海马保护技术在全脑放疗中的剂量学研究及认知功能观察

发布时间：2018-03-19 11:46

本文选题：全脑放疗　切入点：海马保护　出处：《郑州大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景与目的脑转移瘤(Brain metastases,BM)是成人最常见的颅脑肿瘤,发病率接近于10/10万。BM的实际发病率可能比文献中报道出来的还要高,其数量与日俱增。恶性肿瘤进展到BM多提示预后不良,其头痛、头晕、恶心、呕吐、乏力等症状严重降低患者生存质量。全脑放疗(Whole-brain radiotherapy,WBRT)是BM的标准治疗方式之一,其临床应用仍在迅速发展。WBRT后导致的神经认知功能(Neurocognitive function,NCF)损伤逐渐引起临床重视。大量临床前研究显示,NCF的减退与放疗后海马(Hippocampal,HP)损伤有关。海马保护性全脑放疗(Hippocampal-sparing whole-brain radiotherapy,HS-WBRT)可以保护HP,从而避免NCF障碍。螺旋断层放射治疗(Helical tomotherapy,TOMO)的发展使HS-WBRT成为可能,避免BM患者在放疗后出现NCF的损伤。本研究将BM患者分为两组:WBRT组,用传统三维适形放疗(Three dimensional conformal radiotherapy,3D-CRT)两野对穿,不保护HP;HS-WBRT组,用TOMO技术保护HP。统计两组计划的参数及放疗后的NCF评分,通过对比来探讨海马保护技术在WBRT中的可行性,以及保护HP能够减轻放疗后的NCF损伤的可能性。方法选取郑州大学第一附属医院2015年8月至2016年8月期间收治的43例BM患者为研究对象,22例行WBRT;另外21例行HS-WBRT。统计两组的计划参数数值及NCF评分。采用SPSS 21.0软件对数据进行统计学处理:两组计划之间的剂量学、NCF评分对比:用W检验法(Shapiro-Wilk,W test)检验两组数据的正态性,Levene法检验方差齐性:第一,两组数据均服从正态分布,且符合方差齐性,则应用t检验;第二,两组数据服从正态分布,但方差不齐时,用矫正的t检验,即?检验;两组数据不服从正态分布时,采用Wilcoxon秩和检验。组内治疗前后NCF评分对比:数据符合正态性、方差齐性,用配对t检验;否则应用秩和检验。检验标准:P0.05为差异有统计学意义。结果两组之间计划靶区体积(Planning target volume,PTV)的比较,无统计学意义(P0.05);HI比较:3D-CRT组、TOMO组分别为0.12±0.02、0.36±0.03,对比有统计学意义(P0.05),3D-CRT在靶区剂量均匀性上优于TOMO。两组之间Dmean(左HP P=0.00;左HP P=0.00)和D max(左HP P=0.00;左HP P=0.00)的比较,具有统计学意义(P0.05);在HP受量上TOMO明显小于3D-CRT组,左HP的Dmean、Dmax分别降至处方剂量的20.14%、35.39%,右HP的Dmean、Dmax降至降至处方剂量的19.92%、35.14%。NCF评分对比结果:两组治疗前和治疗后1个月的NCF评分的比较均无统计学意义(P0.05);两组间治疗后3个月和治疗后6个月的对比有统计学意义(P0.05)。TOMO组,治疗前与治疗后比较差异无统计学意义(P0.05);3D-CRT组,治疗前和治疗后1个月的比较差异无统计学意义(P0.05);治疗前和治疗后3个月、治疗后6个月的NCF评分对比有统计学意义(P0.05)。TOMO组NCF评分优于3D-CRT组。未观察到3级及以上毒副反应。结论HS-WBRT治疗BM是可行的。TOMO能降低HP受量,在一定程度上避免NCF受损;但是在HI上,与3D-CRT相比,TOMO并无优势。
[Abstract]:Background and objective brain metastases (brain metastases) are the most common craniocerebral tumors in adults. The actual incidence of brain tumors close to 10/10 million BM may be higher than that reported in the literature. The number of brain metastases is increasing. The progression of malignant tumors to BM indicates poor prognosis. The symptoms of headache, dizziness, nausea, vomiting, fatigue and other symptoms seriously reduce the quality of life of patients. Whole-brain radiation therapy is one of the standard treatments for BM. Its clinical application is still developing rapidly. The neurocognitive function NCFs induced by WBRT have attracted more and more attention. A large number of preclinical studies have shown that the decrease of NCF is related to Hippocampal HPP damage after radiotherapy. Hippocampal-sparing is associated with Hippocampal-sparing. HS-WBRT) can protect whole-brain from NCF disorders. The development of helical radiation therapy makes HS-WBRT possible. In this study, BM patients were divided into two groups: WBRT group. Conventional three-dimensional conformal radiotherapy was used to treat with three dimensional conformal radiotherapytic 3D-CRTRT without protecting HPS-WBRT. The TOMO technique was used to protect HP. the parameters of the two groups and the NCF scores after radiotherapy were counted, and the feasibility of hippocampal protection in WBRT was discussed by comparison. Methods 43 patients with BM admitted from August 2015 to August 2016 in the first affiliated Hospital of Zhengzhou University were selected as study subjects: 22 patients were treated with NCF and 21 patients were treated with HS-WBRT.These patients were treated with HS-WBRT.Methods from August 2015 to August 2016, 43 patients with BM were selected as study subjects, 22 with WBRT and 21 with HS-WBRT. Taking into account the planned parameter values and NCF scores of the two groups. The data were processed statistically with SPSS 21.0 software. The dosimetry scores of the two groups were compared. The normal Levene method was used to test the homogeneity of variance between the two groups of data by using the W test method. If both groups of data are subject to normal distribution and conformance to homogeneity of variance, t test is applied. Second, when two groups of data take normal distribution, but the variance is uneven, the corrected t test is used, that is? Wilcoxon rank sum test was used when the two groups of data were not subject to normal distribution. The NCF scores before and after treatment were compared: the data were consistent with normality and homogeneity of variance, and matched t test was used. Otherwise, the rank sum test was used. The test standard: 0. 05 was statistically significant. Results the planned target volume target volume PTV was compared between the two groups. No statistical significance was found in the HI comparison between the TOMO group and the 3D-CRT group (0.12 卤0.02 卤0.36 卤0.03, respectively). The comparison between the two groups in the dose uniformity of the target area was better than that of TOMO.The Dmean (left HP P0. 00; left HP P0. 00) and D max( left HP P0. 00C; left HP P0. 00C) were compared between the two groups. The TOMO of HP was significantly lower than that of 3D-CRT group. Dmean Dmax of left HP decreased to 20.14 ~ 35.39 of prescription dose, Dmean Dmax of right HP decreased to 19.92 ~ 35.14% of prescription dose: there was no significant difference in NCF score between two groups before treatment and one month after treatment (P 0.05). There were significant differences between months after treatment and 6 months after treatment in the TOMO group. There was no significant difference before and after treatment in P0.05D CRT group, there was no significant difference before treatment and 1 month after treatment, there was no significant difference before and after treatment, and there was no significant difference before treatment and 3 months after treatment. Six months after treatment, there was significant difference in the NCF score between the two groups. The NCF score of the tomo group was better than that of the 3D-CRT group. No toxic and adverse reactions were observed in the 3rd grade group or above. Conclusion HS-WBRT treatment with BM can reduce the level of HP and avoid NCF damage to a certain extent. In HI, however, TOMO has no advantage over 3 D-CRT.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.4;R730.55

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