【摘要】：全腦全脊髓放射治療是原發(fā)中樞神經(jīng)系統(tǒng)腫瘤治療流程中一個重要的組成部分。本論文首先回顧國內(nèi)外的文獻資料，大部分研究只是對全腦全脊髓常規(guī)放射治療方法的改進，包括使用半野銜接技術，靜態(tài)調(diào)強技術，非共面野銜接技術，對靶區(qū)射野銜接處劑量作局部改進，在治療過程中需要多次旋轉治療床，準直器等，使治療流程過于復雜，在治療過程中引入誤差，造成治療失敗，甚至造成治療事故。 本研究選取5名已行全腦全脊髓放療患者，為每位患者設計3DCRT計劃，3野sIMRT(sIMRT_(3f))計劃和5野sIMRT(sIMRT_(5f))計劃。計劃靶區(qū)（PTV）處方劑量是36Gy分20次。利用劑量分布、劑量體積直方圖（DVH）評價不同照射技術的靶區(qū)和正常器官的照射劑量、靶區(qū)劑量均質(zhì)指數(shù)，通過總的機器跳數(shù)（MU）間接比較不同照射技術的治療時間。結果3DCRT在射野銜接處有只有處方劑量的70%。計劃靶區(qū)后緣的正常組織（NT）接受的劑量達到處方劑量的140%；3DCRT計劃，sIMRT3f計劃和sIMRT5f計劃靶區(qū)均質(zhì)指數(shù)（HI）分別為0.18±0.02、0.09±0.01、0.08±0.01(t=7.8、7.65,P0.05)；各計劃心臟V10分別為36±6.0，8.4±1.9，8.4±2.0（t=13.3、13.0,P0.05），甲狀腺V20分別69.4±5.7，2.4±1.5，12.4±1.6（t=26.3、26.4，P0.05），喉V20分別為89.4±7.0，17.2±1.2，17.9±1.5，（t=25.5、26.5，P0.05），靶區(qū)后緣正常組織（NT）V30分別為31.9±6.1，4.4±1.4，4.9±1.9（t=8.5,10.1，P0.05），，各計劃的平均機器跳數(shù)（MU）分別為640±78MU、1100±106MU、1160±129MU.用Delta4三維驗證系統(tǒng)對sIMRT計劃驗證，通過率98%，射野銜接處沒有出現(xiàn)過高或過低區(qū)域。 sIMRT計劃在劑量分布，危及器官保護，靶區(qū)劑量均質(zhì)指數(shù)等方面都明顯好于3D-CRT計劃，特別是在射野銜接處，會有較好的劑量分布，值得在臨床得到廣泛應用。
[Abstract]:Whole-brain whole-spinal cord radiotherapy is an important part of the primary central nervous system tumor treatment process. In this paper, we first reviewed the literature at home and abroad. Most of the studies were only about the improvement of conventional radiotherapy for whole brain spinal cord, including the use of hemi-field convergence, static intensity modulation, non-coplanar convergence. The local improvement of the dose at the junction of the projectile field in the target area requires many times rotation of the treatment bed and collimator in the course of treatment, which makes the treatment process too complicated, and introduces errors in the treatment process, resulting in the failure of treatment and even the treatment accident. In this study, 5 patients who had received whole brain whole spinal cord radiotherapy were selected to design 3DCRT plan, 3 field sIMRT (sIMRT_ (3f) plan and 5 field sIMRT (sIMRT_ (5 f) plan) for each patient. The prescribed dose of (PTV) in the planned target area was 36Gy 20 times. Dose distribution and dose volume histogram (DVH) were used to evaluate the dose of target and normal organs of different irradiation techniques, and the dose homogeneity index of target area. The therapeutic time of different irradiation techniques was indirectly compared by total machine hops (MU). Results there were only 70 doses of 3DCRT in the field junction. The dose of (NT) in normal tissue at the posterior edge of the planned target area was 140 / 3DCRT of the prescribed dose. The target area homogeneity index (HI) of sIMRT3f plan and sIMRT5f plan was 0.18 鹵0.02 鹵0.09 鹵0.010.08 鹵0.08 鹵0.08 鹵0.08 鹵0.08 鹵0.08 鹵0.08 鹵0.08 鹵0.08 鹵0.08 鹵0.08 鹵0.08 鹵0.08 鹵0.08 鹵0.08 鹵0.08 鹵0.08 鹵0.08 鹵0.08 鹵 The V10 of heart and thyroid were 36 鹵6.0 鹵8.4 鹵1.9 鹵2.0 and 69.4 鹵5.724 鹵1.5 鹵12.4 鹵1.6 respectively (P 0.05). The V20 of larynx was 89.4 鹵7.0 鹵17.2 鹵1.2 鹵17.9 鹵1.5, respectively (t 25. 5 / 26. 5), and the (NT) V30 of the posterior edge of the target was 31. 9 鹵6. 1 / 4 鹵1. 4 鹵4. 4 鹵1. 9 (t = 8. 5 ~ 10. 1), respectively, and that of the normal tissue of the posterior edge of the target area was 39. 9 鹵6. 1 鹵1. 4 鹵1. 9 respectively. The average machine hops of each program were 640 鹵78MUU 1100 鹵106MUU 1160 鹵129MU, respectively. The Delta4 three dimensional verification system is used to verify the sIMRT plan. The pass rate is 98. There are no high or too low areas in the field junction. The dose distribution, organ protection and target dose homogeneity index of sIMRT plan are obviously better than that of 3D-CRT plan, especially in the junction of field, which is worthy of extensive clinical application.
【學位授予單位】：清華大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R730.55

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