保乳术后调强放疗中增加心脏亚结构作为危及器官的研究

发布时间：2018-01-19 07:19

本文关键词： 乳腺癌调强放疗危及器官心脏保护心脏并发症　出处：《清华大学》2014年硕士论文　论文类型：学位论文

【摘要】：目前常规乳腺癌的治疗手段分为手术,化疗和放射治疗等。对于早期病人,提倡保乳手术治疗和辅助术后放疗。其疗效与乳腺癌改良根治手术相当。相比根治术,保乳术辅助术后放疗也可以起到降低局部复发,提高远期生存率的效果,更重要的可以起到美容效果。接受术后放疗,心脏都将受到一定剂量体积的照射,与其相关的心脏疾病(radiation-associated heart disease,RAHD)有可能发生,在发生的RADH里,多数的产生发病部位在心脏前壁,所以心脏前壁接受照射的剂量体积若减少,远期RAHD的发病几率有可能被减低。在本机构随机选取23位早期左侧乳腺癌术后接受放疗患者。由同一位医师勾画靶区和危及器官。包括双肺,CTV,患侧肺,左心室(left ventricle,LV),心脏,心脏前壁(anterior myocardial territory,AMT),对侧乳腺。由同一物理师,利用相同的优化思路制定8个放疗计划,其中1个是适形计划,另外7个调强计划。这7个调强计划,我们依次设定心脏、AMT、LV、AMT+LV、心脏+AMT、心脏+LV、心脏+AMT+LV为危及器官。计划处方为50GY,分次2GY。然后,将所有的8个计划做全方位的比较,靶区包括比较适形度,均匀度,最大剂量,最小剂量,平均剂量,危及器官比较最大剂量,最小剂量,平均剂量和Vn(表示接受大于nGy照射剂量的OAR体积百分数)。结果发现,相比适形计划,调强计划明显减少心脏,LV,AMT的高剂量体积,但是低剂量体积有所增加。在调强计划里,心脏加LV的计划和心脏加AMT计划在降低心脏照射剂量上大体相当。单独AMT作为OAR的计划,对右侧乳腺和右肺保护更好,故推荐单独使用AMT作为OAR计划。AMT可以替代心脏作为OAR进行剂量优化计算评估。
[Abstract]:At present, conventional treatment of breast cancer is divided into surgery, chemotherapy and radiotherapy, etc. For early patients. The effect of breast conserving surgery and adjuvant postoperative radiotherapy is similar to that of modified radical mastectomy. Compared with radical mastectomy, breast conserving assisted postoperative radiotherapy can also reduce local recurrence and improve long-term survival rate. More importantly, cosmetic effects can be achieved. After postoperative radiotherapy, the heart will be exposed to a certain dose of volume. Radiation-associated heart disease (RAHD) may occur in the RADH in which it occurs. Most of the disease occurs in the anterior wall of the heart, so the dose volume of the anterior wall of the heart is reduced. Long-term risk of RAHD is likely to be reduced. 23 patients with early left breast cancer were randomly selected for postoperative radiotherapy. The target area and organ were drawn by the same physician, including bilateral lung cancer. Left myocardial, left myocardial, left ventricle, left ventricle, left ventricle, left ventricle, left ventricle, left ventricle, anterior myocardial. The contralateral mammary glands. By the same physicist, using the same optimization ideas to formulate 8 radiotherapy plans, including one conformal plan, the other 7 intensity modulation plans, we set the heart in turn AMT. LVV AMT, heart AMT, heart LVL, cardiac AMT LV were the organs at risk. Plan prescription was 50GY, divided into 2GY. then. Compare all the eight programs in all directions. Target areas include comparative conformability, uniformity, maximum dose, minimum dose, average dose, maximum dose and minimum dose for the organ. The results showed that compared with the conformal plan, the IMP significantly reduced the high dose of nGy. But low dose volume has increased. In the intensity modulation program, the heart plus LV program and the heart plus AMT program are roughly equal in reducing the dose of heart exposure. AMT alone is the OAR program. The right mammary gland and the right lung are better protected, so it is recommended to use AMT alone as the OAR plan. AMT can replace the heart as a OAR for dose optimization evaluation.
【学位授予单位】：清华大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.9;R730.55

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