本文選題：海馬結(jié)構(gòu) + 認(rèn)知功能　； 參考：《福建醫(yī)科大學(xué)》2012年碩士論文

【摘要】：目的：分析鼻咽癌調(diào)強(qiáng)放療中海馬結(jié)構(gòu)（HF）受照射劑量大小及海馬結(jié)構(gòu)相關(guān)功能的潛在損害，探討鼻咽癌調(diào)強(qiáng)放療中海馬結(jié)構(gòu)保護(hù)的必要性和可行性。 方法：１、回顧性分析行調(diào)強(qiáng)適形放療（IMRT）的不同分期鼻咽癌病例59例，結(jié)合CT-MR圖像融合技術(shù)勾畫海馬結(jié)構(gòu)，，了解不同T分期海馬結(jié)構(gòu)受量，包括Dmax、Dmean、D20、V_(20)等。２、利用韋氏成人記憶力量表中的敏感項(xiàng)目對其中51例放療后1年病人（分為T1-2組和T3-4組）行記憶力相關(guān)的神經(jīng)認(rèn)知功能檢測比較，同時比較相匹配的鼻咽癌放療前病人和健康人各30例的各項(xiàng)記憶力檢測結(jié)果差異。３、選擇T3、T4期病人39例，比較海馬結(jié)構(gòu)劑量保護(hù)前后的計(jì)劃優(yōu)化設(shè)計(jì)中海馬結(jié)構(gòu)、腫瘤靶區(qū)及其它危及器官劑量學(xué)數(shù)據(jù)。 結(jié)果：１、在59例鼻咽癌病人調(diào)強(qiáng)適形放療中，HF受照劑量值為：Dmax11.1～78.2Gy（均值52.7Gy），Dmean3.2～44.6Gy（均值18.7Gy）, D204.5～64.1Gy（均值29.0Gy），V_(20)0～87.1%（均值35.7%）；其中鼻咽癌T1-2期與T3-4期海馬結(jié)構(gòu)受照劑量Dmax、Dmean分別為40.8±9.4Gy、12.5±5.1Gy和58.6±14.8Gy，21.8±9.3Gy。２、記憶力相關(guān)的神經(jīng)認(rèn)知功能檢測顯示：放療后T1-2期組和T3-4期組除“數(shù)字廣度－逆向”無顯著差異外，其余各項(xiàng)均有統(tǒng)計(jì)學(xué)意義，T3-4組病人的認(rèn)知功能明顯低于T1-2期組；鼻咽癌放療前病人和健康人在聯(lián)想學(xué)習(xí)、數(shù)字累加、數(shù)字廣度、視覺再生方面檢測結(jié)果無顯著差異。３、在海馬結(jié)構(gòu)保護(hù)的計(jì)劃方案中，海馬結(jié)構(gòu)受照劑量明顯降低，尤其HF受照劑量，與海馬結(jié)構(gòu)沒有保護(hù)的計(jì)劃相比：Dmean均值從21.8Gy減少到15.3Gy，減少約29.8%；D20均值減少約38.1%；20Gy及20Gy以上的受照體積顯著減少，大于55%以上，而靶區(qū)及重要器官的劑量無明顯改變。 結(jié)論：鼻咽癌調(diào)強(qiáng)放療中，海馬結(jié)構(gòu)可受到較大劑量和體積的照射，特別在T3-4期病人，并可導(dǎo)致海馬結(jié)構(gòu)功能相關(guān)的認(rèn)知功能損害；利用調(diào)強(qiáng)適形放療技術(shù)可顯著減少海馬結(jié)構(gòu)受照劑量，同時對靶區(qū)及其它危及器官放療計(jì)劃無明顯影響。因此，鼻咽癌放療中應(yīng)該關(guān)注海馬結(jié)構(gòu)的劑量，或?qū)⑵淞袨樾枰^察劑量的重要正常組織加以研究。
[Abstract]:Objective: to analyze the potential damage of dose and function related to hippocampal formation in intensity modulated radiotherapy (IMRT) of nasopharyngeal carcinoma (NPC), and to explore the necessity and feasibility of Hippocampal structure protection in intensity modulated radiotherapy (IMRT) of nasopharyngeal carcinoma (NPC). Methods: one, 59 patients with different stages of nasopharyngeal carcinoma underwent IMRT were retrospectively analyzed. The hippocampal structure was delineated with CT-MR image fusion technique to understand the amount of hippocampal structure in different T stages. Including Dmaxor Dmean D20 / VARD20, etc., 51 patients (divided into T1-2 group and T3-4 group) were tested for memory related neurocognitive function using sensitive items in Wechsler Adult memory scale (Wechsler Adult memory scale) one year after radiotherapy. At the same time, the memory test results of 30 patients with nasopharyngeal carcinoma before radiotherapy and 30 healthy persons were compared. 39 patients with stage T3T 4 were selected to compare the hippocampal structure before and after dose protection. Dosimetric data of tumor target and other dangerous organs. Results: 1, in 59 patients with nasopharyngeal carcinoma (NPC), the dose value of HF was: Dmax11.1 78.2 Gy (mean 52.7 Gyr Dmean 3.2Gy.64.6Gy) (mean 18.7Gy, D204.5N 64.1Gy (mean 29.0Gy): 20087.1Gy (mean 35.77.1.The Dmean of Hippocampal formation in T1-2 stage and T3-4 stage were 40.8 鹵9.4Gy 12.5 鹵5.1Gy and 58.6 鹵14.8Gy 21.8 鹵9.3Gy.2respectively), and the mean dose of Hippocampal formation in stage T1-2 and T3-4 was 40.8 鹵9.4Gy 鹵5.1Gy and 58.6 鹵14.8Gy / 2respectively. The mean dose of HF radiation was 40.8 鹵9.4Gy 鹵5.1Gy and 58.6 鹵14.8Gy / 2, respectively. The neurocognitive function test showed that there was no significant difference between T1-2 stage group and T3-4 stage group except for "digital breadth-reverse" group after radiotherapy. The cognitive function of the patients in the T3-4 group was significantly lower than that in the T1-2 stage group. There was no significant difference in visual regeneration. 3. In the plan of hippocampal structure protection, the irradiation dose of hippocampal formation, especially HF, was significantly decreased. Compared with the unprotected hippocampal formation, the mean value of 21.8Gy was reduced from 21.8Gy to 15.3Gy, and the mean value of D20 was reduced by about 29.8Gy and 38.1g / 20Gy, and the radiation volume above 20Gy was significantly reduced, more than 55%, while the dose of target area and important organs did not change significantly. Conclusion: in intensity modulated radiotherapy for nasopharyngeal carcinoma, the hippocampal structure may be exposed to large dose and volume of irradiation, especially in patients with stage T3-4, and may lead to cognitive impairment related to hippocampal structure and function. Intensity modulated conformal radiotherapy (IMRT) can significantly reduce the radiation dose to the hippocampal structure, but has no significant effect on the radiation planning of the target area and other dangerous organs. Therefore, we should pay attention to the dose of hippocampus in radiotherapy for nasopharyngeal carcinoma, or consider it as an important normal tissue which needs to be observed.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R739.63

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