【摘要】：目的:通過(guò)對(duì)鼻咽癌調(diào)強(qiáng)放療患者每周行一次CBCT掃描,觀察腫瘤、解剖結(jié)構(gòu)的體積和位置的變化,并研究因其變化對(duì)劑量分布產(chǎn)生的影響。方法:利用直線加速器自載CBCT,每周采集鼻咽癌患者調(diào)強(qiáng)放療中的CBCT影像,分析患者GTVnx、GTVnd、體表輪廓、腮腺、頜下腺等相關(guān)解剖結(jié)構(gòu)體積及位置動(dòng)態(tài)變化。在放療第21次時(shí)再次對(duì)患者行CT掃描,再勾畫靶區(qū)和危及器官,將基于初始CT設(shè)計(jì)的調(diào)強(qiáng)計(jì)劃射野導(dǎo)入到新掃描CT中,利用TPS計(jì)算比較因解剖結(jié)構(gòu)變化導(dǎo)致的PGTVnx、PGTVnd、腮腺、頜下腺、脊髓、腦干劑量變化情況。結(jié)果:GTVnx、GTVnd、體表輪廓、腮腺、頜下腺等解剖結(jié)構(gòu)的體積逐步退縮、位置發(fā)生移動(dòng),在第21次放療前后時(shí)變化較顯著。除GTVnx變化與初始體積無(wú)關(guān)外,余均與其初始體積大小正相關(guān)。放療21次時(shí),因各種解剖結(jié)構(gòu)變化后,PGTVnd劑量(D95)平均降低169.55 cGy,雙側(cè)腮腺劑量(Dmean)增加175.70cGy、147.45cGy,雙側(cè)頜下腺劑量(Dmean)增加391.15cGy、479.25cGy,脊髓劑量(Dmax)增加68.55cGy,差異均有統(tǒng)計(jì)學(xué)意義(P0.05);PGTVnx劑量D95、腦干劑量Dmax變化不明顯,無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。體表輪廓體積變化與腮腺、GTVnd的體積變化顯著正相關(guān)(P0.05),與PGTVnd、腮腺、頜下腺、脊髓劑量變化有顯著相關(guān)性(P0.05)。結(jié)論:放療中解剖結(jié)構(gòu)體積縮小、位置改變,致PGTVnd劑量降低,腮腺、頜下腺、脊髓劑量增加。體表輪廓變化能一定程度上反映靶區(qū)和危及器官體積和劑量學(xué)變化,是鼻咽癌放療中一個(gè)敏感觀察指標(biāo)。
[Abstract]:Objective: to observe the volume and location of tumor and anatomical structure in patients with nasopharyngeal carcinoma (NPC) treated by intensity modulated radiotherapy (IMRT) once a week, and to study the effect of these changes on dose distribution. Methods: the CBCT images of patients with nasopharyngeal carcinoma (NPC) were collected weekly by linear accelerator self-loaded CBCT, and the volume and location of GTVnx,GTVnd, anatomical structures such as body surface contour, parotid gland and submandibular gland were analyzed. At the 21st time of radiotherapy, the patients were scanned with CT again, and then the target area and the dangerous organs were delineated. The intensity modulated field based on the initial CT design was introduced into the newly scanned CT. The PGTVnx,PGTVnd, parotid gland caused by the anatomic structure change was compared by TPS calculation. Changes of submandibular gland, spinal cord and brain stem dose. Results: the volume of body surface outline parotid gland and submandibular gland of GTVnx,GTVnd, gradually retreated and the position changed significantly before and after 21st radiotherapy. Except for the change of GTVnx which is independent of the initial volume, the remainder is positively correlated with its initial volume. After 21 times of radiotherapy, the average dose of PGTVnd (D95) decreased by 169.55 cGy, the dose of (Dmean) increased by 175.70 cGy (147.45 cGy), the dose of bilateral submandibular gland (Dmean) increased by 391.15cGy (479.25cGy) after 21 times of radiotherapy. The spinal cord dose of (Dmax) increased 68.55 cGy, the difference was statistically significant (P0.05). PGTVnx dose D 95, brainstem dose Dmax changes were not significant, there was no statistical difference (P0.05). The volume of body surface contour was positively correlated with the volume of parotid gland and GTVnd (P0.05), and was significantly correlated with PGTVnd, parotid gland, submandibular gland and spinal cord dose change (P0.05). Conclusion: the volume of anatomical structure was reduced and the position changed during radiotherapy, which resulted in the decrease of PGTVnd dose, the increase of the dose of parotid gland, submandibular gland and spinal cord. The change of body surface profile can reflect the changes of target area and organ volume and dosimetry to some extent, and is a sensitive index in radiotherapy for nasopharyngeal carcinoma (NPC).
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R739.63

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