【摘要】：目的： 研究局部中晚期鼻咽癌IMRT二次掃描在保護正常組織、提高靶區(qū)劑量及近期療效方面的優(yōu)勢。 實驗方法： 1.對比實驗組病例第一次掃描和第二次掃描BODY、GTVnx、 GTVnd、PGTVnx、PGTVnd、PTV1的體積及脊髓距GTVnx、GTVnd的最短距離,腦干距GTVnx的最短距離,以及雙側(cè)晶體距GTVnx的最短距離的改變。并對比對照組與實驗組第一次掃描GTVnx、 GTVnd、PGTVnx、PGTVnd、PTV1的體積,了解兩組間靶區(qū)體積有無差異。實驗組、對照組靶區(qū)勾畫均由同一影像科教授和同一腫瘤科教授確認(rèn)。 2.收集實驗組運用第二次掃描計劃繼續(xù)放療后脊髓、腦干、雙側(cè)晶體及PGTVnx、PGTVnd、PTV1的劑量分布,并以PGTVnx224cGy/f、PGTVnd212cGy/f、PTV1185cGy/f作為其相應(yīng)的理論劑量,得出PGTVnx、PGTVnd、PTV1相應(yīng)的V100%、V110%、V95%、V93%的相對體積數(shù)值。并收集若以第一次掃描方案繼續(xù)放療上述指標(biāo)的數(shù)值。分析前后兩次掃描高危器官及靶區(qū)的劑量分布。 3.對比實驗組及對照組病人脊髓、腦干、雙側(cè)晶體及PGTVnx、 PGTVnd、PTV1的平均劑量有無差異。 4.在放療結(jié)束3-6月后復(fù)查鼻咽及頸部MRI,評估近期療效。 實驗結(jié)果： 1.用Wilcoxon符號秩檢驗對比第一、二次掃描BODY、GTVnx、 GTVnd、PGTVnx、PGTVnd、PTV1相應(yīng)的體積、脊髓距GTVnd的最短距離,腦干距GTVnx的最短距離,以及雙側(cè)晶體距GTVnx的最短距離,P0.05,差異有統(tǒng)計學(xué)意義。脊髓距GTVnx的最短距離及對照組PGTVnx、PGTVnd、PTV1的體積差異無統(tǒng)計學(xué)意義。 2.對比第二次掃描后放療計劃脊髓、腦干、左右晶體所受劑量及PGTVnx、PGTVnd、PTV1的平均劑量及按一次性計劃放療完成的相應(yīng)劑量,除右側(cè)晶體及脊髓外,第二次掃描危及器官的劑量均較第一次掃描低,靶區(qū)劑量均較第一次掃描高,但是僅左側(cè)晶體的劑量差異有統(tǒng)計學(xué)意義,PGTVnx、PGTVnd、PTV1的V100%、V110%、V95%、V93%兩組對比中,PGTVnd V100%第二次掃描后計劃明顯比第一次掃描后計劃高,P0.05。其余各項兩次掃描后計劃無明顯差異。 3.對比兩組病例脊髓、腦干、左右晶體及PGTVnx、PGTVnd、 PTV1的平均劑量,除左側(cè)晶體及PGTVnx外,實驗組危及器官平均劑量均低于對照組,靶區(qū)劑量均高于對照組,其中,實驗組PTV1的劑量較對照組明顯提高,P0.05。 4.實驗組CR率為41.38%,對照組CR率為31.03%。CR率提高了11.35%。 實驗結(jié)論： 對腫瘤體積較大的局部中晚期鼻咽癌,有必要行二次掃描制定放療計劃使其提高靶區(qū)劑量,保護危及器官,從而提高患者的CR率。
[Abstract]:Objective: to study the advantages of secondary IMRT scan in protecting normal tissue, increasing target dose and short term curative effect of local advanced nasopharyngeal carcinoma (NPC). Experimental method: 1. The volume of BODY,GTVnx, GTVnd,PGTVnx,PGTVnd,PTV1, the shortest distance from spinal cord to GTVnx,GTVnd, the shortest distance from brainstem to GTVnx, and the shortest distance from bilateral lens to GTVnx were compared. The volume of GTVnx, GTVnd,PGTVnx,PGTVnd,PTV1 was compared between the control group and the experimental group. In the experimental group and the control group, the target area drawing was confirmed by the same imaging professor and the same oncology professor. The dose distributions of spinal cord, brain stem, bilateral lens and PGTVnx,PGTVnd,PTV1 were collected by the second scanning plan, and the relative volume value of V 100 V 110 and V 95 V 93% was obtained by using PGTVnx224cGy/f,PGTVnd212cGy/f,PTV1185cGy/f as its corresponding theoretical dose. The values of the above indexes were collected if the first scan was continued. The dose distribution of high risk organs and target area was analyzed before and after twice scanning. The average dose of spinal cord, brain stem, bilateral lens and PGTVnx, PGTVnd,PTV1 were compared between experimental group and control group. 4. Nasopharyngeal and cervical MRI, were reviewed 3-6 months after radiotherapy to evaluate the short-term efficacy. Experimental results: 1. The relative volume of the first and second scanning BODY,GTVnx, GTVnd,PGTVnx,PGTVnd,PTV1, the shortest distance from the spinal cord to GTVnd, the shortest distance from the brainstem to GTVnx, and the shortest distance from bilateral crystals to GTVnx were compared by Wilcoxon sign rank test (P0.05). There was no significant difference between the shortest distance from spinal cord to GTVnx and the volume of PGTVnx,PGTVnd,PTV1 from control group. 2. The dose of spinal cord, brain stem, left and right lens and the average dose of PGTVnx,PGTVnd,PTV1 and the corresponding dose of radiotherapy according to one time plan were compared after the second scan, except for the right crystal and spinal cord. The dose of the second scan was lower than that of the first scan, and the dose of the target area was higher than that of the first scan. However, there was significant difference in the dose of the left crystal only. In the two groups of PGTVnx,PGTVnd,PTV1 V100 and V11010 and V95 / 93%, the plan of PGTVnd V100% after the second scan was significantly higher than that after the first scan (P0.05). There was no significant difference between the other two scans. 3. The average dose of spinal cord, brain stem, left and right lens and PGTVnx,PGTVnd, PTV1 were compared between the two groups. Except for left lens and PGTVnx, the average dose of endangered organs in the experimental group was lower than that in the control group, and the dose in the target area was higher than that in the control group. The dose of PTV1 in the experimental group was significantly higher than that in the control group (P0.05.4). The CR rate in the experimental group was 41.38, and the 31.03%.CR rate in the control group was increased by 11.35%. Conclusion: it is necessary to make radiotherapy plan for locally advanced nasopharyngeal carcinoma with large tumor volume so as to increase the dose of target area and protect the organ so as to improve the CR rate of patients.
【學(xué)位授予單位】：中南大學(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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