本文選題：全腦全脊髓照射 + 劑量分布��； 參考：《廣西醫(yī)科大學(xué)》2013年碩士論文

【摘要】：目的比較不同全腦全脊髓放射治療(craniospinal irradiation, CSI)方式劑量分布的差異及擺位誤差對靶區(qū)劑量的影響,以探究最佳的CSI方式。方法在接受過CSI的9例病人圖像上分別完成傳統(tǒng)二維(傳統(tǒng)2D)、通過子野調(diào)整劑量分布的二維(子野2D)、三維(3D)、調(diào)強(IMRT)及電子線(Electron)的CSI計劃,比較不同計劃間靶區(qū)劑量及危及器官受照劑量。記錄患者每周1次的擺位誤差值,觀察擺位誤差造成的靶區(qū)劑量差異。分別以6MV-X及15MV-X射線能量完成傳統(tǒng)2D及子野2D計劃,比較不同射線能量下靶區(qū)及危及器官的劑量分布。結(jié)果①不同計劃方式全腦靶區(qū)劑量分布大致相同(P0.05)；②IMRT可以顯著降低靶區(qū)高量(Vi07%),提高靶區(qū)適形度(CI),其次為3D(P0.05)；除Electron外,其余各組在靶區(qū)最小劑量(Dmin)、平均劑量(Dmean)、靶區(qū)覆蓋度(V95%)及劑量均一性(DHI)無顯著差異(P0.05)；傳統(tǒng)2D靶區(qū)最大劑量(Dmax)最高(P0.05)；③Electron靶區(qū)Dmin、V95%、DHI、CI均小于其余各組(P0.05)；Electron脊髓深度4.5cm者, V107%、DHI、CI與傳統(tǒng)2D、子野2D類似(P0.05)；Dmin、V95%略低(P0.05)；④IMRT與Electron能明顯降低正常器官10Gy以上劑量,3D僅次之；Electron具有最小的5Gy劑量體積；⑤引入擺位誤差后,子野2D及3D靶區(qū)劑量與原計劃差別小于其余各組。⑥15MV-X靶區(qū)劑量分布略優(yōu)于6MV-X,同時可降低全身V110%、V120%及V130%；但危及器官接受劑量高于6MV-X(P0.05)。結(jié)論綜合考慮靶區(qū)劑量分布、正常器官保護及擺位誤差的影響,可選擇3D或IMRT行CSI；對于脊髓深度4.5cm者也可選擇電子線照射。6MV-X可靶區(qū)達到臨床滿意的情況下更好地保護危及器官。
[Abstract]:Objective to compare the difference of dose distribution in different whole brain and spinal cord radiotherapy modes and the effect of positioning error on the dose of target area in order to explore the best (craniospinal irradiation, mode. Methods the CSI programs of traditional 2D, 3D, IMRT and Electron were performed on 9 patients with CSI. The dose of target area and organ exposure were compared between different plans. The difference of target dose caused by the error of pendulum was recorded once a week. The conventional 2D and subfield 2D projects were completed with 6MV-X and 15MV-X energy, respectively. The dose distributions of target region and endangered organs were compared under different radiation energies. Results (1) the dose distribution of the whole brain target area in different planning methods was approximately the same (P0.05). IMRT significantly decreased the target area high (Vi07%), increased the target area conformability (CI), followed by 3D (P0.05), except Electron, the dose distribution of the whole brain target area was similar (P0.05). There was no significant difference in minimum dose (Dmin), mean dose (Dmean), coverage (V95%) and dose uniformity (DHI) between the other groups (P0.05), and the highest maximum dose (Dmax) in traditional 2D target (P0.05) was lower than that in other groups (P0.05). In patients with electron spinal cord depth 4.5cm, V107 DHICI was similar to the traditional 2D, and the subfield 2D was similar (P0.05). (P05) Dmin4IMRT and Electron could significantly reduce the dose of normal organs above 10 Gy and the electron had the smallest dose volume of 5 Gy after introducing the pendulum error. The difference of 2D and 3D target dose between subfield and original plan was less than that of other groups. 615MV-X target dose distribution was slightly better than 6MV-X, at the same time, V110V 120% and V130 were decreased, but the acceptance dose of endangerment organs was higher than 6MV-X (P0.05). Conclusion considering the effects of target dose distribution, normal organ protection and pendulum error, 3D or IMRT can be used for CSI. For the patients with deep spinal cord 4.5cm, the electron ray irradiation. 6MV-X could better protect the injured organs if the target area reached clinical satisfaction.
【學(xué)位授予單位】：廣西醫(yī)科大學(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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