本文選題：乳腺癌　切入點：改良根治術　出處：《昆明醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：[目的]:研究比較左乳腺癌改良根治術后胸壁電子線照射、X線調(diào)強照射、X線和電子線混合調(diào)強照射三種放療計劃的劑量學特點。[方法]:選取2014年12月至2015年9月昆明醫(yī)科大學第三附屬醫(yī)院收治的女性中晚期左側(cè)乳腺癌改良根治術后患者16例,左胸壁表面墊5mm厚度的等效填充物,用熱塑體膜固定后行CT定位,用Pinnacle39.10三維調(diào)強治療計劃系統(tǒng)對每位患者分別設計三種胸壁放射治療計劃:電子線照射計劃(E計劃)、X線調(diào)強照射計劃(IMRT計劃)、X線和電子線混合調(diào)強照射計劃(IMRT+E計劃),并對三種計劃靶區(qū)和危及器官的劑量學參數(shù)進行評估和比較。[結(jié)果]:1.靶區(qū)劑量學比較結(jié)果:三種計劃所有靶區(qū)劑量學參數(shù)的組間比較,差異均有統(tǒng)計學意義(P0.05);靶區(qū)適形指數(shù)CI: IMRT+E計劃最好,E計劃最差;IMRT+E計劃與E計劃、IMRT計劃之間的兩兩比較差異有統(tǒng)計學意義(P0.05);靶區(qū)均勻性指數(shù)HI: IMRT計劃最好,E計劃值最差;E計劃與IMRT計劃、IMRT+E計劃之間的兩兩比較差異均有統(tǒng)計學意義(P0.05);機器跳數(shù)MU: E計劃出束時間最短,IMRT+E計劃時間最長,差異有統(tǒng)計學意義(P0.05)。2.危及器官劑量學比較結(jié)果:(1)危及器官肺:三組計劃左肺的Vs、V10、右肺Dmean等參數(shù)的組間比較差異有統(tǒng)計學意義(P0.05) , E計劃最小,IMRT+E計劃最大,E計劃優(yōu)于IMRT+E計劃和IMRT計劃,尤其對于左肺V5及右肺Dmean差異顯著(P0.05);左肺V20: IMRT計劃最小,E計劃最大;IMRT計劃明顯優(yōu)于E計劃和IMRT+E計劃(P0.05);全肺Dmean、V20: IMRT計劃最小,差異均沒有統(tǒng)計學意義(P0.05)。(2)危及器官心臟:V10、Dmean: E計劃值最低,IMRT+E計劃值最高;E計劃明顯優(yōu)于IMRT計劃和IMRT+E計劃(P0.05) ; V30: E計劃值最低,IMRT計劃值最高;E計劃明顯優(yōu)于IMRT計劃(P0.05)。(3)右乳Dmean:E計劃要優(yōu)于IMRT計劃值和IMRT+E計劃,差異有統(tǒng)計學意義(P0.05);脊髓Dmax: IMRT計劃最低,IMRT+E計劃最高,均在限定范圍內(nèi)。[結(jié)論]:E計劃靶區(qū)的均勻性和適形度最差,但對左肺的低劑量體積、心臟及對側(cè)乳腺的保護上優(yōu)于IMRT計劃和IMRT+E計劃;IMRT計劃靶區(qū)分布最均勻,適形度也較好,但增加了心臟及肺的低劑量受照體積,在危及器官的保護上存在不足;IMRT+E計劃在整體的靶區(qū)分布上表現(xiàn)最好,體現(xiàn)出明顯優(yōu)勢,但是在危及器官的保護上表現(xiàn)最差,且治療時間最長、操作復雜。乳腺癌改良術后胸壁放療應根據(jù)患者自身胸壁輪廓、胸壁厚度不同,選擇合適的射線種類、能量、等效填充物的厚度以及放療技術制定出個性化放療方案。
[Abstract]:[objective]: to compare the dosimetric characteristics of three radiotherapy plans of chest wall electron ray irradiation after modified radical mastectomy for left breast cancer. [methods] from December 2014 to September 2015, three radiotherapy plans, intensity modulated X-ray and mixed intensity modulated electron irradiation, were compared. Sixteen female patients after modified radical mastectomy for middle and late stage breast cancer were treated in the third affiliated Hospital of Kunming Medical University. The 5mm thickness of the left chest surface pad was fixed with thermoplastic membrane and then fixed with CT. Three kinds of chest wall radiotherapy plans were designed for each patient by using the Pinnacle39.10 three dimensional intensity modulated treatment plan system: electron ray radiation plan E plan X ray intensity modulated radiation plan / IMRT plan and mixed intensity modulated X-ray radiation plan / IMRT E meter. The dosimetric parameters of the three planned target areas and organ hazards were evaluated and compared. [results] 1.The dosimetry comparison of the target areas: comparison of dosimetry parameters of all target areas in the three plans, The difference was statistically significant (P 0.05); the target area conformability index (CI) was the best in IMRT E plan and the worst in E plan. There was a significant difference between IMRT E plan and E plan (P 0.05); the target area uniformity index (HI): IMRT plan was the best one. There were statistically significant differences between the worst plan and IMRT plan (P 0.05), and the shortest beam time of plan MUE was the shortest time of plan IMRT E, and the time of plan IMRT E was the longest. The difference was statistically significant (P 0.05. 2.The results of endangering organ dosimetry: 1) endangering organ lung: the difference between three groups of parameters such as Vslr V10 of left lung and Dmean of right lung was statistically significant (P0.05), and the minimum of plan E was the maximum of IMRTE plan (P0.05), and the difference was significant (P0.05) between the three groups in the parameters of left lung, right lung, etc. (P < 0.05). Better than the IMRT E and IMRT plans, Especially for the left lung V5 and the right lung Dmean, the left lung V20: IMRT plan, the minimum E plan and the maximum IMRT plan were significantly superior to the E plan and the IMRT E plan, and the whole lung Dmean V20: IMRT plan was the smallest, especially for the left lung V5 and the right lung. No significant difference was found between the two groups (P < 0.05, P < 0.05, P = 0. 05)) the lowest Dmean: e plan value was lower than IMRT plan and IMRT E plan (P 0. 05), and V30: e plan value was lower than that of IMRT plan, and the lowest value of V30: e plan was significantly better than that of IMRT plan (P < 0. 05), and the lowest value of V30: e plan was higher than that of IMRT E plan (P < 0. 05). The right breast Dmean:E plan was superior to IMRT plan value and IMRT E plan. The difference was statistically significant (P 0.05), spinal cord Dmax: IMRT was the lowest and IMRT E was the highest, all of them were within a limited range. [conclusion] the uniformity and conformability of the target area of Plan E was the worst, but the low dose volume of left lung was the lowest. The protection of heart and contralateral mammary gland was better than that of IMRT and IMRT E plan. The distribution of target area was the most uniform and the conformal degree was better, but the low dose radiation volume of heart and lung was increased. In the aspect of organ protection, IMRT E has the best performance in the overall target area distribution, showing obvious advantages, but the worst performance in organ protection, and the longest treatment time. The operation is complicated. According to the profile of the chest wall and the thickness of the chest wall, we should choose the appropriate radiation type, energy, the thickness of the equivalent fillers and the radiotherapy technology to make the individualized radiotherapy plan according to the breast cancer modified postoperative chest wall radiotherapy.
【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R737.9

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