口腔矫形器在口腔颌面部肿瘤三维适形放疗中对邻近重要组织的保护作用

发布时间：2018-06-10 03:37

本文选题：放射治疗 + 头颈部肿瘤　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:目前,放疗已成为治疗肿瘤的三大主流方法之一。在肿瘤放疗不断发展的过程中,自始至终的目的即是尽可能使肿瘤的局部控制率得到提高,使正常组织并发症的发生率降到最低,从而达到治愈肿瘤的目的。本研究利用CT等影像学工具,在电脑模拟情况下,针对口腔颌面部各部位肿瘤进行三维适形放疗,制定放疗计划,在肿瘤靶区域接受常规放射线剂量时,通过佩戴个性化口腔矫形器,比较邻近正常组织受到的剂量体积的不同,来研究其对正常组织器官的保护作用。同时也探讨该矫形器对口腔颌面部肿瘤患者三维适形放疗靶区的勾画,放疗计划设计的影响,以评价其临床应用价值,以期临床推广应用。方法:选取受试者成年女性一名,进行颅颌面部的螺旋CT扫描,以2mm为层厚,扫描范围以眉弓为上界,以喉状软骨为下界。之后佩戴10mm厚度的口腔矫形器以同样的体位、标记再次进行CT扫描,务必保证与之前的各项物理参数相同,减少不必要的误差。其中口腔矫形器由于肿瘤部位、大小、及被保护器官的不同而形状各异,佩戴方式也不同,需按照实验分组进行单独设计制作。分别在两次完成的CT图像上模拟相同部位和大小的肿瘤病灶,并将其上传至三维适形放疗系统,由物理师及医师进行三维平面上的放射靶区勾画,包括肿瘤区、临床靶区、内靶区、计划靶区、治疗区和照射区以及相邻重要组织器官区。根据模拟病灶肿瘤的T分期,以及被保护器官的不同进行分组,并根据最新的口腔颌面部恶性肿瘤治疗指南给予放疗剂量。分组如下:组一:唇癌组,以下颌骨及下颌牙齿为保护器官。PTV设定为21.6ccm时,给予根治性放疗70Gy;PTV设定为33.2ccm时,给予术后放疗60Gy;组二:舌癌组,以上、下颌骨为保护器官。PTV设定为31.5ccm时,给予根治性放疗70Gy;PTV设定为47.5ccm时,给予术后放疗60Gy;组三:上颌牙龈癌组,以下颌骨及舌体为保护器官。PTV设定为15.6ccm时,给予根治性放疗70Gy;PTV设定为17.0ccm时,给予术后放疗60gy;通过三维适形放疗设计系统及配套软件分析,选择照射野,以90㳠-95㳠剂量曲线覆盖肿瘤ptv靶区,测定在给予靶区常规放射剂量下被保护器官佩戴矫形器前后的剂量体积变化,记录数据,并进行统计学分析。结果:患者均能顺利佩戴各类口腔矫形器进行定位和ct扫描。1唇癌组:实验数据表明,在受到同等强度的放射剂量情况下,佩戴矫形器后,目标器官所受到的剂量体积值均有不同程度的减小。将数据进行统计学分析。经配对t检验结果,mandible(70gy)组p=0.001(p0.05);teeth(70gy)组p=0.000(p0.05);mandible(60gy)组p=0.009(p0.05);teeth(60gy)组p=0.000(p0.05),认为佩戴前后有明显差异,有统计学意义,说明佩戴矫形器后正常组织所受到的放射剂量体积值小于未佩戴组。2舌癌组:实验数据表明,在根治性放疗和术后放疗两种情况下,下颌骨作为保护器官,在高剂量区时(50gy和40gy以上)佩戴矫形器后受到的剂量体积减少,而在低剂量区时(30gy、20gy、10gy以上)受到的剂量体积值反而增多。上颌骨作为目标器官所受到的剂量体积值均有不同程度的减小。将数据进行统计学分析。经配对t检验结果,mandible(70gy)组p=0.543(p㧐0.05);maxilla(70gy)组p=0.000(p0.05);mandible(60gy)组p=0.391(p㧐0.05);maxilla(60gy)组p=0.000(p0.05),认为maxilla组佩戴前后有明显差异,有统计学意义。mandible组无统计学意义。3上颌牙龈癌组:数据显示佩戴矫形器后舌所受到的剂量体积明显小于未佩戴时的情况。下颌骨则不太明显甚至低剂量区所受到的放射体积反而有所增加。将数据进行统计学分析。经配对t检验结果,mandible(70gy)组p=0.136(p㧐0.05);tongue(70gy)组p=0.002(p0.05);mandible(60gy)组p=0.101(p㧐0.05);tongue(60gy)组p=0.005(p0.05),认为tongue组佩戴前后有明显差异,有统计学意义。mandible组无统计学意义。结论:佩戴口腔矫形器能在一定程度上保护正常组织,减少放疗射线对邻近组织器官的损伤,同时由于隔开与固定肿瘤与邻近组织的空间距离,也有助于三维适形放疗设计中对肿瘤靶区的勾画,提高放疗的精确度,准确控制剂量分布,值得临床推广。
[Abstract]:Objective: at present, radiotherapy has become one of the three main methods for the treatment of tumor. In the course of the continuous development of tumor radiotherapy, the first and final purpose is to improve the local control rate of the tumor as far as possible, to minimize the incidence of normal tissue complications, and to achieve the purpose of curing the tumor. This study uses CT and other imaging studies. In the case of computer simulation, a three-dimensional conformal radiotherapy for tumors in the oral and maxillofacial region is carried out, and the radiotherapy plan is planned. The dose volume of the adjacent normal tissue is compared by wearing a personalized oral orthosis to study the protection of the normal tissues by using the individual oral orthosis to compare the dose volume of the adjacent normal tissues. At the same time, the effect of the orthopedics on the three-dimensional conformal radiotherapy target area of oral and maxillofacial tumor patients and the effect of radiotherapy plan design are also discussed in order to evaluate the clinical application value of the orthopedics in order to evaluate the clinical application value. Method: select the adult female one in the subjects, carry on the spiral CT scan in the craniofacial face, take the 2mm as the thickness, and the scanning range of the eyebrow bow as the upper part. The boundary is the lower boundary of the laryngeal cartilage. Then the oral orthosis with the thickness of 10mm is marked again with the same body position, and the CT scan is marked again. It is necessary to ensure the same physical parameters as before, and reduce the unnecessary error. In the same way, we should design and make a separate design according to the experimental group, simulate the tumor lesion of the same location and size on the two CT images, and upload it to the three-dimensional conformal radiotherapy system. The physical division and the doctor carry out the radiation target area on the three-dimensional plane, including the tumor area, the clinical target area, the target area, the planned target area, the treatment area and the treatment area. The irradiated area and the adjacent important tissues and organs were grouped according to the T staging of the tumor and the different protective organs, and the radiotherapy dose was given according to the latest oral and maxillofacial malignant tumor treatment guidelines. Group 1: the group of lip cancer, the following jaw and lower jaw teeth as the protective organ.PTV set as 21.6ccm Radical radiotherapy 70Gy; PTV set for 33.2ccm, give postoperative radiotherapy 60Gy; group two: tongue cancer group, above, the mandible for protective organ.PTV set to 31.5ccm, give radical radiotherapy 70Gy; PTV set 47.5ccm, give postoperative radiotherapy 60Gy; Group Three: maxillary gingival cancer group, the following jaw and tongue body for.PTV setting 15.6ccm, when jaw and tongue body for protective organ for 15.6ccm, given.PTV to organ organs 15.6ccm, given organ protection organ when the jaw and tongue body for protected organ.PTV when 15.6ccm, given 15.6ccm, given 15.6ccm, given organ.PTV to 15.6ccm, given 15.6ccm, given.PTV organ organs organs organ organs when jaw and lingual body organs for 15.6ccm, given.PTV to the organ 15.6ccm, given jaw and tongue body for protective organs when jaw and tongue body for protected organs when the jaw and tongue body for protected organ.PTV when 15.6ccm, given 15.6ccm, given 15.6ccm, given.PTV organ organ organs jaw and lingual body organs, jaws and tongue body, The radical radiotherapy 70Gy was given; when the PTV was set as 17.0ccm, the postoperative radiotherapy 60Gy was given. Through the three-dimensional conformal radiotherapy design system and the software analysis, the radiation field was selected and the dose curve of the tumor PTV target area was covered with 90? -95? Dose curve, and the dose volume changes before and after the protective organs were worn under the conventional radiation dose of the target area were measured, and the data were recorded. Results: all the patients were able to wear all kinds of oral orthosis to locate and scan the.1 lip cancer group with CT scan. The experimental data showed that the dose volume value of the target organs decreased to varying degrees after wearing the same intensity of radiation dose, and the data were statistically analyzed. The results of paired t test, mandible (70Gy) group p=0.001 (P0.05), teeth (70Gy) group p=0.000 (P0.05), mandible (60Gy) group p=0.009 (60Gy), showed significant difference before and after wearing, indicating that the dose volume value of normal tissue after wearing orthosis was less than that of the non wearing group of tongue cancer group: The data showed that under the two cases of radical radiotherapy and postoperative radiotherapy, the dose volume of the mandible as a protective organ was reduced after the orthosis was worn (50gy and 40gy above) in the high dose area, while the dose volume increased in the low dose area (30Gy, 20GY, 10GY above). Volume values were reduced in varying degrees. The data were statistically analyzed. After paired t tests, mandible (70Gy) group p=0.543 (P? 0.05); maxilla (70Gy) group p=0.000 (P0.05); mandible (60Gy) group p=0.391 (0.05). Statistical significance of the.3 maxillary gingival cancer group: the data showed that the dose of the tongue was significantly smaller than that of the non wearer when the orthosis was worn. The volume of the radiation was increased in the lower jaw or in the low dose area. The data were statistically analyzed. The results of the paired t test, the p=0.136 (P? 0.05) of the group of mandible (70Gy); Tongue (70Gy) group p=0.002 (P0.05); mandible (60Gy) group p=0.101 (P? 0.05); tongue (60Gy) group p=0.005 (P0.05). There was no significant difference between before and after wearing. Conclusion: wearing oral orthosis can protect normal tissues to a certain extent and reduce the damage to adjacent tissues and organs by radiotherapy. Injury, at the same time, because of the space distance between the isolated and fixed tumor and adjacent tissue, can also help to draw the target area of the tumor in the design of three-dimensional conformal radiotherapy, improve the accuracy of radiotherapy, control the dose distribution accurately, and be worthy of clinical promotion.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.8

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