宮頸癌移位卵巢的位點(diǎn)選擇及其放療防護(hù)的研究
發(fā)布時(shí)間：2018-10-11 11:05
【摘要】：目的：本課題旨在探討需行術(shù)后放療的宮頸癌患者的最佳卵巢移位點(diǎn)以及移位卵巢在盆腔盒式放療中的防護(hù)措施。 方法：在仿真體模上模擬宮頸癌盒式放療，選取體模3個(gè)高度層面、每一層面上5個(gè)“卵巢移位點(diǎn)”，每一位點(diǎn)上分別以垂直及平行皮緣的方式平面布放LiF熱釋光劑量計(jì)，并在中間層面選擇4個(gè)位點(diǎn)，采用與橫截面垂直向下的方式豎直布放劑量計(jì)，分別測(cè)定每一劑量計(jì)在體模接受單次盒式放療（四野均等給量）后的吸收劑量；在放療計(jì)劃系統(tǒng)中對(duì)體模6個(gè)層面、每個(gè)層面上的5個(gè)“移位卵巢”進(jìn)行勾畫并評(píng)估劑量；選取6例宮頸癌患者，分別勾畫出2個(gè)層面、每個(gè)層面上5個(gè)“移位卵巢”，制定四野均等與非均等給量的盒式放療計(jì)劃并評(píng)估劑量。分別使用2mmPb鉛皮、0.35mmPb鉛衣，自制為寬度10cm、5cm的“鉛皮條”，，對(duì)仿真體模進(jìn)行環(huán)繞式全覆蓋防護(hù)，其下界為髂嵴平面，測(cè)定髂嵴上3cm層面垂直向下布放的4粒劑量計(jì)在各種防護(hù)條件下的吸收劑量。 結(jié)果： 1、體模每一層面的同一位點(diǎn)，劑量計(jì)平行及垂直皮緣放置的所測(cè)數(shù)據(jù)相近；同一位點(diǎn)上的劑量計(jì)測(cè)量值與計(jì)劃系統(tǒng)的評(píng)估值較為一致。 2、體模上“移位卵巢”的實(shí)測(cè)劑量隨高度的增加而顯著降低。髂嵴上3cm層面“移位卵巢”的劑量為2.7-3.7Gy（單次劑量乘25所得）。 3、在各測(cè)量方式中的每一高度層面上，靠近后方的2個(gè)“移位卵巢”比側(cè)方的2個(gè)“移位卵巢”在盒式放療中的吸收劑量少；在宮頸癌患者放療計(jì)劃中的2個(gè)層面上有統(tǒng)計(jì)學(xué)意義（P＜0.05）。 4、鉛當(dāng)量2mm，寬度5cm、10cm的“鉛皮條”對(duì)“移位卵巢”的劑量減少為：13.07%、20.63%；鉛當(dāng)量0.35mm，寬度5cm、10cm的“鉛皮條”的劑量減少：12.95%、-2.93%。 結(jié)論： 1對(duì)于接受盒式放療的宮頸癌患者，建議在允許范圍內(nèi)將卵巢至少移至髂嵴上3~4.5cm。 2宮頸癌盆腔盒式放療中，卵巢移位于結(jié)腸旁溝后方較側(cè)方的吸收劑量小。 3“鉛皮條”覆蓋于仿真體模能在一定程度上減少吸收劑量，可能與鉛當(dāng)量與寬度有關(guān)。
[Abstract]:Objective: to investigate the optimal ovarian translocation and the protective measures of ovarian translocation in patients with cervical cancer undergoing postoperative radiotherapy. Methods: cervical cancer boxed radiotherapy was simulated on simulated phantom. Three height layers of phantom were selected, 5 "ovarian translocation points" were selected on each level, and LiF thermoluminescence metering was arranged in vertical and parallel skin margin respectively. At the middle level, four sites were selected and vertical dosimeter was used to measure the absorbed dose of each dosimeter after a single dose box radiotherapy (equal dose in four fields) was given to each dosimeter. In the radiotherapy planning system, the six levels of phantom, the five "translocation ovaries" at each level and the dose were evaluated, and six patients with cervical cancer were selected to draw two layers, five ovaries on each level. Develop four-field equal and unequal dose boxed radiotherapy plan and evaluate dose. The 2mmPb lead coat and the 0.35mmPb lead coat were used respectively, and the "lead strip" with a width of 10 cm or 5 cm was made by ourselves. The simulated phantom was completely covered with circumferential cover. The lower boundary was the iliac crest plane. The absorption dose of 4 grains placed vertically downwards on the 3cm layer of iliac crest under various protective conditions was measured. Results: 1. The data of the same site in each plane of the phantom were similar to those of the parallel and vertical skin margin placed by the dosimeter. The dosimeter measured at the same site was in good agreement with the evaluation value of the planning system. 2. The measured dose of "translocation of ovary" on the phantom decreased significantly with the increase of height. The dose of "ovarian translocation" at the 3cm level on the iliac crest was 2.7-3.7Gy (single dose multiplied by 25). The amount of absorbents in the two "translocated ovaries" near the rear side was less than that in the lateral ones. There was significant difference in the two levels of radiotherapy plan for patients with cervical cancer (P < 0.05). The dose of "lead strip" with lead equivalent of 2 mm and width of 5 cm / 10 cm was reduced to 13.07% 20.63 cm. The lead equivalent of 0.35 mm and the width of 5 cm / 10 cm "lead lice" decreased: 12.95% -2.93%. Conclusion: 1 for patients with cervical cancer receiving box radiotherapy, it is recommended that the ovary be moved to the upper iliac crest at least 34.5 cm 路2 to the extent permitted. The absorption dose of ovarian translocation to the posterior side of the paracolonic sulcus was lower. 3 the "lead lice" covered in the phantom could reduce the absorbed dose to a certain extent, which might be related to the lead equivalent and width.
【學(xué)位授予單位】：川北醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R737.33
本文編號(hào)：2263959
[Abstract]:Objective: to investigate the optimal ovarian translocation and the protective measures of ovarian translocation in patients with cervical cancer undergoing postoperative radiotherapy. Methods: cervical cancer boxed radiotherapy was simulated on simulated phantom. Three height layers of phantom were selected, 5 "ovarian translocation points" were selected on each level, and LiF thermoluminescence metering was arranged in vertical and parallel skin margin respectively. At the middle level, four sites were selected and vertical dosimeter was used to measure the absorbed dose of each dosimeter after a single dose box radiotherapy (equal dose in four fields) was given to each dosimeter. In the radiotherapy planning system, the six levels of phantom, the five "translocation ovaries" at each level and the dose were evaluated, and six patients with cervical cancer were selected to draw two layers, five ovaries on each level. Develop four-field equal and unequal dose boxed radiotherapy plan and evaluate dose. The 2mmPb lead coat and the 0.35mmPb lead coat were used respectively, and the "lead strip" with a width of 10 cm or 5 cm was made by ourselves. The simulated phantom was completely covered with circumferential cover. The lower boundary was the iliac crest plane. The absorption dose of 4 grains placed vertically downwards on the 3cm layer of iliac crest under various protective conditions was measured. Results: 1. The data of the same site in each plane of the phantom were similar to those of the parallel and vertical skin margin placed by the dosimeter. The dosimeter measured at the same site was in good agreement with the evaluation value of the planning system. 2. The measured dose of "translocation of ovary" on the phantom decreased significantly with the increase of height. The dose of "ovarian translocation" at the 3cm level on the iliac crest was 2.7-3.7Gy (single dose multiplied by 25). The amount of absorbents in the two "translocated ovaries" near the rear side was less than that in the lateral ones. There was significant difference in the two levels of radiotherapy plan for patients with cervical cancer (P < 0.05). The dose of "lead strip" with lead equivalent of 2 mm and width of 5 cm / 10 cm was reduced to 13.07% 20.63 cm. The lead equivalent of 0.35 mm and the width of 5 cm / 10 cm "lead lice" decreased: 12.95% -2.93%. Conclusion: 1 for patients with cervical cancer receiving box radiotherapy, it is recommended that the ovary be moved to the upper iliac crest at least 34.5 cm 路2 to the extent permitted. The absorption dose of ovarian translocation to the posterior side of the paracolonic sulcus was lower. 3 the "lead lice" covered in the phantom could reduce the absorbed dose to a certain extent, which might be related to the lead equivalent and width.
【學(xué)位授予單位】：川北醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R737.33
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