本文選題：乳腺癌　切入點：放射治療　出處：《重慶醫(yī)科大學(xué)》2016年博士論文　論文類型：學(xué)位論文

【摘要】：第一部分早期乳腺癌保乳術(shù)后3DCRT和eComp放療的劑量學(xué)比較目的:比較早期乳腺癌保乳術(shù)后3DCRT和eComp兩種不同放療技術(shù)的劑量學(xué)特點,確定是否有必要進一步探討哪些患者最大可能從eComp技術(shù)獲益。材料與方法:60例早期乳腺癌保乳術(shù)后放療患者,分別設(shè)計三維適形放療計劃(3DCRT)和電子組織補償放療計劃(eComp)。放療計劃的基本劑量標準為95%的處方劑量覆蓋95%以上的PTV(D95≥95%),同時盡可能降低肺、心臟受照射劑量。在兩種放療計劃之間比較設(shè)計計劃的時間、輻射劑量機器監(jiān)測單位(MU)以及腫瘤靶區(qū)劑量覆蓋和正常組織器官受照射劑量等參數(shù)。結(jié)果:兩種放療計劃平均完成時間eComp約比3DCRT多10分鐘,但沒有統(tǒng)計學(xué)差異。3DCRT和eComp的平均MU分別為274±82、302±56(P=0.102)。兩種方案都能滿足腫瘤靶區(qū)的劑量覆蓋標準;采用eComp計劃,肺V20和皮膚平均劑量比3DCRT計劃更低,差異有統(tǒng)計學(xué)意義;心臟平均劑量,兩種方案之間沒有統(tǒng)計學(xué)差異。結(jié)論:在保證腫瘤靶區(qū)得到足量照射,即不影響腫瘤控制的前提下,eComp可以降低肺和皮膚的受照射劑量,但并非在所有乳腺癌保乳術(shù)后放射治療的患者中,eComp都優(yōu)于3DCRT,因此,有必要進一步探討哪些病人最大可能從eComp技術(shù)獲益。第二部分影像學(xué)幾何參數(shù)與3DCRT和eComp劑量-體積參數(shù)的關(guān)系目的:分析早期乳腺癌保乳術(shù)后放療患者影像學(xué)解剖特征與3DCRT和eComp劑量-體積參數(shù)之間的關(guān)系,探討基于影像學(xué)解剖參數(shù)選擇不同放療技術(shù)的可行性。方法:60例早期乳腺癌保乳術(shù)后放療患者,分別設(shè)計三維適形放療計劃(3DCRT)和電子組織補償放療計劃(eComp)。放療計劃的基本劑量標準為95%的處方劑量覆蓋95%以上的PTV(D95≥95%),最大劑量Dmax不超過110%處方量,同時盡可能降低肺、心臟受照射劑量。統(tǒng)計學(xué)分析兩種放療技術(shù)對應(yīng)的危及器官受照射劑量與影像學(xué)解剖參數(shù)之間的關(guān)系;影像學(xué)解剖參數(shù)包括中心肺厚度(central lung distance,CLD),最大心臟距離(maximal heart distance,MHD),最大心臟長度(maximal heart length,MHL)以及乳房內(nèi)外界間距(breast separation,BS)。結(jié)果:乳房更大的患者最大可能從eComp放療技術(shù)獲益,如果要將同側(cè)肺V20控制在20%以下、平均肺劑量控制在10Gy以下、皮膚平均劑量控制在85%處方劑量以下,CLD超過2.3厘米或/和BS超過22.5厘米是決定選擇eComp放療方案而不宜再選用3DCRT放療方案的預(yù)測參數(shù)指標。結(jié)論:本研究的結(jié)果為我們的臨床工作提供了一個方便、快速的劑量評估工具。乳腺癌保乳術(shù)后開始設(shè)計放療計劃之前,可根據(jù)本研究所確定的參數(shù)-劑量關(guān)系,快速地在不同放療技術(shù)之間選擇合適的放療方案。第三部分eComp技術(shù)減輕了乳腺癌放射治療急性皮膚毒性反應(yīng)目的:我們前期的研究結(jié)果已經(jīng)證實eComp技術(shù)是乳房分離間距(BS)超過22.5cm的乳腺癌患者保乳術(shù)后首選的放療方案。本部分根據(jù)這一影像學(xué)解剖參數(shù)標準選擇病例進行隨機對照研究,比較eComp和3DCRT技術(shù)應(yīng)用于乳腺癌全乳放療急性皮膚毒性反應(yīng)的差異。材料與方法:總共69例0-Ⅱ期、BS超過22.5cm的早期乳腺癌保乳術(shù)后需全乳放療的患者納入本研究。所有患者均根據(jù)放療前的模擬CT圖像設(shè)計放療計劃。35例(50.7%)采用eComp技術(shù),34例(49.3%)采用3DCRT技術(shù)。開始放療前及放療期間每周拍攝雙側(cè)乳房正位照片用于研究評估。放療期間至結(jié)束后6周,每周評估1次急性放射性皮膚毒性反應(yīng)。結(jié)果:相比較于3DCRT技術(shù),eComp明顯減少了2級急性放射性皮炎的發(fā)生率(67.6%vs.42.9%,P=0.038)。eComp組無患者發(fā)生3級急性放射性皮炎,與之相對應(yīng)的3DCRT組有2例發(fā)生。兩組間急性放射性乳房水腫沒有統(tǒng)計學(xué)差異(P=0.754)。eComp減少了3級乳房疼痛的發(fā)生率(P=0.019)。多變量分析結(jié)果顯示,不同放療技術(shù)和BS是急性放射性皮炎的影響因素(P=0.045,0.026),不同放療技術(shù)是放射性乳房疼痛的影響因素(P=0.036)。結(jié)論:根據(jù)我們之前所確定的乳腺癌保乳術(shù)后選擇eComp放療技術(shù)的影像學(xué)幾何參數(shù)標準,對于患側(cè)乳房分離間距(BS)大于22.5cm的早期乳腺癌保乳術(shù)后患者,在不影響腫瘤控制的前提下,采用eComp技術(shù),相比較于3DCRT,可以明顯降低急性放射性皮膚毒性。
[Abstract]:The first part for early breast cancer after breast conserving surgery and radiotherapy 3DCRT eComp objective to compare the breast conserving surgery for early breast cancer after 3DCRT and eComp of two different radiotherapy dosimetric characteristics to determine whether it is necessary to further explore which patients may benefit from eComp technology. Materials and methods: 60 cases of patients with early breast radiotherapy after breast conserving surgery, were designed for 3-dimensional conformal radiotherapy (3DCRT) and electronic compensation Organization (eComp). The basic plan of radiotherapy dose standard radiotherapy for covering more than 95% of the prescription dose of PTV 95% (D95 = 95%), at the same time as far as possible to reduce the lung, heart dose. The planned time comparison design between the two radiotherapy, radiation dose (MU) and machine monitoring unit dose of tumor target coverage and normal tissue dose parameters. Results: two radiotherapy plans the average completion time about eComp 10 more than 3DCRT minutes, but no significant difference in average MU.3DCRT and eComp were 274 + 82302 + 56 (P=0.102). The two schemes can meet the tumor target dose coverage criteria; using the eComp plan, the average dose of V20 lung and skin than the 3DCRT plan is lower, the difference was statistically significant; the average dose the heart, no statistically significant differences between the two methods. Conclusion: in which the tumor target get enough exposure, that does not affect the premise of tumor control, eComp can reduce the radiation dose to the lung and skin, but not all the radiation therapy in breast cancer after breast conserving surgery in patients with eComp are better than 3DCRT, therefore and it is necessary to further explore which patients may benefit from the largest eComp. The relationship between the geometric parameters and 3DCRT and eComp dose volume parameters of the second part imaging: analysis of early breast conserving surgery after radiotherapy were imaging anatomy The relationship between the feature and the 3DCRT and eComp dose volume parameters, evaluate the imaging anatomy parameter selection technique based on the feasibility of different radiotherapy. Methods: 60 cases of radiotherapy in patients with early breast cancer after breast conserving surgery, were designed for 3-dimensional conformal radiotherapy (3DCRT) and electron radiotherapy (eComp) tissue compensation standard radiotherapy dose. The plan for covering more than 95% of the prescription dose of PTV 95% (D95 = 95%), the maximum dose of Dmax is not more than 110% prescriptions, as well as reduce the lung, heart dose. Statistical analysis of the relationship between the two radiotherapy techniques corresponding organ radiation dose and imaging anatomy parameters; imaging anatomy parameters including the center of lung (central lung distance, thickness CLD), maximum distance (maximal heart heart distance, MHD), the maximum length of the heart (maximal heart length, MHL) and milk in the room outside space (breast separati On, BS). Results: the maximum possible breast patients greater benefit from eComp radiotherapy, if the ipsilateral lung V20 below 20%, the mean lung dose below 10Gy, the average dose of skin in 85% prescription dose, CLD more than 2.3 cm or / and BS more than 22.5 cm is decided while not using 3DCRT radiotherapy prediction parameters eComp radiotherapy. Conclusion: This study provides a convenient results for our clinical work, dose assessment tools quickly. Before the start of breast cancer radiotherapy plan design, according to the parameters of the study and determination of the dose relationship to select a suitable treatment plan between different radiotherapy techniques. In the third part, eComp technology reduces the radiation therapy for breast cancer acute skin toxicity Objective: our previous studies have demonstrated that eComp technology is the separation of breast 闂磋窛(BS)瓚呰繃22.5cm鐨勪鉤鑵虹檶鎮(zhèn)ｈ，

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