【摘要】： 目的:運用重復CT掃描和重新設計計劃,觀察鼻咽癌患者在調(diào)強放療過程中正常器官體積及劑量的變化。 方法:選擇接受全程調(diào)強放療(intensity modulated radiotherapy, IMRT)的首治鼻咽癌(nasopharyngeal carcinoma, NPC)患者20例,鼻咽、頸部和鎖骨上區(qū)均懫用IMRT技術,按IMRT步驟設計計劃1并得到DVH1。患者在放療20次時,按原固定體位和參考坐標重新CT掃描,拷貝計劃1至重新勾畫的靶區(qū)產(chǎn)生計劃1-2和DVH1-2,對第二次CT掃描重新進行設計得到計劃2并得到DVH2。應用CT掃描和DVH圖對放療前和放療20次時正常器官的體積劑量進行比較分析。 結果:與計劃1相比較,計劃1-2左右腮腺體積明顯小于DVH1(P0.05),左右腮腺的最大劑量、平均劑量、D50和V35,脊髓的最大劑量、平均劑量和D1cc均明顯增加(P0.05),腦干最大劑量增大(P=0.011),腮腺的劑量增加與放療所致的體重下降、輪廓減少和腮腺體積縮小程度密切相關性,脊髓的最大劑量增加與左右輪廓減少程度有一定的相關性(r=0.469,p=0.037),其余無統(tǒng)計學意義。 結論:鼻咽癌IMRT過程中正常器官體積劑量會發(fā)生一些變化,特別是腮腺變化較明顯,建議放療中后期有必要重新勾畫靶區(qū),重新計劃,以減小正常器官的受照量和放療反應。
[Abstract]:Aim: to observe the changes of normal organ volume and dose during intensity modulated radiotherapy (IMRT) in nasopharyngeal carcinoma (NPC) patients by repeated CT scanning and redesign. Methods: IMRT technique was used in 20 patients with nasopharyngeal carcinoma (nasopharyngeal carcinoma, NPC) who received full-course intensity modulated radiotherapy (intensity modulated radiotherapy, IMRT). IMRT technique was used in nasopharyngeal carcinoma (NPC), neck and supraclavicular region. Plan 1 was designed according to IMRT procedure and DVH1. was obtained. At 20 times of radiotherapy, the patient re-scanned the CT according to the original fixed position and reference coordinates, copied the plan 1 to the redrawn target generation plan 1, and DVH1-2, re-designed the second CT scan to get the plan 2 and get the DVH2.. The volume doses of normal organs before and after 20 times of radiotherapy were analyzed by CT and DVH. Results: compared with Plan 1, the volume of left and right parotid glands in Plan 1 / 2 was significantly smaller than that in DVH1 (P0.05). The maximum dose, average dose, D50 and V35 of the left and right parotid glands, the maximum dose of spinal cord, the average dose and the D1cc of the left and right parotid glands were significantly increased (P0.05). The maximum dose of brain stem (P0. 011) and the dose increase of parotid gland were closely related to the weight loss, silhouette reduction and parotid volume reduction induced by radiotherapy. There was a certain correlation between the maximum dose of spinal cord and the degree of reduction of left and right contours (r = 0.469, p = 0.037), but there was no statistical significance in the rest. Conclusion: there are some changes in the volume dose of normal organs during IMRT, especially in parotid gland. It is suggested that it is necessary to redraw and plan the target area in the middle and late stage of radiotherapy in order to reduce the irradiation dose and radiation response of normal organs.
【學位授予單位】：蘇州大學
【學位級別】：碩士
【學位授予年份】：2010
【分類號】：R739.63

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