)用婦產(chǎn)科雜志;2013年09期

5 辛軍;王丹波;;PET/CT在婦科惡性腫瘤診斷中的價(jià)值[J];中國(guó)實(shí)用婦科與產(chǎn)科雜志;2010年09期

6 馬金平;陳遞林;;~(18)F-氟代脫氧葡萄糖PET/CT在宮頸癌診斷與治療的研究進(jìn)展[J];中華婦幼臨床醫(yī)學(xué)雜志(電子版);2011年03期

7 王慧杰;王朝霞;尚愛(ài)蓮;;宮頸癌高劑量率~(192)Ir腔內(nèi)放療不同劑量分割的臨床研究[J];中華放射腫瘤學(xué)雜志;2007年04期

8 戴曉波,陳曉品,張玲;高劑量率~(192)Ir腔內(nèi)近距離加體外照射治療宮頸癌[J];重慶醫(yī)科大學(xué)學(xué)報(bào);2002年01期

9 孫建衡;婦科惡性腫瘤放射療法現(xiàn)狀[J];中國(guó)醫(yī)學(xué)科學(xué)院學(xué)報(bào);2003年04期

本文編號(hào)：1639265