本文選題：調(diào)強放射治療（IMRT）　切入點：生物優(yōu)化　出處：《南華大學(xué)》2013年碩士論文

【摘要】：目的探討等效均勻劑量（EUD，Equivalent Uniform Dose）在胸部腫瘤調(diào)強放射治療（IMRT）計劃設(shè)計優(yōu)化過程中的作用。做兩組計劃，分別是基于單純劑量-體積（DV）物理優(yōu)化的計劃和在DVH物理優(yōu)化基礎(chǔ)上使用EUD優(yōu)化的計劃，通過對這兩組計劃的比較，尋找兩者在劑量特性上的優(yōu)化結(jié)果差異。 方法選取在胸部中有代表性的各部位的病種：肺癌、乳腺癌。各病種分別隨機選取100例病人，各選取10例符合常規(guī)放療條件的患者入組分析。患者影像經(jīng)GE高速大孔徑CT模擬機掃描后經(jīng)局域網(wǎng)傳入ADAC治療計劃系統(tǒng)，根據(jù)ICRU62號報告勾畫靶區(qū)和危及器官。胸部代表性危及器官為肺、心臟、脊髓。然后分別用基于DVH優(yōu)化和EUD優(yōu)化的方法進行調(diào)強計劃設(shè)計(在兩種優(yōu)化方法中能量、主照射野個數(shù)和入射方向、子野數(shù)均相同)，對計劃的劑量分布、危及器官保護、約束條件復(fù)雜性進行比較。 結(jié)果用等劑量曲線分布及劑量體積直方圖曲線數(shù)據(jù)評估治療計劃，，非小細胞肺癌患者計劃中，基于DV優(yōu)化的IMRT計劃與基于EUD優(yōu)化的IMRT計劃靶體積（PTV）100%處方劑量包繞體積分別為97%和96%，最大劑量（D1%）均為68Gy，最小劑量（D99%）均為55Gy,平均劑量分別為58Gy和57Gy，脊髓的最大劑量分別均為43Gy，全肺平均劑量分別為15%和12%；全肺的V30為18%和14%；而全肺的V20為27%和21%。而在乳腺癌患者計劃中，基于DV優(yōu)化的IMRT計劃與基于EUD優(yōu)化的IMRT計劃靶體積的適形度和均勻性均無明顯差異。心臟的劑量受量對比明顯，其中基于EUD優(yōu)化的計劃中，V40降低了4%；平均劑量降低了6%。 結(jié)論：調(diào)強計劃中靶區(qū)中等效均勻劑量(EUD)優(yōu)化方法的應(yīng)用比一般純物理約束限制調(diào)強計劃能更好的保護危及器官。在適形度方面沒有明顯改善，但是在基于EUD優(yōu)化的計劃中，EUD的合理使用能減少心臟和肺組織的劑量受量。從而可以有效地減少放療并發(fā)癥。
[Abstract]:Objective to investigate the effect of equivalent dose of equivalent Uniform in the design optimization of intensity modulated radiotherapy (IMRT) for chest tumors. The plan is based on the pure dose-volume VV) physical optimization plan and the EUD optimization plan based on the DVH physical optimization. Through the comparison of the two groups of plans, the difference of the optimization results in the dose characteristics between the two groups is found. Methods 100 cases of lung cancer and breast cancer were selected randomly. Ten patients who were in accordance with conventional radiotherapy were selected. The images of the patients were scanned by GE high speed large aperture CT simulator and then introduced into the ADAC treatment planning system via local area network (LAN). The chest representative organs are lung, heart and spinal cord. Then the intensity modulation plan is designed based on DVH optimization and EUD optimization, respectively. The number of main irradiating fields, the direction of incidence and the number of sub-fields are all the same. The planned dose distribution, organ protection endangering and the complexity of constraint conditions are compared. Results the data of isodose curve distribution and dose volume histogram curve were used to evaluate the treatment plan and the plan for patients with non-small cell lung cancer (NSCLC). The target volume of IMRT plan based on DV optimization and that of IMRT plan based on EUD optimization are 97% and 96%, respectively, and the maximum dose of D1 is 68 Gy, the minimum dose is 55 Gy, the average dose is 58Gy and 57 Gy, and the maximum dose of spinal cord is 57 Gy. They were 43 Gy, with an average dose of 15% and 12% for the whole lung, 18% and 14% for the whole lung, 27% and 21% for the whole lung, and 27% and 21% for the whole lung, respectively. There was no significant difference in the conformability and uniformity of the target volume between the IMRT plan based on DV optimization and the IMRT plan based on EUD optimization. Conclusion: the application of equivalent uniform dose (EUD) optimization method in target area of intensity modulation plan can better protect the organ from danger than that of general physical restriction intensity modulation plan, but it has no obvious improvement in shape conformability. However, the rational use of EUD in the plan based on EUD can reduce the dose to the heart and lung tissue, which can effectively reduce the complications of radiotherapy.
【學(xué)位授予單位】：南華大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R730.55

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