鼻咽癌调强放疗中海马结构功能保护的研究

发布时间：2018-04-22 03:39

本文选题：海马结构 + 认知功能　；参考：《福建医科大学》2012年硕士论文

【摘要】：目的：分析鼻咽癌调强放疗中海马结构（HF）受照射剂量大小及海马结构相关功能的潜在损害，探讨鼻咽癌调强放疗中海马结构保护的必要性和可行性。方法：１、回顾性分析行调强适形放疗（IMRT）的不同分期鼻咽癌病例59例，结合CT-MR图像融合技术勾画海马结构，，了解不同T分期海马结构受量，包括Dmax、Dmean、D20、V_(20)等。２、利用韦氏成人记忆力量表中的敏感项目对其中51例放疗后1年病人（分为T1-2组和T3-4组）行记忆力相关的神经认知功能检测比较，同时比较相匹配的鼻咽癌放疗前病人和健康人各30例的各项记忆力检测结果差异。３、选择T3、T4期病人39例，比较海马结构剂量保护前后的计划优化设计中海马结构、肿瘤靶区及其它危及器官剂量学数据。结果：１、在59例鼻咽癌病人调强适形放疗中，HF受照剂量值为：Dmax11.1～78.2Gy（均值52.7Gy），Dmean3.2～44.6Gy（均值18.7Gy）, D204.5～64.1Gy（均值29.0Gy），V_(20)0～87.1%（均值35.7%）；其中鼻咽癌T1-2期与T3-4期海马结构受照剂量Dmax、Dmean分别为40.8±9.4Gy、12.5±5.1Gy和58.6±14.8Gy，21.8±9.3Gy。２、记忆力相关的神经认知功能检测显示：放疗后T1-2期组和T3-4期组除“数字广度－逆向”无显著差异外，其余各项均有统计学意义，T3-4组病人的认知功能明显低于T1-2期组；鼻咽癌放疗前病人和健康人在联想学习、数字累加、数字广度、视觉再生方面检测结果无显著差异。３、在海马结构保护的计划方案中，海马结构受照剂量明显降低，尤其HF受照剂量，与海马结构没有保护的计划相比：Dmean均值从21.8Gy减少到15.3Gy，减少约29.8%；D20均值减少约38.1%；20Gy及20Gy以上的受照体积显著减少，大于55%以上，而靶区及重要器官的剂量无明显改变。结论：鼻咽癌调强放疗中，海马结构可受到较大剂量和体积的照射，特别在T3-4期病人，并可导致海马结构功能相关的认知功能损害；利用调强适形放疗技术可显著减少海马结构受照剂量，同时对靶区及其它危及器官放疗计划无明显影响。因此，鼻咽癌放疗中应该关注海马结构的剂量，或将其列为需要观察剂量的重要正常组织加以研究。
[Abstract]:Objective: to analyze the potential damage of dose and function related to hippocampal formation in intensity modulated radiotherapy (IMRT) of nasopharyngeal carcinoma (NPC), and to explore the necessity and feasibility of Hippocampal structure protection in intensity modulated radiotherapy (IMRT) of nasopharyngeal carcinoma (NPC). Methods: one, 59 patients with different stages of nasopharyngeal carcinoma underwent IMRT were retrospectively analyzed. The hippocampal structure was delineated with CT-MR image fusion technique to understand the amount of hippocampal structure in different T stages. Including Dmaxor Dmean D20 / VARD20, etc., 51 patients (divided into T1-2 group and T3-4 group) were tested for memory related neurocognitive function using sensitive items in Wechsler Adult memory scale (Wechsler Adult memory scale) one year after radiotherapy. At the same time, the memory test results of 30 patients with nasopharyngeal carcinoma before radiotherapy and 30 healthy persons were compared. 39 patients with stage T3T 4 were selected to compare the hippocampal structure before and after dose protection. Dosimetric data of tumor target and other dangerous organs. Results: 1, in 59 patients with nasopharyngeal carcinoma (NPC), the dose value of HF was: Dmax11.1 78.2 Gy (mean 52.7 Gyr Dmean 3.2Gy.64.6Gy) (mean 18.7Gy, D204.5N 64.1Gy (mean 29.0Gy): 20087.1Gy (mean 35.77.1.The Dmean of Hippocampal formation in T1-2 stage and T3-4 stage were 40.8 卤9.4Gy 12.5 卤5.1Gy and 58.6 卤14.8Gy 21.8 卤9.3Gy.2respectively), and the mean dose of Hippocampal formation in stage T1-2 and T3-4 was 40.8 卤9.4Gy 卤5.1Gy and 58.6 卤14.8Gy / 2respectively. The mean dose of HF radiation was 40.8 卤9.4Gy 卤5.1Gy and 58.6 卤14.8Gy / 2, respectively. The neurocognitive function test showed that there was no significant difference between T1-2 stage group and T3-4 stage group except for "digital breadth-reverse" group after radiotherapy. The cognitive function of the patients in the T3-4 group was significantly lower than that in the T1-2 stage group. There was no significant difference in visual regeneration. 3. In the plan of hippocampal structure protection, the irradiation dose of hippocampal formation, especially HF, was significantly decreased. Compared with the unprotected hippocampal formation, the mean value of 21.8Gy was reduced from 21.8Gy to 15.3Gy, and the mean value of D20 was reduced by about 29.8Gy and 38.1g / 20Gy, and the radiation volume above 20Gy was significantly reduced, more than 55%, while the dose of target area and important organs did not change significantly. Conclusion: in intensity modulated radiotherapy for nasopharyngeal carcinoma, the hippocampal structure may be exposed to large dose and volume of irradiation, especially in patients with stage T3-4, and may lead to cognitive impairment related to hippocampal structure and function. Intensity modulated conformal radiotherapy (IMRT) can significantly reduce the radiation dose to the hippocampal structure, but has no significant effect on the radiation planning of the target area and other dangerous organs. Therefore, we should pay attention to the dose of hippocampus in radiotherapy for nasopharyngeal carcinoma, or consider it as an important normal tissue which needs to be observed.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R739.63

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