本文選題：乳腺癌　切入點：改良根治術　出處：《昆明醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：[目的]:比較左乳腺癌改良根治術后胸壁電子線照射、三維適形放療、X線和電子線混合三維適形放療三種治療方法的劑量學特點。[方法]:選取2014年1月至2015年5月昆明醫(yī)科大學第三附屬醫(yī)院收治的女性中晚期左側乳腺癌改良根治術后患者15例,左胸壁表面墊0. 5cm厚的等效填充物,熱塑體膜固定后行CT定位,用Pinnacle3 9. 10三維調強治療計劃系統(tǒng)對每位患者分別設計三種胸壁放射治療計劃:電子線照射計劃(E計劃)、3D-CRT照射計劃(3D-CRT計劃)、X線和電子線混合3D-CRT照射計劃(3D-CRT+E計劃),并對三種計劃靶區(qū)的劑量學參數如:PTV: V90、V95、V100、V105、V110、Dmax、Dmin、Dmean、D5、D95、CI、HI 和危及器官:左肺:V5、V10、V15、V20、V30、V40、Dmean;心臟:V5、V1o、V15、V20、V30、V40、Dmean;右肺:Dmean進行評估和比較。[結果]:1. E計劃vs 3D-CRT計劃:(1)靶區(qū)劑量學比較:V90、V95、V100、V110、Dmax、Dmin、Dmean、D95、CI、HI 兩組比較差異均有統(tǒng)計學意義(P0.05) ; V105、D5兩組比較差異均無統(tǒng)計學意義(P0.05)。(2)危及器官劑量學比較:左肺:V5、V10、V15、V20,、V30、V40、Dmean、心臟:V5、V10、V15兩組比較差異均有統(tǒng)計學意義(P0. 05);右肺:Dmean、心臟:V20、V30、V40、Dmean兩組比較差異均無統(tǒng)計學意義(P0. 05)。2. E 計劃 vs 3D-CRT+E 計劃:(1)靶區(qū)劑量學比較:V90 V95、V100、V110、Dmax、Dmin、Dmean、D5、D95、CI、HI 兩組比較差異均有統(tǒng)計學意義(P0. 05) ; V105兩組比較差異無統(tǒng)計學意義(P0.05)。(2)危及器官劑量學比較:左肺:V5、V10、V15、V20、V30、V40、Dmean、心臟:V5、V10、V15兩組比較差異均有統(tǒng)計學意義(P0.05);右肺Dmean、心臟:V20、V30、V40、Dmean兩組比較差異均無統(tǒng)計學意義(P0.05)。3. 3D-CRT 計劃 vs 3D-CRT+E 計劃:(1)靶區(qū)劑量學比較:V105、Dmax、D5、CI兩組比較差異均有統(tǒng)計學意義(P0.05) ; V90、V95、V100、V110、Dm10、Dmmin、Dmean、D95、HI 兩組比較差異均無統(tǒng)計學意義(P0. 05)。(2)危及器官劑量學比較:左肺:V5、V10、心臟V5兩組比較差異均有統(tǒng)計學意義(P0.05);左肺:V15、V20、V30、V40、Dmean、右肺 Dmean、心臟:V10、V15、V20、V30、V40、Dmean兩組比較差異均無統(tǒng)計學意義(P0.05)。[結論]:胸壁單純電子線放療盡量不推薦常規(guī)使用。三維適形放療靶區(qū)的適形性、均勻性及對危及器官的保護方面均較單純電子線計劃有明顯提高,且臨床容易實施。3D-CRT+E計劃并沒有顯示出混合射線的明顯優(yōu)勢。因此,乳腺癌術后胸壁放療建議根據患者的實際情況制定個體化治療方案。
[Abstract]:[objective]: to compare the electron irradiation of chest wall after modified radical mastectomy for left breast cancer. Dosimetric characteristics of three dimensional conformal radiotherapy combined with three-dimensional conformal radiotherapy. [methods]: from January 2014 to May 2015, the left breast of female patients admitted to the third affiliated Hospital of Kunming Medical University was selected. There were 15 patients with adenocarcinoma after modified radical mastectomy. The thickness of the left chest wall was 0.5 cm thick. The thermoplastic membrane was fixed with CT. Three kinds of chest wall radiotherapy plans were designed for each patient by using Pinnacle3 910 three dimensional intensity modulated treatment plan system: electron line irradiation plan E plan 3D-CRT radiation plan 3D-CRT plan 3D-CRT radiation plan and 3D-CRT hybrid 3D-CRT radiation plan 3D-CRT plan. Dosimetric parameters of three planned target areas such as: V90V95V95V100V105V110DmaxDminD5D95CIHI and dangerous organs: left lung: V5V10V10V15V20V30V40Dmean; heart V5V1: V15V20V30V40Dmean; right lung Dmean. [results] 1e vs 3D-CRT. No significant difference was found between the two groups (P < 0.05); there was no significant difference between the two groups (P 0.05). 2) the dosimetry comparison of the organs of the two groups was not statistically significant. There was no significant difference between the two groups (P 0. 05). There was no significant difference between the two groups (P 0. 05), and there was no significant difference between the two groups (P 0. 05). The difference between the two groups was not statistically significant (P 0. 05), but there was no significant difference between the two groups (P < 0. 05). Comparison of dosimetry of target area between the two groups: 1: V90 V95N V100 D110DmaxDmin Dmean D5D95CIHI); V105 has no significant difference between the two groups (P0.05. 2) comparison of organ dosimetry: left lung V5V10V15 V20V30V40Dmean, heart V5V10V10V15 compared with V10V15V30V40Dmean, heart V5V10V10V15 compared with V10V15V10V30V40Dmean, heart V5V10V10V15 compared with V10V15V10V30V40Dmean, V10V15 V10V15 compared with V10V15V30V40Dmean, V10V10V15 V10V15 compared with V10V15V30V40Dmean, V10V10V15. There was no significant difference between the two groups in Dmean of right lung, Dmean of right lung, V30 / V20 / V40Dmean of the right lung. There was no significant difference between the two groups in Dmean (P0.05) .3.3D-CRT vs V3D-CRE (1)) the difference of dosimetry in target area between the two groups was significant (P0.05); there was significant difference between the two groups (P < 0.05); There was no significant difference in dosimetry between the two groups. There was no significant difference between the two groups (P < 0.05). There was no significant difference between the two groups (P < 0.05). There was no significant difference between the two groups. [conclusion] there was no significant difference between the two groups. [conclusion]: the left lung: V15V20 V30 V40Dmean, the right lung Dmean, the heart V10V15V15V20V30V40Dmean have no statistical significance. [conclusion]: the chest wall is pure. Electron line radiotherapy is not recommended for conventional use as far as possible. Conformability of three-dimensional conformal radiotherapy target, The uniformity and protection of organ endangering organs were significantly improved than those of the simple electron line program, and the clinical easy implementation of the .3D-CRT E program did not show the obvious advantages of mixed radiation. Postoperative chest wall radiotherapy for breast cancer suggests individualized treatment according to the actual conditions of the patients.
【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R737.9

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