【摘要】：目的:確定胃癌術(shù)后放療靶區(qū)移動(dòng)度及比較三維適形和調(diào)強(qiáng)兩種放療技術(shù)靶區(qū)的劑量學(xué)分布,為臨床應(yīng)用提供參考。方法:(1)選取15例在南昌大學(xué)一附院行胃癌D2根治術(shù)的胃癌患者,進(jìn)行CT掃描定位,患者空腹3小時(shí),放療定位前5分鐘飲400ml水,使胃充盈,然后進(jìn)行CT模擬掃描定位,在Pinnacle計(jì)劃系統(tǒng)上勾畫靶區(qū)及周圍正常組織,物理師計(jì)劃制定,臨床醫(yī)師確認(rèn)。(2)計(jì)劃驗(yàn)證前5分鐘患者空腹飲400ml水+10ml泛影葡胺,模擬機(jī)下觀察胃靶區(qū)移動(dòng)度,采用同樣方法在放療中、放療結(jié)束前再次觀察胃靶區(qū)移動(dòng)度。(3)選取上述5例胃癌術(shù)后患者分別設(shè)計(jì)三維適形放療(3DCRT)和調(diào)強(qiáng)放療(IMRT)兩組計(jì)劃進(jìn)行對(duì)比,95%的PTV的處方劑量為45Gy,99%的PTV處方劑量42.75 Gy,用等劑量曲線和劑量體積直方圖(DVH)評(píng)價(jià)治療計(jì)劃,評(píng)價(jià)參數(shù)包括V95%,適形度指數(shù)(conformal index,CI),均勻性指數(shù)(homogeneity index,HI)及肝腎、脊髓的照射劑量。結(jié)果:(1)在頭腳方向上胃癌靶區(qū)移動(dòng)度移動(dòng)度最大,為11.76±0.46mm;左右方向上最小,為5.24±0.20mm;腹背方向?yàn)?.71±0.28mm。計(jì)劃驗(yàn)證、放療中、放療結(jié)束前等不同時(shí)間點(diǎn)靶區(qū)移動(dòng)度差異未達(dá)到統(tǒng)計(jì)學(xué)意義。(2)三維放療與調(diào)強(qiáng)放療兩組計(jì)劃比較,V95%的差異無統(tǒng)計(jì)學(xué)意義(P0.05),IMRT的CI、HI均優(yōu)于3DCRT(P0.05);對(duì)于肝臟,IMRT的肝臟D1/3和Dmean比3DCRT低(P0.05),差異有顯著統(tǒng)計(jì)學(xué)意義;對(duì)于腎臟,IMRT和3DCRT的D1/3均滿足腎臟的劑量學(xué)要求,兩組計(jì)劃對(duì)比腎臟D1/3差異無統(tǒng)計(jì)學(xué)意義。3DCRT右腎D1/2低于IMRT,3DCRT與IMRT比較能降低右腎D1/2(P0.05),對(duì)于左腎D1/2,3DCRT與IMRT無統(tǒng)計(jì)學(xué)差異。脊髓Dmax:3DCRT脊髓Dmax低于IMRT。結(jié)論:(1)胃癌術(shù)后放療靶區(qū)移動(dòng)度在頭腳方向上移動(dòng)度最大,為11.76±0.46mm,左右方向上最小,為5.24±0.20mm;腹背方向?yàn)?.71±0.28mm。(2)在胃癌術(shù)后放療中,IMRT在靶區(qū)適形性、均勻性上優(yōu)于3DCRT;IMRT對(duì)肝臟的照射劑量低于3DCRT;在降低腎臟劑量上兩組計(jì)劃無統(tǒng)計(jì)學(xué)意義;3DCRT脊髓Dmax低于IMRT,但I(xiàn)MRT脊髓Dmax也在正常劑量范圍。
[Abstract]:Objective: to determine the target area mobility after operation for gastric cancer and to compare the dosimetric distribution between three dimensional conformal and intensity modulated radiotherapy techniques, so as to provide reference for clinical application. Methods: (1) Fifteen patients with gastric cancer undergoing D2 radical gastrectomy in an affiliated hospital of Nanchang University were selected to perform CT scanning and localization. The patients had 3 hours of fasting, and 5 minutes before radiotherapy, they drank 400ml water to fill the stomach, and then CT simulated scanning localization was performed. Drawing the target area and normal tissue around the Pinnacle planning system, the physicist made the plan, the clinician confirmed it. (2) the patient drank 10ml diatrizoate on an empty stomach 5 minutes before the plan validation. The motility of the gastric target area was observed under the simulator. The motility of gastric target was observed again before the end of radiotherapy with the same method. (3) the three dimensional conformal radiotherapy (3DCRT) and intensity modulated radiotherapy (IMRT) were designed in 5 patients with gastric cancer after operation respectively to compare the three dimensional conformal radiotherapy (3DCRT) and intensity modulated radiotherapy (IMRT). The prescription dose of 95% PTV was 45 Gy ~ 99% PTV prescription dose was 42.75 Gy,. The treatment plan was evaluated with isodose curve and dose volume histogram (DVH). The evaluation parameters included V95g, conformability index (conformal index,CI), conformability index (conformal index,CI). Uniformity index (homogeneity index,HI) and irradiation dose of liver, kidney and spinal cord. Results: (1) in the direction of head and foot, the moving degree of the target area of gastric cancer was 11.76 鹵0.46 mm, the smallest in the left and right directions was 5.24 鹵0.20 mm, and the direction of dorsal abdomen was 7.71 鹵0.28 mm. The difference of target mobility at different time points before the end of radiotherapy was not statistically significant. (2) there was no significant difference in V95% between three dimensional radiotherapy and intensity modulated radiotherapy (P0.05), IMRT CI,). HI was better than 3DCRT (P0.05). For liver, D1 / 3 and Dmean of IMRT were lower than that of 3DCRT (P0.05), the difference was statistically significant. For the kidney, D1 / 3 of IMRT and 3DCRT met the dosimetry requirements of kidney. There was no significant difference between the two groups in kidney D1 / 3.The right kidney D1 / 2 of 3DCRT was lower than that of IMRT,3DCRT and IMRT (P0.05). There was no significant difference between 3 D CRT and IMRT for left kidney D 1 / 2 D CRT. Spinal cord Dmax:3DCRT Dmax lower than IMRT. Conclusion: (1) after operation of gastric cancer, the moving degree of the target area in the head and foot direction is the highest, 11.76 鹵0.46 mm and 5.24 鹵0.20 mm in the left and right directions, respectively. The abdominal dorsal direction was 7.71 鹵0.28 mm. (2) in post-operation radiotherapy for gastric cancer, IMRT was superior to 3DCRTIMRT in shape conformability and homogeneity in target area, but the dose of 3DCRT in liver was lower than that in 3DCRT, but there was no significant difference between the two groups in reducing the dose of kidney. 3DCRT spinal cord Dmax was lower than IMRT, but IMRT spinal cord Dmax was also in the normal dose range.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R735.2

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