PET-CT和3D超声在前列腺癌精确大分割放疗中的应用初探

发布时间：2018-03-07 18:36

本文选题：前列腺癌　切入点：PET-CT　出处：《广西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨PET-CT在前列腺癌精确大分割放疗中生物靶区勾画的应用,以及3D超声对前列腺定位和保护膀胱、直肠的作用。方法:收集初次放疗的局限期中高危前列腺癌患者10例,分为A、B两组。放疗前行PSA检查、前列腺穿刺组织病理确诊为前列腺腺癌。A、B两组患者放疗前同时行定位CT和3D超声检查、盆腔增强MRI检查,A组患者加做使用18F-FDG(18氟-脱氧葡萄糖)和11C-CH(11C-胆碱)两种造影剂的PET-CT检查。A组患者参考定位CT、3D超声、MRI和PET-CT勾画GTVPET、CTV、RPV、CTVnd、PTV;B组患者仅参考定位CT、3D超声和MRI勾画CTV、RPV、CTVnd、PTV。放疗前使用3D超声和CBCT两种引导方式定位,记录二组误差数据,最后将CBCT获得的位移误差传至加速器进行修正及移床,然后实施放疗。观察放疗过程中患者出现的各种急性毒副反应(如直肠、膀胱、血液学等),记录患者初诊时、放疗前和放疗后1月的血清PSA数值以及影像资料,评价近期疗效。结果:A组患者CTV体积为71.10±15.78cm3,B组CTV体积为68.45±14.51cm3,P0.05,两组体积差别没有统计学意义。A组GTVPET体积为6.83±8.05cm3,仅占A组CTV体积的9.6%。A组CTV生物有效剂量(BED)为119.74±1.78Gy,B组CTV的BED为129.20±2.70Gy,A组GTVPET的BED为139.92±3.45Gy。A组CTV的的BED小于B组CTV,而A组GTVPET的的BED大于B组CTV,两组差异均有统计学意义(P0.05)。A、B两组患者膀胱、直肠的计划和实际受照剂量体积均在正常限制范围内。3D超声引导获得的位移误差在左右方向和上下方向与CBCT引导获得的位移误差相似,P0.05,没有统计学差异。超声引导获得的位移误差在前后方向上是3.4±1.4mm,大于CBCT获得的1.0±0.8mm,P0.01,差异有统计学意义。使用3D超声引导前列腺的同时,可测得膀胱、邻近直肠体积,确保每次放疗时膀胱和直肠的实际体积与定位时体积大致相等。放疗过程中A组有2例患者出现1级骨髓抑制,有1例出现2级泌尿道症状,有2例出现1级直肠反应;B组有1例患者出现1级骨髓抑制,有1例患者出现1级直肠反应,两组患者均未出现其他严重早期不良反应。从PSA变化趋势图可以看出,A、B两组患者经放射治疗后PSA均明显下降,A组患者PSA下降趋势比B组PSA下降趋势显著。结论:1.PET-CT可应用于前列腺癌精确大分割放疗中生物靶区的勾画,能够提高局部病灶(DIL)剂量,同时减少临床靶区剂量,早期副反应和普通大分割放疗类似。2.3D超声可应用于引导前列腺癌实行精确放疗,同时能在引导过程中确保膀胱和直肠的实际体积与定位时体积大致相等。
[Abstract]:Objective: to investigate the application of PET-CT in the mapping of biological target area in prostate cancer with accurate large fractionation radiotherapy, and the role of 3D ultrasound in prostate localization and protection of bladder and rectum. Methods: ten patients with high risk prostate cancer in local stage of initial radiotherapy were collected. The patients were divided into two groups: PSA examination before radiotherapy and localization CT and 3D ultrasound examination before radiotherapy. Pelvic Enhancement MRI in Group A: PET-CT examination with 18F-FDG ~ (18 Fluorodeoxyglucose) and 11C-CHN _ (11C- choline). Group A. patients in Group A with reference location CTV 3D Ultrasound MRI and PET-CT to draw CTVndPTVB only reference CTT 3D Ultrasound and MRI. Before radiotherapy, 3D ultrasound and CBCT were used to guide the localization. Two sets of error data were recorded, and then the displacement errors obtained by CBCT were transmitted to the accelerator to correct and move the bed, then radiotherapy was performed. All kinds of acute side effects (such as rectum, bladder, bladder) were observed during radiotherapy. Hematology, recording the serum PSA values and imaging data of patients at first visit, before radiotherapy and January after radiotherapy. Results the volume of CTV in group B was 68.45 卤14.51 cm ~ (-3) P 0.05, the volume of GTVPET in group A was 6.83 卤8.05 cm ~ (3), the BED of CTV in group A was 129.20 卤2.70 Gy. The BED of GTVPET in group A was 139.92 卤3.45Gy.A, the BED of CTV in group A was lower than that of group B, while the BED of group A was larger than that of group B, and the difference between the two groups was statistically significant. The displacement error obtained by 3D ultrasound guidance is similar to that obtained by CBCT guidance in the direction of left and right, which is similar to that obtained by CBCT guidance (P 0.05). There is no statistical difference in ultrasonic guidance. The displacement error was 3.4 卤1.4mm in front and back direction, which was higher than that obtained by CBCT (1.0 卤0.8mm P0.01), the difference was statistically significant. The volume of bladder and rectum was measured to make sure that the actual volume of bladder and rectum was approximately equal to that of localization. In group A, there were 2 patients with grade 1 bone marrow depression and 1 patient with grade 2 urinary tract symptoms during radiotherapy. There were 2 patients with grade 1 rectal reaction in group B, 1 patient with grade 1 bone marrow depression and 1 patient with grade 1 rectal reaction. There were no other serious early adverse reactions in both groups. It can be seen from the trend map of PSA changes in both groups that the PSA of both groups decreased significantly after radiotherapy. The decrease trend of PSA in group A is significantly higher than that in group B. conclusion: 1. PET-CT. It can be used to delineate the biological target area in prostate cancer with accurate large fraction radiotherapy. It can increase the dose of local lesion and reduce the dose of clinical target area. The early side effects are similar to those of conventional large segment radiotherapy. 2.3D ultrasound can be used to guide prostate cancer to carry out accurate radiotherapy. It can also ensure that the actual volume of bladder and rectum is approximately equal to that of localization.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.25

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