头颈部肿瘤IGRT摆位误差、临床疗效及急性放疗毒性反应研究

发布时间：2018-07-07 15:54

本文选题：头颈部肿瘤 + 滑轨CT　；参考：《安徽医科大学》2017年硕士论文

【摘要】：目的:研究头颈部肿瘤图像引导放射治疗(IGRT)中不同图像配准方法对放疗摆位误差的影响,并对经IGRT、IMRT临床疗效及并发症发生率进行比较,提高配准精确率,实现放射性治疗靶区剂量精准控制,降低副反应,提高放疗有效率及患者生活质量。材料与方法:1.随机选取头颈部肿瘤患者22例使用西门子CTVision直线加速器进行治疗,患者治疗前均行滑轨CT(CT-ON-RAIL)扫描,获得的CT图像与原放疗计划CT图像进行配准,分析X、Y、Z轴方向的平移误差,比较骨性、灰度值及手动三种配准方式间的差异。2.选取鼻咽癌患者共32例,分为IMRT治疗组和IGRT治疗组,比较两组间临床有效率及急性放疗毒性反应发生率之间的差异。结果:1.经114次滑轨CT扫描治疗前头颈部肿瘤患者(22例),手动配准、骨性配准、灰度值配准三种配准方式在X轴的平移摆位误差分别为0.06±0.16 cm,0.07±0.17 cm,0.06±0.18cm;在Y轴的平移摆位误差分别为0.05±0.23 cm,0.06±0.24cm,0.05±0.25 cm;在Z轴的平移摆位误差分别为-0.03±0.17cm,-0.03±0.14cm,0.04±0.19。研究结果提示X轴平移误差最大,其次为Y轴,Z轴最小,但是三种配准方式结果差异无统计学意义(P0.05)。2.IGRT治疗组临床有效率为93.75%,IMRT治疗组临床有效率为87.5%,两组数据之间的差异无显著统计学意义(P0.05)。3.两治疗治疗组间的急性放疗毒性反应,急性骨髓抑制发生率之间的差异无显著统计学意义(P0.05),而IGRT治疗组皮肤毒性反应、上消化道反应等近期毒性反应较IMRT治疗组显著降低(P0.05)。结论:1.头颈部肿瘤患者行IGRT时,应用CT-ON-RAIL系统可缩小摆位误差,建议首选骨性配准,实际操作过程中可结合手动微调,直到结果满足配准需要。2.滑轨CT引导下头颈部肿瘤患者IGRT治疗,疗效确切,局部控制率优良,放疗副反应少,值得在临床上大力推广。
[Abstract]:Objective: to study the effect of different image registration methods in head and neck tumor guided radiotherapy (IGRT) on the positioning error of radiotherapy, and to compare the clinical efficacy and complication rate with IGRTIMRT in order to improve the accuracy of registration. The target dose of radiation therapy can be controlled accurately, the side effects can be reduced, and the effective rate of radiotherapy and the quality of life of patients can be improved. Materials and methods: 1. Twenty-two patients with head and neck tumors were randomly selected to be treated with Siemens CTVision linear accelerator. All patients were scanned by CT-ON-RAIL before treatment. The CT images obtained were matched with CT images of the original radiotherapy plan. Compare the difference of bone quality, gray value and manual registration method. 2. 2. Thirty-two patients with nasopharyngeal carcinoma were divided into IMRT group and IGRT group. The result is 1: 1. Twenty-two patients (22 cases) with head and neck neoplasms treated by 114 times of slide CT scan were registered by manual registration and bone registration. The translation error of three registration modes on X axis is 0.06 卤0.16 cm ~ (-1) 0.07 卤0.17 cm ~ (-1) 0.06 卤0.18 cm, that of Y axis is 0.05 卤0.23 cm ~ (-1) 0.06 卤0.24 cm ~ (-1) 0.05 卤0.25 cm, and that of Z axis is -0.03 卤0.17 cm ~ (-1) -0.03 卤0.14 cm ~ (-1) 0.04 卤0.19 cm ~ (-1) respectively. The results show that the translation error of X axis is the largest, and that of Y axis Z axis is the smallest. But there was no significant difference among the three registration methods (P0.05). 2. The clinical effective rate of IGRT group was 93.75%. The clinical effective rate of IGRT group was 87.5%. There was no significant difference between the two groups (P0.05). 3. There was no significant difference in the incidence of acute radiation toxicity and acute bone marrow suppression between the two groups (P0.05), while the short-term toxic reactions such as skin toxicity and upper digestive tract reaction in IGRT group were significantly lower than those in IMRT group (P0.05). Conclusion 1. Using CT-ON-RAIL system in head and neck tumor patients with IGRT can reduce the error of pendulum. It is suggested that the first choice of bone registration can be combined with manual fine-tuning in practical operation until the results meet the registration needs. 2. The treatment of head and neck tumor with IGRT guided by slide CT is effective, local control rate is good, and the side effects of radiotherapy are few, so it is worth popularizing in clinic.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R730.55;R739.91

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