本文關(guān)鍵詞：鼻咽癌調(diào)強(qiáng)放療中不確定因素的臨床研究　出處：《濟(jì)南大學(xué)》2013年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 鼻咽癌 調(diào)強(qiáng)放療 靶區(qū)勾畫 擺位誤差 器官運(yùn)動(dòng)

【摘要】：目的：鼻咽癌患者調(diào)強(qiáng)放療過程中許多不確定性因素將降低放療計(jì)劃的優(yōu)越性，以往大多數(shù)研究僅關(guān)注其中某一方面，本文研究放療過程中在靶區(qū)勾畫、擺位誤差及器官運(yùn)動(dòng)方面存在的不確定性以更好的指導(dǎo)臨床計(jì)劃靶區(qū)及計(jì)劃危及器官體積的確定，指導(dǎo)臨床進(jìn)行二次計(jì)劃修改的最佳時(shí)機(jī)。 方法：選取我院2011年11月-2012年7月首診經(jīng)病理學(xué)證實(shí)的鼻咽癌患者10例，獲取其計(jì)劃CT圖像及放療過程中第1-5周每周重復(fù)CT掃描圖像。2位醫(yī)師和1位影像醫(yī)師分別勾畫雙側(cè)腮腺、頜下腺和脊髓，研究不同勾畫者間的勾畫差異。將計(jì)劃CT圖像與每周重復(fù)CT圖像融合，于計(jì)劃系統(tǒng)內(nèi)建立空間坐標(biāo)系選取參考點(diǎn)觀察放療過程中每周擺位位移情況，計(jì)算擺位系統(tǒng)誤差及擺位隨機(jī)誤差，進(jìn)而得出計(jì)劃靶區(qū)外擴(kuò)范圍，于計(jì)劃CT和每周重復(fù)CT上逐層勾畫腮腺外輪廓，于計(jì)劃系統(tǒng)內(nèi)計(jì)算每周腮腺體積、位移及實(shí)際受照劑量的變化情況，觀察三者變化最顯著時(shí)刻，并根據(jù)患者每周雙側(cè)腮腺空間中心點(diǎn)空間三維方向位移變化情況確定雙側(cè)腮腺計(jì)劃危及器官體積，隨訪患者放療結(jié)束后3個(gè)月口腔干燥程度并計(jì)算其與腮腺體積及實(shí)際受照劑量之間的相關(guān)性大小。 結(jié)果：脊髓勾畫差異最小為2.7%～4.3%，雙側(cè)頜下腺勾畫差異最顯著分別是5.5%～7.6%和-4.1%～6.2%，雙側(cè)腮腺勾畫差異居中分別為-2.3%～5.6%和-1.4%～3.8%。側(cè)向、上下、前后方向擺位位移分別為（0.93±0.71）mm、（1.12±0.84）mm、（1.21±1.12）mm，擺位系統(tǒng)誤差及擺位隨機(jī)誤差于空間三維方向均2mm，4.5-5mmPTV邊界即足夠。雙側(cè)腮腺放療5周后體積分別較放療前縮小29%-44.9%和28%-57.1%，雙側(cè)腮腺劑量分別為放療前的148.3%-259.4%和198.1%-274.7%，雙側(cè)腮腺中心點(diǎn)于三維方向位移分別為（3.86±3.39）、（4.15±2.17）、（2.89±2.84）；（3.56±2.18）、（3.83±2.96）、（3.25±2.96）。左側(cè)腮腺體積、側(cè)向位移及劑量均于放療第3周變化最顯著，右側(cè)腮腺體積、側(cè)向位移及劑量分別于放療第4周、第2周和第3周變化最顯著，且三者均為放療過程中前3周的變化幅度大于放療過程中后2周的變化幅度�；紓�(cè)腮腺位移變化所致系統(tǒng)誤差最大為2.19mm，健側(cè)腮腺位移變化所致系統(tǒng)誤差最大為2.23mm。理論上，腮腺計(jì)劃危及器官體積應(yīng)為6.5mm，尤其是健側(cè)腮腺。放療3個(gè)月后患者多為輕中度口干，無重度口干發(fā)生，其與腮腺體積、劑量變化間有明顯相關(guān)性。 結(jié)論：鼻咽癌患者調(diào)強(qiáng)放療過程中，，應(yīng)注意眾多不確定因素對(duì)放療計(jì)劃實(shí)施的影響，減少靶區(qū)及危及器官的勾畫差異，外擴(kuò)一定計(jì)劃靶體積危及器官體積將會(huì)有更好的臨床獲益，在放療過程中第3周修改放射治療計(jì)劃將使腮腺實(shí)際受照劑量進(jìn)一步降低。
[Abstract]:Objective: many uncertain factors in intensity modulated radiotherapy (IMRT) in nasopharyngeal carcinoma (NPC) patients will reduce the superiority of radiotherapy plan. The uncertainty of pendulum error and organ movement can better guide the target area of clinical planning and the determination of organ volume and the best time to modify the second plan. Methods: ten patients with nasopharyngeal carcinoma confirmed by pathology from November 2011 to July 2012 in our hospital were selected. During the 1-5 weeks, 2 doctors and 1 imager drew bilateral parotid gland, submandibular gland and spinal cord respectively. To study the difference of drawing between different sketchers, combine the planned CT images with the weekly repeated CT images, and set up the reference points in the planning system to select the reference points to observe the weekly displacement during radiotherapy. The systematic error of pendulum and random error of pendulum were calculated, and then the expanding range of planning target area was obtained. The outline of parotid gland was drawn layer by layer on plan CT and repeated CT every week, and the volume of parotid gland per week was calculated in planning system. The changes of displacement and actual radiation dose were observed and the most significant changes were observed. According to the change of three-dimensional displacement of the center space of bilateral parotid gland every week, the volume of organ was determined by the plan of bilateral parotid gland. The degree of oral dryness was calculated 3 months after radiotherapy and the correlation with the volume of parotid gland and the actual dose of irradiation was calculated. Results: the minimum difference of spinal cord delineation was 2.7% and 4.3.The most significant difference in bilateral submandibular gland was 5.6% and -4.1%, respectively. The difference between bilateral parotid gland drawing and parotid gland drawing was -2.3% and -1.4%, respectively. The displacement of lateral, upper-down and anteroposterior directions was 0.93 鹵0.71 mm. The systematic error and random error of the pendulum were all 2mm in three dimensional direction, and 1.12 鹵1.12 鹵1.21 鹵1.12 鹵1.12 鹵0.84 鹵0.84 鹵0.84 鹵0.84 鹵0.84 鹵0.84 鹵0.84 鹵0.84 mm respectively. The volume of bilateral parotid gland decreased by 29% -44.9% and 28-57.1% respectively after 5 weeks of radiotherapy. The dosages of bilateral parotid gland were 148.3% -259.4% and 198.1%, respectively. The displacement of the central point of bilateral parotid gland in three dimensional direction was 3.86 鹵3.39). 4.15 鹵2.17, 2.89 鹵2.84; The volume, lateral displacement and dose of the left parotid gland were the most significant at the 3rd week of radiotherapy, and the volume of the right parotid gland was the most significant. Lateral displacement and dose showed the most significant changes at week 4, week 2 and week 3, respectively. The range of change in the first three weeks of radiotherapy was greater than that in the second week of radiotherapy. The maximum systematic error caused by the change of parotid gland displacement in the affected side was 2.19 mm. The maximum systematic error caused by the displacement of the healthy parotid gland was 2.23mm. theoretically, the organ volume of the parotid gland planned to endanger should be 6.5mm, especially the healthy parotid gland. After 3 months of radiotherapy, the majority of patients were mild to moderate dry mouth. There was no severe xerostomy, and there was a significant correlation between the volume and dose of parotid gland. Conclusion: in the course of intensity-modulated radiotherapy for nasopharyngeal carcinoma patients, we should pay attention to the influence of many uncertain factors on the implementation of radiotherapy plan, and reduce the difference of target area and dangerous organs. The external expansion of target volume will have a better clinical benefit to the organ volume, and the modification of the radiotherapy plan in the third week of radiotherapy will further reduce the actual radiation dose of the parotid gland.
【學(xué)位授予單位】：濟(jì)南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R739.63

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