本文關(guān)鍵詞： 螺旋斷層放射治療 容積旋轉(zhuǎn)調(diào)強放射治療 全腦全脊髓放療 骨髓保護　出處：《昆明醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：[目的]分析全腦全脊髓放射治療患者骨結(jié)構(gòu)受照射劑量體積與血液學(xué)毒性的關(guān)系,并初步探索螺旋斷層放射治療(helical tomotherapy,HT)及容積旋轉(zhuǎn)調(diào)強放射治療(volumetric modulated arc therapy,VMAT)在全腦全脊髓放射治療中骨髓的劑量學(xué)差異。[方法]收集我院2011年12月至2015年12月接受螺旋斷層全腦全脊髓放射治療的20例患者的臨床資料及TOMO計劃,將TOMOTHERAPY上患者的物理計劃回傳至MIM系統(tǒng),然后在CT上依次勾畫患者的顱骨、下頜骨、鎖骨、胸骨、肩胛骨、肋骨、椎體骨、盆骨,并在DVH圖上分別讀出每位患者上述骨性結(jié)構(gòu)及外輪廓Body、總骨(上述八個骨結(jié)構(gòu)合成一個整體)的V2(受到2Gy照射的體積占總體積的百分數(shù))、V5、V10、V15、V20、V25、V30、V35、Dmean、Dmax 值,分析上述指標與患者2級及以上血液學(xué)毒性的相關(guān)性。再從中選取6例患者為對象,將圖像傳輸至Monaco計劃系統(tǒng)并完成VMAT計劃,對比兩種計劃的上述各骨結(jié)構(gòu)劑量體積是否具有差異。[結(jié)果]1、患者的2度及以上白細胞減低與椎骨的Dmax、盆骨的V25呈正相關(guān)(r=0.564、0.466,P=0.010、0.038);2度及以上血小板減少與盆骨的V20呈正相關(guān)(r=0.460,P=0.041);2度及以上中性粒細胞減低與椎骨的V10呈正相關(guān)(r=0.471,P=0.036)。2、患者總骨的V5與2度及以上白細胞減低呈正相關(guān)(r=0.449,P=0.025)。3、患者外輪廓 Body 的 V10、V15、V20、V25、Dmean與2度及以上白細胞減低呈正相關(guān)(r=0.499、0.607、0.520、0.488、0.520,P=0.025、0.005、0.019、0.029、0.019)。4、患者 VMAT 計劃的椎體、盆骨的各劑量體積指標較TOMO計劃無明顯差異,P0.05。[結(jié)論]1、本研究中,患者的2度及以上白細胞減低與椎骨的最大值、盆骨的V25呈正向相關(guān);2度及以上血小板減少與盆骨的V20呈正相關(guān);2度及以上中性粒細胞減低與椎骨的V10呈正相關(guān)。2、本研究顯示,患者總骨的V5與2度及以上白細胞減低呈正相關(guān),而總骨的各劑量體積指標與2度及以上血小板、中性粒細胞、血紅蛋白減低無相關(guān)性�；颊咄廨喞狟ody的V10、V15、V20、V25、Dmean與2度及以上白細胞減低呈正相關(guān),而外輪廓的各劑量體積指標與2度及以上血小板、中性粒細胞、血紅蛋白減低無相關(guān)性。3、本研究中,患者VMAT計劃與TOMO計劃相比,椎骨、盆骨的各劑量體積無明顯差異。
[Abstract]:[objective] to analyze the relationship between the dose volume of bone structure and hematological toxicity in patients with whole brain and spinal cord radiotherapy. And to explore the difference of bone marrow dose between helical tomography radiotherapy and volumetric modulated arc therapy from December 2011 to December 2015. [methods] from December 2011 to December 2015, we collected the dose difference of bone marrow in the whole brain. [methods] from December 2011 to December 2015, we collected the dose difference of bone marrow in whole brain whole spinal cord radiotherapy. [methods] from December 2011 to December 2015, we collected the dose difference of volumetric modulated arc therapy in whole brain spinal cord radiotherapy. Clinical data and TOMO Program of 20 patients with whole brain and Spinal Cord radiotherapy, The physical plan of the patient on TOMOTHERAPY was passed back to the MIM system, and then the patient's skull, mandible, clavicle, sternum, scapula, rib, vertebrae, pelvis were depicted on CT. The bone structure and the outer outline of each patient were read out on the DVH diagram respectively. The V2 (the volume of the above eight bone structures synthesized as a whole) of the total bone (the volume irradiated by 2Gy as a percentage of the total volume) was read out respectively on each patient's bone structure, and the V5V10 / V15V10 / V25V30 / V35Dmax value was obtained respectively. To analyze the correlation between the above indexes and the hematological toxicity of patients with grade 2 or above, 6 patients were selected as objects, and the images were transferred to the Monaco planning system and the VMAT plan was completed. [results] 1. There was a positive correlation between leukopenia of degree 2 and above and Dmaxof vertebrae and V25 of pelvis. There was a positive correlation between thrombocytopenia and V20 in pelvis. There was a positive correlation between neutropenia and V10 in vertebrae, between V5 of total bone and leukopenia of degree 2 and above, and between V10V15V15V20V25Dmean and 2 degree and above leukopenia of patients with external outline Body. The vertebral body of the patient with VMAT program is 0.499U 0.607U 0.520U 0.488U 0.520Pu 0.0250.255U 0.01929 0. 019m. 4, the vertebrae of the patient with VMAT program, the vertebral body of the patient is 0. 499, 0. 607, 0. 488, 0. 58. There was no significant difference in the volume of pelvic bone between the two doses and the TOMO plan (P 0.05). [conclusion] 1. In this study, the number of leukopenia and the maximum value of vertebrae in patients with leucopenia and above were not significantly different from those of TOMO plan. There was a positive correlation between V25 and V25 in pelvis and 2 degree and above thrombocytopenia in pelvis and V20 in pelvis. 2 degree and above neutropenia were positively correlated with V10 in vertebrae. There was a positive correlation between V5 and leukopenia in the total bone of the patients, and there was a positive correlation between the dose volume of the total bone and the platelet, neutrophils, and neutrophils of the total bone. There was no correlation between hemoglobin reduction. There was a positive correlation between the V10 / V15V15 / V25 Dmean of Body and leukopenia of degree 2 or above, while the volume index of each dose of the contour was positively correlated with platelet and neutrophils of degree 2 and above. There was no correlation between hemoglobin reduction. In this study, there was no significant difference in the dose volumes of vertebrae and pelvis between patients with VMAT plan and TOMO plan.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R730.55

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本文編號：1517238