本文選題：放射治療 + 頭頸部腫瘤��； 參考：《河北醫(yī)科大學》2017年碩士論文

【摘要】：目的:目前,放療已成為治療腫瘤的三大主流方法之一。在腫瘤放療不斷發(fā)展的過程中,自始至終的目的即是盡可能使腫瘤的局部控制率得到提高,使正常組織并發(fā)癥的發(fā)生率降到最低,從而達到治愈腫瘤的目的。本研究利用CT等影像學工具,在電腦模擬情況下,針對口腔頜面部各部位腫瘤進行三維適形放療,制定放療計劃,在腫瘤靶區(qū)域接受常規(guī)放射線劑量時,通過佩戴個性化口腔矯形器,比較鄰近正常組織受到的劑量體積的不同,來研究其對正常組織器官的保護作用。同時也探討該矯形器對口腔頜面部腫瘤患者三維適形放療靶區(qū)的勾畫,放療計劃設(shè)計的影響,以評價其臨床應用價值,以期臨床推廣應用。方法:選取受試者成年女性一名,進行顱頜面部的螺旋CT掃描,以2mm為層厚,掃描范圍以眉弓為上界,以喉狀軟骨為下界。之后佩戴10mm厚度的口腔矯形器以同樣的體位、標記再次進行CT掃描,務必保證與之前的各項物理參數(shù)相同,減少不必要的誤差。其中口腔矯形器由于腫瘤部位、大小、及被保護器官的不同而形狀各異,佩戴方式也不同,需按照實驗分組進行單獨設(shè)計制作。分別在兩次完成的CT圖像上模擬相同部位和大小的腫瘤病灶,并將其上傳至三維適形放療系統(tǒng),由物理師及醫(yī)師進行三維平面上的放射靶區(qū)勾畫,包括腫瘤區(qū)、臨床靶區(qū)、內(nèi)靶區(qū)、計劃靶區(qū)、治療區(qū)和照射區(qū)以及相鄰重要組織器官區(qū)。根據(jù)模擬病灶腫瘤的T分期,以及被保護器官的不同進行分組,并根據(jù)最新的口腔頜面部惡性腫瘤治療指南給予放療劑量。分組如下:組一:唇癌組,以下頜骨及下頜牙齒為保護器官。PTV設(shè)定為21.6ccm時,給予根治性放療70Gy;PTV設(shè)定為33.2ccm時,給予術(shù)后放療60Gy;組二:舌癌組,以上、下頜骨為保護器官。PTV設(shè)定為31.5ccm時,給予根治性放療70Gy;PTV設(shè)定為47.5ccm時,給予術(shù)后放療60Gy;組三:上頜牙齦癌組,以下頜骨及舌體為保護器官。PTV設(shè)定為15.6ccm時,給予根治性放療70Gy;PTV設(shè)定為17.0ccm時,給予術(shù)后放療60gy;通過三維適形放療設(shè)計系統(tǒng)及配套軟件分析,選擇照射野,以90㳠-95㳠劑量曲線覆蓋腫瘤ptv靶區(qū),測定在給予靶區(qū)常規(guī)放射劑量下被保護器官佩戴矯形器前后的劑量體積變化,記錄數(shù)據(jù),并進行統(tǒng)計學分析。結(jié)果:患者均能順利佩戴各類口腔矯形器進行定位和ct掃描。1唇癌組:實驗數(shù)據(jù)表明,在受到同等強度的放射劑量情況下,佩戴矯形器后,目標器官所受到的劑量體積值均有不同程度的減小。將數(shù)據(jù)進行統(tǒng)計學分析。經(jīng)配對t檢驗結(jié)果,mandible(70gy)組p=0.001(p0.05);teeth(70gy)組p=0.000(p0.05);mandible(60gy)組p=0.009(p0.05);teeth(60gy)組p=0.000(p0.05),認為佩戴前后有明顯差異,有統(tǒng)計學意義,說明佩戴矯形器后正常組織所受到的放射劑量體積值小于未佩戴組。2舌癌組:實驗數(shù)據(jù)表明,在根治性放療和術(shù)后放療兩種情況下,下頜骨作為保護器官,在高劑量區(qū)時(50gy和40gy以上)佩戴矯形器后受到的劑量體積減少,而在低劑量區(qū)時(30gy、20gy、10gy以上)受到的劑量體積值反而增多。上頜骨作為目標器官所受到的劑量體積值均有不同程度的減小。將數(shù)據(jù)進行統(tǒng)計學分析。經(jīng)配對t檢驗結(jié)果,mandible(70gy)組p=0.543(p㧐0.05);maxilla(70gy)組p=0.000(p0.05);mandible(60gy)組p=0.391(p㧐0.05);maxilla(60gy)組p=0.000(p0.05),認為maxilla組佩戴前后有明顯差異,有統(tǒng)計學意義。mandible組無統(tǒng)計學意義。3上頜牙齦癌組:數(shù)據(jù)顯示佩戴矯形器后舌所受到的劑量體積明顯小于未佩戴時的情況。下頜骨則不太明顯甚至低劑量區(qū)所受到的放射體積反而有所增加。將數(shù)據(jù)進行統(tǒng)計學分析。經(jīng)配對t檢驗結(jié)果,mandible(70gy)組p=0.136(p㧐0.05);tongue(70gy)組p=0.002(p0.05);mandible(60gy)組p=0.101(p㧐0.05);tongue(60gy)組p=0.005(p0.05),認為tongue組佩戴前后有明顯差異,有統(tǒng)計學意義。mandible組無統(tǒng)計學意義。結(jié)論:佩戴口腔矯形器能在一定程度上保護正常組織,減少放療射線對鄰近組織器官的損傷,同時由于隔開與固定腫瘤與鄰近組織的空間距離,也有助于三維適形放療設(shè)計中對腫瘤靶區(qū)的勾畫,提高放療的精確度,準確控制劑量分布,值得臨床推廣。
[Abstract]:Objective: at present, radiotherapy has become one of the three main methods for the treatment of tumor. In the course of the continuous development of tumor radiotherapy, the first and final purpose is to improve the local control rate of the tumor as far as possible, to minimize the incidence of normal tissue complications, and to achieve the purpose of curing the tumor. This study uses CT and other imaging studies. In the case of computer simulation, a three-dimensional conformal radiotherapy for tumors in the oral and maxillofacial region is carried out, and the radiotherapy plan is planned. The dose volume of the adjacent normal tissue is compared by wearing a personalized oral orthosis to study the protection of the normal tissues by using the individual oral orthosis to compare the dose volume of the adjacent normal tissues. At the same time, the effect of the orthopedics on the three-dimensional conformal radiotherapy target area of oral and maxillofacial tumor patients and the effect of radiotherapy plan design are also discussed in order to evaluate the clinical application value of the orthopedics in order to evaluate the clinical application value. Method: select the adult female one in the subjects, carry on the spiral CT scan in the craniofacial face, take the 2mm as the thickness, and the scanning range of the eyebrow bow as the upper part. The boundary is the lower boundary of the laryngeal cartilage. Then the oral orthosis with the thickness of 10mm is marked again with the same body position, and the CT scan is marked again. It is necessary to ensure the same physical parameters as before, and reduce the unnecessary error. In the same way, we should design and make a separate design according to the experimental group, simulate the tumor lesion of the same location and size on the two CT images, and upload it to the three-dimensional conformal radiotherapy system. The physical division and the doctor carry out the radiation target area on the three-dimensional plane, including the tumor area, the clinical target area, the target area, the planned target area, the treatment area and the treatment area. The irradiated area and the adjacent important tissues and organs were grouped according to the T staging of the tumor and the different protective organs, and the radiotherapy dose was given according to the latest oral and maxillofacial malignant tumor treatment guidelines. Group 1: the group of lip cancer, the following jaw and lower jaw teeth as the protective organ.PTV set as 21.6ccm Radical radiotherapy 70Gy; PTV set for 33.2ccm, give postoperative radiotherapy 60Gy; group two: tongue cancer group, above, the mandible for protective organ.PTV set to 31.5ccm, give radical radiotherapy 70Gy; PTV set 47.5ccm, give postoperative radiotherapy 60Gy; Group Three: maxillary gingival cancer group, the following jaw and tongue body for.PTV setting 15.6ccm, when jaw and tongue body for protective organ for 15.6ccm, given.PTV to organ organs 15.6ccm, given organ protection organ when the jaw and tongue body for protected organ.PTV when 15.6ccm, given 15.6ccm, given 15.6ccm, given organ.PTV to 15.6ccm, given 15.6ccm, given.PTV organ organs organs organ organs when jaw and lingual body organs for 15.6ccm, given.PTV to the organ 15.6ccm, given jaw and tongue body for protective organs when jaw and tongue body for protected organs when the jaw and tongue body for protected organ.PTV when 15.6ccm, given 15.6ccm, given 15.6ccm, given.PTV organ organ organs jaw and lingual body organs, jaws and tongue body, The radical radiotherapy 70Gy was given; when the PTV was set as 17.0ccm, the postoperative radiotherapy 60Gy was given. Through the three-dimensional conformal radiotherapy design system and the software analysis, the radiation field was selected and the dose curve of the tumor PTV target area was covered with 90? -95? Dose curve, and the dose volume changes before and after the protective organs were worn under the conventional radiation dose of the target area were measured, and the data were recorded. Results: all the patients were able to wear all kinds of oral orthosis to locate and scan the.1 lip cancer group with CT scan. The experimental data showed that the dose volume value of the target organs decreased to varying degrees after wearing the same intensity of radiation dose, and the data were statistically analyzed. The results of paired t test, mandible (70Gy) group p=0.001 (P0.05), teeth (70Gy) group p=0.000 (P0.05), mandible (60Gy) group p=0.009 (60Gy), showed significant difference before and after wearing, indicating that the dose volume value of normal tissue after wearing orthosis was less than that of the non wearing group of tongue cancer group: The data showed that under the two cases of radical radiotherapy and postoperative radiotherapy, the dose volume of the mandible as a protective organ was reduced after the orthosis was worn (50gy and 40gy above) in the high dose area, while the dose volume increased in the low dose area (30Gy, 20GY, 10GY above). Volume values were reduced in varying degrees. The data were statistically analyzed. After paired t tests, mandible (70Gy) group p=0.543 (P? 0.05); maxilla (70Gy) group p=0.000 (P0.05); mandible (60Gy) group p=0.391 (0.05). Statistical significance of the.3 maxillary gingival cancer group: the data showed that the dose of the tongue was significantly smaller than that of the non wearer when the orthosis was worn. The volume of the radiation was increased in the lower jaw or in the low dose area. The data were statistically analyzed. The results of the paired t test, the p=0.136 (P? 0.05) of the group of mandible (70Gy); Tongue (70Gy) group p=0.002 (P0.05); mandible (60Gy) group p=0.101 (P? 0.05); tongue (60Gy) group p=0.005 (P0.05). There was no significant difference between before and after wearing. Conclusion: wearing oral orthosis can protect normal tissues to a certain extent and reduce the damage to adjacent tissues and organs by radiotherapy. Injury, at the same time, because of the space distance between the isolated and fixed tumor and adjacent tissue, can also help to draw the target area of the tumor in the design of three-dimensional conformal radiotherapy, improve the accuracy of radiotherapy, control the dose distribution accurately, and be worthy of clinical promotion.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R739.8

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