本文選題：鼻腔 + 鼻旁��； 參考：《廣州醫(yī)科大學》2017年碩士論文

【摘要】：目的:比較鼻腔鼻旁竇癌術后調強放療(IMRT)、質子雙散射放療(DS-PBT)以及質子調強放療(IMPT)的靶區(qū)以及正常組織的劑量分布。材料和方法:選取2012年10月至2014年5月在佛羅里達質子中心行術后放療的鼻腔鼻旁竇癌患者8例,其中男性5例,女性3例,中位年齡59歲(43-76歲)。8例患者采用Eclipse治療計劃系統(tǒng)制定質子雙散射放療計劃,同時采用Raystation治療計劃系統(tǒng)制定光子調強放療計劃及質子調強放療計劃。對這三種計劃的靶區(qū)覆蓋、靶區(qū)劑量最大值(Dmax)、最小值(Dmin)、平均值(Dmean),適形指數(conformal index,CI)、均勻指數(homogeneity index,HI),以及正常組織的平均劑量(Dmean),最大劑量(Dmax)、最小劑量(Dmin)、非靶區(qū)(nontargetbody)的劑量體積以及劑量體積關系曲線(DVH)進行比較。結果:IMRT、D-PBTS以及IMPT計劃均能提供臨床可接受的靶區(qū)覆蓋:在所有病人中至少95%以上的PTV體積接受95%處方劑量。三種計劃的靶區(qū)Dmin均大于95%處方劑量,但在IMRT以及DS-PBT計劃中,靶區(qū)Dmax均明顯高于IMPT計劃,分別達處方劑量的110%以及111%,而IMPT計劃的靶區(qū)Dmax僅為處方劑量的106%。對于V107,IMRT以及DS-PBT亦明顯高于IMPT計劃,分別為26.5%以及29.59%,IMPT僅僅為1.5%。適形指數方面,IMRT最優(yōu)(CI=0.89),而IMPT在靶區(qū)劑量分布的均勻性方面(HI=1.061)最優(yōu)。大腦、腦干顳葉的受照劑量方面,三種計劃均為超出最大限量。IMRT、DS-PBT、IMPT的大腦平均受照劑量為:15.09Gy、5.32CGE、4.42CGE,三者間比較有統(tǒng)計學差異(卡方值:12.3、P0.001),對比IMRT,DS-PBT放療(P=0.018)以及IMPT放療(P=0.03)均能明顯減少大腦受照平均劑量;IMRT、DS-PBT以及IMPT的腦干平均受照劑量為:33.54Gy、15.18CGE以及8.65CGE,(卡方值:12.3、P0.001),與IMRT比較,DS-PBT計劃(P=0.018)、IMPT計劃(P=0.03)均明顯減少腦干受照射的平均劑量。同側顳葉,IMRT、DS-PBT以及IMPT平均受照劑量分別為:22.11Gy、13.10CGE、7.11CGE,三者間比較有統(tǒng)計學差異(卡方值:6.0、P=0.049),IMPT相對IMRT能明顯降低受照射的平均劑量(P=0.043),IMRT對比DS-PBT以及IMPT對比DS-PBT無明顯差異統(tǒng)計學差異(P值均為0.662)。對側顳葉,IMRT、DS-PBT、IMPT三種計劃平均劑量分別為:18.60Gy、0.91CGE、4.83CGE,三者間比較有統(tǒng)計學差異(卡方值:6.0、P=0.049),DS-PBT相對IMRT能明顯降低受照射的平均劑量(P=0.043),IMRT對比IMPT以及DS-PBT對比IMPT無明顯統(tǒng)計學差異(P均為0.662)。在視覺器官受量方面,同側視覺器官中的晶體、視神經、視網膜三種計劃均超過最大限制劑量。對側晶體三種放療計劃均已超出最大限制量,對側視神經最大劑量方面,IMRT、DS-PBT以及IMPT三種計劃分別為53.25Gy、36.21CGE以及54.72CGE,三者間比較有統(tǒng)計學差異(卡方值:12.3、P0.01),DS-PBT計劃顯著低于IMRT(P=0.018)以及IMPT計劃(P=0.003)。IMRT、DS-PBT以及IMPT在對側視神經平均受量分別為:39.00Gy、19.13CGE、38.20CGE,三者間比較有統(tǒng)計學差異(卡方值:12.3、P0.01),DS-PBT計劃顯著低于IMRT(P=0.003)計劃以及IMPT計劃(P=0.018)。IMRT、DS-PBT以及IMPT在視交叉的平均受量分別為:46.28Gy、22.53CGE以及35.65CGE,三者間比較有統(tǒng)計學差異(卡方值:13.3、P0.01),DS-PBT計劃明顯優(yōu)于IMRT計劃(P=0.001),IMRT計劃對比IMPT計劃無統(tǒng)計學意義(P=0.401),DS-PBT對比IMPT無統(tǒng)計學差異(P=0.073)。腫瘤雙側內耳,同側腮腺均值、對側腮腺均值以及V30三種計劃均未超出最大限制量,同側腮腺的V30,DS-PBT計劃超出限制量。同側內耳的平均劑量分別為:38.82Gy、40.14CGE、26.12CGE,三者間比較有統(tǒng)計學差異(卡方值:8.0、P=0.018),IMPT計劃顯著低于IMRT計劃以及DS-PBT計劃(P值均為0.023),同側內耳的最大劑量,三者分別為:42.28Gy、43.47CGE以及32.03CGE,三者間比較有統(tǒng)計學差異(卡方值:12.3、P0.01),IMPT顯著低于DS-PBT(P=0.002),IMRT對比IMPT無明顯差異(P=0.544),DS-PBT對比IMRT無統(tǒng)計學意義(P=0.098)。IMRT、DS-PBT以及IMPT在對側內耳平均劑量分別為:30.23Gy、5.45CGE以及19.09CGE,三者間比較有統(tǒng)計學差異(卡方值:12.3、P0.01),DS-PBT顯著低于IMRT計劃(P0.001),對比IMPT無統(tǒng)計學差異(P=0.184),IMRT與IMPT間比較無統(tǒng)計學差異(P=0.184);在對側內耳的最大劑量上,三種計劃分別為:33.47Gy、9.86CGE以及23.62CGE,三者間比較有統(tǒng)計學差異(卡方值:12.3、P0.01),DS-PBT計劃亦顯著低于IMRT(P=0.002),對比IMPT計劃無明顯統(tǒng)計學差異(P=0.544),IMRT與IMPT計劃間比較無統(tǒng)計學差異(P=0.098)。同側腮腺的V30,IMRT、DS-PBT以及IMPT計劃分別為:17.70%、55.10%、10.75%,但統(tǒng)計學上三種計劃無明顯差異(卡方值:5.5、P=0.05)。對側腮腺的平均受量,IMRT、DS-PBT以及IMPT均未超出最大限制量,分別為:15.82Gy、7.68CGE、14.25CGE,三者間比較有統(tǒng)計學差異(卡方值:9.8、P0.01),DS-PBT計劃明顯優(yōu)于IMRT(P=0.008),對比IMPT無統(tǒng)計學意義(P=0.073),IMRT與IMPT間比較亦無統(tǒng)計學意義(P=1)。靶區(qū)外受照組織的劑量(nontargetbody),對于在受照劑量低于20Gy時,DS-PBT以及IMPT技術較IMRT計劃均明顯減少了照射體積(P均0.05),在20至40Gy照射范圍IMPT技術較IMRT計劃明顯減少了照射體積(P0.05),但DS-PBT對比IMRT減少照射體積不明顯(P0.05)。結論:鼻腔鼻旁竇癌的IMRT計劃、DS-PBT計劃、IMPT計劃均能提供滿足臨床的靶區(qū)覆蓋,IMRT在適形指數方面有優(yōu)勢,IMPT在靶區(qū)均勻性方面更有優(yōu)勢。質子放療的DS-PBT計劃以及IMPT計劃不同程度地較IMRT計劃降低了正常組織平均劑量和最大劑量以及非靶區(qū)體積的低劑量照射范圍,兩種計劃在危及器官的劑量限制各有優(yōu)勢。而三種計劃均在同側晶體、視神經以及視網膜,對側晶體接受的最大劑量超出了限制量。
[Abstract]:Objective: To compare the dose distribution of the target area and normal tissue in the intensity modulated radiotherapy (IMRT), proton double scattering radiotherapy (DS-PBT) and proton intensity modulated radiation therapy (IMPT) after nasal paranasal sinus surgery. Materials and methods: 8 cases of nasal paranasal sinus carcinoma were selected from October 2012 to May 2014 in Florida proton center, 5 of them were male, 3 women, 59 years of age (43-76 years old),.8 patients, using the Eclipse treatment plan system to develop proton double scattering radiotherapy plan, and use the Raystation treatment plan system to develop photon intensity modulated radiotherapy plan and proton intensity modulated radiotherapy plan. The target area coverage of the three plans, the target area dose maximum value (Dmax), the minimum value (Dmin), average value (Dmean), the conformal index (conformal index, CI), the uniform index (homogeneity index, HI), the average dose (Dmean) of the normal tissue, the maximum dose (Dmax), the minimum dose (Dmin), the dose volume of the non target region (nontargetbody) and the dose volume relation curve (DVH) are compared. The target area coverage accepted: at least 95% of the PTV volume in all patients received 95% prescription doses. The target area Dmin of the three plans was greater than the 95% prescription dose, but in the IMRT and DS-PBT programs, the target area Dmax was significantly higher than the IMPT plan, 110% and 111% of the prescription dose, respectively, while the target Dmax of the IMPT program was only 106%. of the prescription dose. For V107, IMRT and DS-PBT is also significantly higher than the IMPT scheme, 26.5% and 29.59% respectively. IMPT is only the 1.5%. conformal index, IMRT optimal (CI=0.89), and IMPT is optimal in the uniformity of dose distribution in the target region (HI=1.061). The three plans are beyond the maximum limit.IMRT, DS-PBT, and the brain stem temporal lobe. The average exposure dose of the brain was 15.09Gy, 5.32CGE, 4.42CGE, and there was a statistically significant difference between the three (chi square: 12.3, P0.001). Compared with IMRT, DS-PBT radiotherapy (P=0.018) and IMPT radiotherapy (P=0.03), the average dose of the brain was significantly reduced; IMRT, DS-PBT, and IMPT (chi square) Value: 12.3, P0.001), compared with IMRT, DS-PBT program (P=0.018), IMPT plan (P=0.03) obviously reduced the average dose of the brain stem irradiated. The average exposure dose of the same lateral temporal lobe, IMRT, DS-PBT, and IMPT are: 22.11Gy, 13.10CGE, 7.11CGE, and there is a statistically significant difference between the three groups (the chi square value: 6). The average dose (P=0.043), IMRT contrast DS-PBT and IMPT compared to DS-PBT had no significant difference (P value was 0.662). The three planned average doses for the lateral temporal lobe, IMRT, DS-PBT, and IMPT were respectively 18.60Gy, 0.91CGE, 4.83CGE, and there was a statistically significant difference between the three groups (6 The average dose (P=0.043), IMRT contrast IMPT and DS-PBT compared to IMPT had no significant statistical difference (P was 0.662). In the visual organ volume, the crystal, optic nerve, and retina in the visual organ were all over the maximum limit dose. The three kinds of radiotherapy plans in the contralateral lens have exceeded the maximum limit and the maximum dose of the lateral optic nerve. In terms of quantity, the three schemes of IMRT, DS-PBT and IMPT were 53.25Gy, 36.21CGE and 54.72CGE respectively. There was a statistical difference between the three (12.3, P0.01). The DS-PBT plan was significantly lower than IMRT (P=0.018) and IMPT plan (P=0.003). There were statistical differences (12.3, 12.3, P0.01), and the DS-PBT plan was significantly lower than the IMRT (P=0.003) plan and IMPT plan (P=0.018).IMRT, DS-PBT and IMPT were respectively 46.28Gy, 22.53CGE, and 35.65CGE. There were statistical differences between the three. .001), the IMRT program had no statistical significance (P=0.401) compared to the IMPT program, and there was no statistical difference between DS-PBT and IMPT (P=0.073). Both the bilateral inner ear, the mean of the parotid gland, the mean parotid gland in the contralateral parotid gland and the V30 three plans were not beyond the maximum limit, and the V30 of the parotid gland in the ipsilateral parotid gland was beyond the limit. The average dose of the ipsilateral inner ear was: 38.82G Y, 40.14CGE, 26.12CGE, there were statistically significant differences (chi square value: 8, P=0.018), IMPT plan was significantly lower than IMRT plan and DS-PBT program (P value was 0.023), and the maximum dose of the same side inner ear, three were 42.28Gy, 43.47CGE and 32.03CGE, the three were statistically different (12.3, 12.3, P0.01). P=0.002), there was no significant difference between IMRT and IMPT (P=0.544), and DS-PBT compared to IMRT without statistical significance (P=0.098).IMRT, DS-PBT and IMPT in the contralateral inner ear were respectively: 30.23Gy, 5.45CGE, and, there was a statistically significant difference between the three (chi square value: 12.3). There was no statistical difference (P=0.184) between IMRT and IMPT (P=0.184). In the maximum dose of the lateral inner ear, the three schemes were 33.47Gy, 9.86CGE and 23.62CGE respectively. There was a statistically significant difference between the three (chi square value: 12.3, P0.01), and the DS-PBT program was significantly lower than IMRT (P=0.002), and there was no significant difference in the IMPT plan. There was no statistical difference compared with the IMPT plan (P=0.098). The V30, IMRT, DS-PBT, and IMPT plans of the parotid gland were 17.70%, 55.10%, 10.75% respectively, but there was no significant difference between the three plans (5.5, P=0.05). The average amount of the parotid gland, IMRT, DS-PBT, and IMPT were not beyond the maximum limit, respectively 15.82Gy, 7.68CGE, 14.2. 5CGE, there were statistically significant differences between the three (chi square: 9.8, P0.01), DS-PBT plan was significantly better than IMRT (P=0.008), there was no statistical significance between IMPT (P=0.073), IMRT and IMPT were not statistically significant (P=1). The volume of irradiation (P 0.05) was significantly reduced. The radiation volume (P0.05) was significantly reduced by IMPT technique compared with IMRT in the range of 20 to 40Gy, but DS-PBT contrasted IMRT to reduce the volume of irradiation (P0.05). Conclusion: the IMRT plan, DS-PBT plan, IMPT plan of nasal paranasal sinus carcinoma can provide the target coverage of the clinic, IMRT is in the conformal index. There are advantages. IMPT has a better advantage in the uniformity of target area. The DS-PBT plan of proton radiotherapy and the IMPT program have different degrees of IMRT plan to reduce the average dose and maximum dose of normal tissue and the low dose radiation range of the non target volume. The two plans have advantages in the dose restriction endanger organs. The three plans are all at the same time. The maximum dose accepted by the contralateral lens, optic nerve and retina is beyond the limit.

【學位授予單位】：廣州醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R739.62;R730.55

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相關期刊論文 前1條

1 毛云飛;張紅雁;高勁;劉磊;閆冰;沈芳;;鼻咽癌調強放療后感音神經性聽力下降的臨床分析[J];中華放射腫瘤學雜志;2013年06期

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本文編號：1781875