立體定向放射治療局部進(jìn)展期胰腺癌的臨床研究
發(fā)布時間：2018-11-28 12:16
【摘要】：目的1、應(yīng)用四維CT(4D-CT)測量胰腺腫瘤在三維方向上隨呼吸運(yùn)動的位移,并分析其相關(guān)的影響因素,為胰腺腫瘤的立體定向放射治療制定精確的內(nèi)靶區(qū)提供參考依據(jù)。2、評價采用射波刀(Cyber Knife#174;)立體定向放射手術(shù)平臺治療局部進(jìn)展期胰腺癌患者的有效性和安全性。方法1、選擇10例擬接受射波刀治療的胰腺腫瘤患者,采用B超、CT、超聲內(nèi)鏡引導(dǎo)下穿刺植入或術(shù)中植入的方法將至少1枚純金標(biāo)記(Fiducial)植入胰腺腫瘤體內(nèi),并行4D-CT掃描。經(jīng)4D工作站分析處理,得到從0-90%共十個序列的呼吸時相。通過Pinnacle治療計(jì)劃系統(tǒng)勾畫金標(biāo)輪廓,并自動確定金標(biāo)的質(zhì)心(Centroid)位置。記錄質(zhì)心位置在各呼吸時相的三維空間坐標(biāo),并計(jì)算其在L-R(Left-Right side)、A-P(Anterior-Posterior side)和S-I(Superior-Inferior side)方向上隨呼吸運(yùn)動的范圍。同時采集10例患者的性別、年齡、身高、體重、腫瘤位置和腫瘤體積等臨床參數(shù),采用多元線性回歸模型分析其與胰腺腫瘤位移的相關(guān)性,從而找出胰腺腫瘤運(yùn)動的相關(guān)影響因素。2、回顧性分析2006.10-2014.9期間接受射波刀立體定向放射手術(shù)平臺治療的59例局部進(jìn)展期胰腺癌患者的療效。中位腫瘤體積為27.1ml(13.0-125.1 ml),中位處方劑量為45Gy(35-50 Gy),中位分割次數(shù)為5次(3-8次)。采用RECIST標(biāo)準(zhǔn)評價治療區(qū)域的變化,采用Kaplan-Meier曲線計(jì)算總生存期(OS)和無局部進(jìn)展生存率(FFLP)。結(jié)果:1、10例患者中男性5例,女性5例。中位年齡66歲(28-76歲),中位身高167.5cm(158-180 cm),平均體重61.4kg(49-74kg)。病灶位于胰頭者6例,胰體尾者4例。腫瘤體積平均值為50.81ml(9.63-125.15ml)。測量結(jié)果顯示10例患者金標(biāo)的質(zhì)心點(diǎn)在L-R、A-P和S-I方向上隨呼吸運(yùn)動的位移分別為0.16±0.09cm(0.06-0.29cm)、0.31±0.12cm(0.13-0.47cm)和0.72±0.25cm(0.31-1.16cm),其中S-I方向上的位移明顯大于L-R和A-P方向(P0.001)。其移動距離與患者年齡、身高、體重、腫瘤位置無關(guān),但S-I方向的位移與腫瘤體積的大小密切相關(guān),體積超過50ml的胰腺腫瘤在S-I方向的運(yùn)動幅度明顯小于體積在50ml以下的腫瘤(P0.05)。2、59例局部進(jìn)展期胰腺癌患者的中位隨訪時間為10.9個月(3.2-48.7個月),目前仍生存患者的中位隨訪期為15.6個月(3.9-37.6個月)。中位生存期為12.5個月,1年和2年的生存率分別為53.9%和35.1%。采用以CT為基礎(chǔ)的評價方式,1年的無局部進(jìn)展生存率(Freedom From Local Progression,FFLP)為90.8%。治療后2周的疼痛緩解率為92.5%。1-2級急性和晚期胃腸道反應(yīng)出現(xiàn)在61%的患者。1例患者出現(xiàn)3級晚期胃腸道反應(yīng),表現(xiàn)為腸道的不全梗阻,無4級及以上胃腸道副反應(yīng)發(fā)生。結(jié)論:1、胰腺腫瘤的運(yùn)動主要受呼吸運(yùn)動影響,且在S-I方向的移動距離最大,在確定內(nèi)靶區(qū)時應(yīng)主要考慮在S-I方向的外擴(kuò)。腫瘤體積可能是影響其呼吸運(yùn)動幅度的主要影響因素2、采用射波刀立體定向放射手術(shù)平臺治療局部進(jìn)展期胰腺癌可以獲得很好的臨床療效,且并發(fā)癥很小。
[Abstract]:Objective 1. To measure the displacement of pancreatic tumors with respiration in three dimensional direction by using four dimensional CT (4D-CT), and to analyze the related factors. To provide reference for stereotactic radiotherapy of pancreatic neoplasms to establish accurate internal target areas. 2. To evaluate the application of Cyber Knife#174; in the evaluation of pancreatic neoplasms by stereotactic radiotherapy. The efficacy and safety of stereotactic radiosurgery platform in the treatment of locally advanced pancreatic cancer. Methods 1. Ten patients with pancreatic neoplasms undergoing radiosurgery were enrolled in this study. At least one gold labeled (Fiducial) was implanted into the pancreatic tumor by B-ultrasound and CT, ultrasound guided puncture or intraoperative implantation. Parallel 4D-CT scanning. After 4 D workstation analysis, 10 sequence respiratory phases from 0 to 90% were obtained. The outline of gold mark is drawn by Pinnacle therapy plan system, and the center of mass (Centroid) position of gold mark is automatically determined. The position of the center of mass was recorded in the three-dimensional coordinates of each breathing phase, and the range of movement with the respiration in the direction of L-R (Left-Right side), A-P (Anterior-Posterior side) and S-I (Superior-Inferior side) was calculated. The clinical parameters such as sex, age, height, weight, tumor location and tumor volume were collected from 10 patients, and the correlation between tumor displacement and pancreatic tumor displacement was analyzed by multivariate linear regression model. In order to find out the related factors of pancreatic tumor movement. 2. The curative effect of 59 patients with locally advanced pancreatic cancer treated with radiosurgery platform during the period from June 10 to April 2014.9 was analyzed retrospectively. The median tumor volume was 27.1ml (13.0-125.1 ml),) and the median prescription dose was 45Gy (35-50 Gy),). The median fraction was 5 times (3-8 times). RECIST criteria were used to evaluate the changes in the treatment area, and Kaplan-Meier curve was used to calculate the total survival time (OS) and the local progression free survival rate (FFLP). Results: 1 among 10 patients, 5 were male and 5 were female. The median age was 66 years (28-76 years) and the median height 167.5cm (158-180 cm), mean weight 61.4kg (49-74kg). The lesions were located in the head of pancreas in 6 cases and in the body and tail of pancreas in 4 cases. The mean volume of tumor was 50.81ml (9.63-125.15ml). The results showed that the displacement of the centroid points with respiration in the direction of L-RN A-P and S-I was 0.16 鹵0.09cm (0.06-0.29cm), respectively. The displacement in the S-I direction was significantly higher than that in the L-R and A-P directions (P0.001), and 0.31 鹵0.12cm (0.13-0.47cm) and 0.72 鹵0.25cm (0.31-1.16cm). The distance of movement was not related to the patient's age, height, weight, tumor location, but the displacement of the S-I direction was closely related to the size of the tumor. The amplitude of motion in S-I direction of pancreatic tumors over 50ml was significantly smaller than that in tumors below 50ml (P0.05). The median follow-up time of 259 patients with locally advanced pancreatic cancer was 10.9 months (3.2-48.7 months). The median follow-up period was 15.6 months (3.9-37.6 months). The median survival time was 12.5 months and the 1-and 2-year survival rates were 53.9% and 35.1% respectively. The 1-year local progressive survival rate (Freedom From Local Progression,FFLP) based on CT was 90.8. Two weeks after treatment, the pain relief rate was 92.5 grade and grade 1-2 acute and late gastrointestinal reactions occurred in 61% of the patients. One patient developed grade 3 late gastrointestinal reaction, which was characterized by incomplete intestinal obstruction. No side effects occurred in grade 4 or above. Conclusion: 1. The movement of pancreatic tumor is mainly affected by respiratory movement, and the movement distance in S-I direction is the largest, so the extension in S-I direction should be considered in determining the inner target area. The volume of tumor may be the main factor affecting the amplitude of respiratory movement. 2. The treatment of local advanced pancreatic cancer with wave knife stereotactic radiosurgery platform can obtain a good clinical effect, and the complications are very small.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2015
【分類號】：R735.9
本文編號：2362797
[Abstract]:Objective 1. To measure the displacement of pancreatic tumors with respiration in three dimensional direction by using four dimensional CT (4D-CT), and to analyze the related factors. To provide reference for stereotactic radiotherapy of pancreatic neoplasms to establish accurate internal target areas. 2. To evaluate the application of Cyber Knife#174; in the evaluation of pancreatic neoplasms by stereotactic radiotherapy. The efficacy and safety of stereotactic radiosurgery platform in the treatment of locally advanced pancreatic cancer. Methods 1. Ten patients with pancreatic neoplasms undergoing radiosurgery were enrolled in this study. At least one gold labeled (Fiducial) was implanted into the pancreatic tumor by B-ultrasound and CT, ultrasound guided puncture or intraoperative implantation. Parallel 4D-CT scanning. After 4 D workstation analysis, 10 sequence respiratory phases from 0 to 90% were obtained. The outline of gold mark is drawn by Pinnacle therapy plan system, and the center of mass (Centroid) position of gold mark is automatically determined. The position of the center of mass was recorded in the three-dimensional coordinates of each breathing phase, and the range of movement with the respiration in the direction of L-R (Left-Right side), A-P (Anterior-Posterior side) and S-I (Superior-Inferior side) was calculated. The clinical parameters such as sex, age, height, weight, tumor location and tumor volume were collected from 10 patients, and the correlation between tumor displacement and pancreatic tumor displacement was analyzed by multivariate linear regression model. In order to find out the related factors of pancreatic tumor movement. 2. The curative effect of 59 patients with locally advanced pancreatic cancer treated with radiosurgery platform during the period from June 10 to April 2014.9 was analyzed retrospectively. The median tumor volume was 27.1ml (13.0-125.1 ml),) and the median prescription dose was 45Gy (35-50 Gy),). The median fraction was 5 times (3-8 times). RECIST criteria were used to evaluate the changes in the treatment area, and Kaplan-Meier curve was used to calculate the total survival time (OS) and the local progression free survival rate (FFLP). Results: 1 among 10 patients, 5 were male and 5 were female. The median age was 66 years (28-76 years) and the median height 167.5cm (158-180 cm), mean weight 61.4kg (49-74kg). The lesions were located in the head of pancreas in 6 cases and in the body and tail of pancreas in 4 cases. The mean volume of tumor was 50.81ml (9.63-125.15ml). The results showed that the displacement of the centroid points with respiration in the direction of L-RN A-P and S-I was 0.16 鹵0.09cm (0.06-0.29cm), respectively. The displacement in the S-I direction was significantly higher than that in the L-R and A-P directions (P0.001), and 0.31 鹵0.12cm (0.13-0.47cm) and 0.72 鹵0.25cm (0.31-1.16cm). The distance of movement was not related to the patient's age, height, weight, tumor location, but the displacement of the S-I direction was closely related to the size of the tumor. The amplitude of motion in S-I direction of pancreatic tumors over 50ml was significantly smaller than that in tumors below 50ml (P0.05). The median follow-up time of 259 patients with locally advanced pancreatic cancer was 10.9 months (3.2-48.7 months). The median follow-up period was 15.6 months (3.9-37.6 months). The median survival time was 12.5 months and the 1-and 2-year survival rates were 53.9% and 35.1% respectively. The 1-year local progressive survival rate (Freedom From Local Progression,FFLP) based on CT was 90.8. Two weeks after treatment, the pain relief rate was 92.5 grade and grade 1-2 acute and late gastrointestinal reactions occurred in 61% of the patients. One patient developed grade 3 late gastrointestinal reaction, which was characterized by incomplete intestinal obstruction. No side effects occurred in grade 4 or above. Conclusion: 1. The movement of pancreatic tumor is mainly affected by respiratory movement, and the movement distance in S-I direction is the largest, so the extension in S-I direction should be considered in determining the inner target area. The volume of tumor may be the main factor affecting the amplitude of respiratory movement. 2. The treatment of local advanced pancreatic cancer with wave knife stereotactic radiosurgery platform can obtain a good clinical effect, and the complications are very small.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2015
【分類號】：R735.9
【共引文獻(xiàn)】
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