【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(gè)重要的組成部分。本論文首先回顧國內(nèi)外的文獻(xiàn)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(jìn)，包括使用半野銜接技術(shù)，靜態(tài)調(diào)強(qiáng)技術(shù)，非共面野銜接技術(shù)，對靶區(qū)射野銜接處劑量作局部改進(jìn)，在治療過程中需要多次旋轉(zhuǎn)治療床，準(zhǔn)直器等，使治療流程過于復(fù)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(shè)計(jì)3DCRT計(jì)劃，3野sIMRT(sIMRT_(3f))計(jì)劃和5野sIMRT(sIMRT_(5f))計(jì)劃。計(jì)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(jià)不同照射技術(shù)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(jī)器跳數(shù)（MU）間接比較不同照射技術(shù)的治療時(shí)間。結(jié)果3DCRT在射野銜接處有只有處方劑量的70%。計(jì)劃靶區(qū)后緣的正常組織（NT）接受的劑量達(dá)到處方劑量的140%；3DCRT計(jì)劃，sIMRT3f計(jì)劃和sIMRT5f計(jì)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(jì)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(jì)劃的平均機(jī)器跳數(shù)（MU）分別為640±78MU、1100±106MU、1160±129MU.用Delta4三維驗(yàn)證系統(tǒng)對sIMRT計(jì)劃驗(yàn)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(jì)劃在劑量分布，危及器官保護(hù)，靶區(qū)劑量均質(zhì)指數(shù)等方面都明顯好于3D-CRT計(jì)劃，特別是在射野銜接處，會(huì)有較好的劑量分布，值得在臨床得到廣泛應(yīng)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(xué)位授予單位】：清華大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R730.55

【參考文獻(xiàn)】

相關(guān)期刊論文 前7條

1 徐韜;古模發(fā);李群;伍建華;秦海燕;張華滿;胡偉漢;管迅行;;一種新型全腦全脊髓放療技術(shù)[J];中國神經(jīng)腫瘤雜志;2008年01期

2 于紅;夏云飛;王巖;易煒;高勁;;全中樞放療精確定位的CT模擬技術(shù)[J];中國神經(jīng)腫瘤雜志;2008年04期

3 曲寶林;徐壽平;戴相昆;張慧娟;崔書祥;馬林;;全中樞神經(jīng)系統(tǒng)螺旋斷層放射治療初探[J];軍醫(yī)進(jìn)修學(xué)院學(xué)報(bào);2008年02期

4 李珠明;崔玉琴;;全腦全脊髓照射仰臥位CT模擬定位技術(shù)[J];中國醫(yī)學(xué)物理學(xué)雜志;2006年01期

5 楊金磊;吳丹;卜明偉;路雙臣;張賀;;全中樞照射技術(shù)新探索[J];中國醫(yī)學(xué)物理學(xué)雜志;2012年03期

6 戴建榮,胡逸民,張紅志,關(guān)瑩,張可,王闖;針對患者調(diào)強(qiáng)放射治療計(jì)劃的劑量學(xué)驗(yàn)證[J];中華放射腫瘤學(xué)雜志;2004年03期

7 耿輝;戴建榮;李曄雄;張可;王綠化;;一種簡單調(diào)強(qiáng)放療技術(shù)應(yīng)用的初步研究[J];中華放射腫瘤學(xué)雜志;2006年05期

本文編號：2330208