本文選題：上頜竇癌　切入點(diǎn)：調(diào)強(qiáng)放療　出處：《蘇州大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的 通過(guò)比較未行手術(shù)治療的上頜竇癌三維適形放療（3D-CRT）與調(diào)強(qiáng)放療（IMRT）靶區(qū)劑量分布的均勻性、適形性、靶區(qū)劑量情況，以及各危及器官受照體積、劑量情況，評(píng)價(jià)調(diào)強(qiáng)放療較三維適形放療的劑量學(xué)優(yōu)勢(shì)。 方法 選取2010年~2012年在蘇州大學(xué)附屬第一醫(yī)院放療科就診的并經(jīng)病理證實(shí)的上頜竇癌患者5例。將這5例患者治療前的CT定位掃描圖像資料導(dǎo)入3D-TPS工作站。根據(jù)患者M(jìn)RI所顯示出來(lái)的病灶圖像，在CT橫斷面上勾畫出靶區(qū)和危及器官。分別對(duì)每個(gè)病例分別作出3D-CRT計(jì)劃以及5野、7野、9野的IMRT計(jì)劃。評(píng)價(jià)指標(biāo)為：PTV靶體積的適形指數(shù)(CI)、均勻指數(shù)(HI)、V95、D95、Dmax、Dmin和Dmean；危及器官(包括腦干、視交叉、垂體、視神經(jīng)、眼球和晶體)的Dmax和Dmean等。比較這些指標(biāo)在3D-CRT和各組IMRT之間的差異。 結(jié)果 1．靶區(qū)：各組IMRT與3D-CRT相比前者顯著提高了PTV-G的Dmax、V95%和CI值（P0.05）以及PTV-C的Dmax、Dmin和CI值（P0.05）。與3D-CRT相比，各組IMRT顯著降低了PTV-C的V95%（P0.05）。而在PTV-G和PTV-C的靶區(qū)均勻指數(shù)（HI）方面，3D-CRT與各組IMRT相比較都未表現(xiàn)出統(tǒng)計(jì)學(xué)差異（P值分別為0.596和0.103）。此外，各組IMRT間比較，IMRT-5F的PTV-C靶區(qū)適形度較IMRT-7F和IMRT-9F要差，有統(tǒng)計(jì)學(xué)差異（P0.05），靶區(qū)其他的觀察指標(biāo)在各組IMRT計(jì)劃之間無(wú)明顯差別(P0.05)。九野調(diào)強(qiáng)放療的靶區(qū)適形度相對(duì)七野而言并沒(méi)有增加；綜合考慮IMRT-7F有更好的增益比。 2．危及器官：在腦干、視交叉、垂體和視神經(jīng)的保護(hù)方面，各組IMRT均優(yōu)于3D-CRT (P0.05)。IMRT-7F與3D-CRT相比，腦干的Dmean降低了約32.25%；視交叉的Dmax和Dmean分別降低了7.66%和20.92%；垂體的Dmax和Dmean分別降低了17.19%和34.10%；同側(cè)視神經(jīng)的Dmax和Dmean分別降低了約5.19%和15.53%；對(duì)側(cè)視神經(jīng)的Dmax和Dmean分別降低了約7.20%和12.80%。而眼和晶體的各觀察指標(biāo)均為各組IMRT計(jì)劃大于3D-CRT（P0.05）。所有的危及器官，，除腦干Dmean值IMRT-7F小于IMRT-5F和IMRT-9F外（P0.05），其他指標(biāo)在各組IMRT計(jì)劃中均無(wú)明顯差別(P0.05)。 結(jié)論 1.3D-CRT和IMRT均能較好地滿足靶區(qū)劑量覆蓋、均勻性和適形性的要求，但在危及器官保護(hù)方面，IMRT明顯優(yōu)于3D-CRT，其中IMRT-7F的增益比較高。 2．增加IMRT照射野的數(shù)目(從5野到9野)并不能明顯提高靶區(qū)的覆蓋率、均勻性和適形性，亦不能明顯降低危及器官的受量。
[Abstract]:Purpose. By comparing the dose distribution in the target area of maxillary sinus carcinoma without surgical treatment (3D-CRT) and IMRTT, the dose distribution of the target area, the radiation volume and dose of each organ at risk, were compared. To evaluate the dosimetric advantages of IMRT over 3 D conformal radiotherapy. Method. From 2010 to 2012, 5 patients with maxillary sinus cancer confirmed by pathology were selected from the radiotherapy Department of the first affiliated Hospital of Suzhou University. The CT scanning images of the 5 patients before treatment were imported into 3D-TPS workstation. The image of the lesion displayed by MRI, The target area and the organ at risk were delineated on the CT cross section. The 3D-CRT plan and the IMRT plan of 5 field and 7 field and 9 field were performed respectively for each case. The evaluation indexes were the conformal index of the target volume of 1: PTV, the homogeneity index, the uniform index, the V95 D95DmaxDmin and the Dmean. the organs (including brain stem) were endangered. Dmax and Dmean of optic chiasma, pituitary, optic nerve, eyeball and lens were compared between 3D-CRT and IMRT. Results. 1. Target area: compared with 3D-CRT, the IMRT of each group significantly increased the Dmaxus V95% and CI value (P0.05) of PTV-G, and the Dmaxn Dmin and CI value of PTV-C (P0.05), compared with 3D-CRT, compared with 3D-CRT, the target area of each group was significantly higher than that of 3D-CRT. IMRT in each group significantly decreased the V95g of PTV-C, but the 3D-CRT of PTV-G and PTV-C showed no significant difference compared with IMRT of each group (P = 0.596 and P = 0.103). In addition, the conformability of PTV-C in IMRT group was lower than that in IMRT-7F and IMRT-9F. There was no significant difference in other observation indexes of target area between the IMRT plan of each group (P 0.05). The conformal degree of target area of NIMRT was not increased compared with that of seven fields, and IMRT-7F had a better gain ratio. 2. Endangering organs: in the protection of brain stem, optic chiasma, pituitary and optic nerve, IMRT in each group was superior to 3D-CRT in P0.05, IMRT-7F and 3D-CRT. Dmean of brainstem decreased about 32.25%; Dmax and Dmean of optic chiasma decreased 7.66% and 20.92; Dmax and Dmean of pituitary decreased 17.19% and 34.10 respectively; Dmax and Dmean of ipsilateral optic nerve decreased about 5.19% and 15.53, respectively; Dmax and Dmean of contralateral optic nerve decreased respectively. About 7.20% and 12.80.All the observation indexes of the eye and lens were that the IMRT plan of each group was greater than 3D-CRTP0.050.All the organs were endangered. Except that the IMRT-7F of brainstem Dmean was lower than that of IMRT-5F and IMRT-9F, there was no significant difference in other indexes in IMRT planning. Conclusion. 1.3D-CRT and IMRT can meet the requirements of target dose coverage, uniformity and conformability, but IMRT is better than 3D-CRT in endangering organ protection, among which the gain of IMRT-7F is higher. 2. Increasing the number of IMRT irradiation fields (from 5 to 9 fields) could not significantly improve the coverage, uniformity and conformability of the target area, nor could it significantly reduce the amount of organ damage.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R739.8

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本文編號(hào)：1580578