全脑全脊髓放射治疗骨髓保护的初步研究

发布时间：2018-02-17 04:40

本文关键词： 螺旋断层放射治疗容积旋转调强放射治疗全脑全脊髓放疗骨髓保护　出处：《昆明医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：[目的]分析全脑全脊髓放射治疗患者骨结构受照射剂量体积与血液学毒性的关系,并初步探索螺旋断层放射治疗(helical tomotherapy,HT)及容积旋转调强放射治疗(volumetric modulated arc therapy,VMAT)在全脑全脊髓放射治疗中骨髓的剂量学差异。[方法]收集我院2011年12月至2015年12月接受螺旋断层全脑全脊髓放射治疗的20例患者的临床资料及TOMO计划,将TOMOTHERAPY上患者的物理计划回传至MIM系统,然后在CT上依次勾画患者的颅骨、下颌骨、锁骨、胸骨、肩胛骨、肋骨、椎体骨、盆骨,并在DVH图上分别读出每位患者上述骨性结构及外轮廓Body、总骨(上述八个骨结构合成一个整体)的V2(受到2Gy照射的体积占总体积的百分数)、V5、V10、V15、V20、V25、V30、V35、Dmean、Dmax 值,分析上述指标与患者2级及以上血液学毒性的相关性。再从中选取6例患者为对象,将图像传输至Monaco计划系统并完成VMAT计划,对比两种计划的上述各骨结构剂量体积是否具有差异。[结果]1、患者的2度及以上白细胞减低与椎骨的Dmax、盆骨的V25呈正相关(r=0.564、0.466,P=0.010、0.038);2度及以上血小板减少与盆骨的V20呈正相关(r=0.460,P=0.041);2度及以上中性粒细胞减低与椎骨的V10呈正相关(r=0.471,P=0.036)。2、患者总骨的V5与2度及以上白细胞减低呈正相关(r=0.449,P=0.025)。3、患者外轮廓 Body 的 V10、V15、V20、V25、Dmean与2度及以上白细胞减低呈正相关(r=0.499、0.607、0.520、0.488、0.520,P=0.025、0.005、0.019、0.029、0.019)。4、患者 VMAT 计划的椎体、盆骨的各剂量体积指标较TOMO计划无明显差异,P0.05。[结论]1、本研究中,患者的2度及以上白细胞减低与椎骨的最大值、盆骨的V25呈正向相关;2度及以上血小板减少与盆骨的V20呈正相关;2度及以上中性粒细胞减低与椎骨的V10呈正相关。2、本研究显示,患者总骨的V5与2度及以上白细胞减低呈正相关,而总骨的各剂量体积指标与2度及以上血小板、中性粒细胞、血红蛋白减低无相关性。患者外轮廓Body的V10、V15、V20、V25、Dmean与2度及以上白细胞减低呈正相关,而外轮廓的各剂量体积指标与2度及以上血小板、中性粒细胞、血红蛋白减低无相关性。3、本研究中,患者VMAT计划与TOMO计划相比,椎骨、盆骨的各剂量体积无明显差异。
[Abstract]:[objective] to analyze the relationship between the dose volume of bone structure and hematological toxicity in patients with whole brain and spinal cord radiotherapy. And to explore the difference of bone marrow dose between helical tomography radiotherapy and volumetric modulated arc therapy from December 2011 to December 2015. [methods] from December 2011 to December 2015, we collected the dose difference of bone marrow in the whole brain. [methods] from December 2011 to December 2015, we collected the dose difference of bone marrow in whole brain whole spinal cord radiotherapy. [methods] from December 2011 to December 2015, we collected the dose difference of volumetric modulated arc therapy in whole brain spinal cord radiotherapy. Clinical data and TOMO Program of 20 patients with whole brain and Spinal Cord radiotherapy, The physical plan of the patient on TOMOTHERAPY was passed back to the MIM system, and then the patient's skull, mandible, clavicle, sternum, scapula, rib, vertebrae, pelvis were depicted on CT. The bone structure and the outer outline of each patient were read out on the DVH diagram respectively. The V2 (the volume of the above eight bone structures synthesized as a whole) of the total bone (the volume irradiated by 2Gy as a percentage of the total volume) was read out respectively on each patient's bone structure, and the V5V10 / V15V10 / V25V30 / V35Dmax value was obtained respectively. To analyze the correlation between the above indexes and the hematological toxicity of patients with grade 2 or above, 6 patients were selected as objects, and the images were transferred to the Monaco planning system and the VMAT plan was completed. [results] 1. There was a positive correlation between leukopenia of degree 2 and above and Dmaxof vertebrae and V25 of pelvis. There was a positive correlation between thrombocytopenia and V20 in pelvis. There was a positive correlation between neutropenia and V10 in vertebrae, between V5 of total bone and leukopenia of degree 2 and above, and between V10V15V15V20V25Dmean and 2 degree and above leukopenia of patients with external outline Body. The vertebral body of the patient with VMAT program is 0.499U 0.607U 0.520U 0.488U 0.520Pu 0.0250.255U 0.01929 0. 019m. 4, the vertebrae of the patient with VMAT program, the vertebral body of the patient is 0. 499, 0. 607, 0. 488, 0. 58. There was no significant difference in the volume of pelvic bone between the two doses and the TOMO plan (P 0.05). [conclusion] 1. In this study, the number of leukopenia and the maximum value of vertebrae in patients with leucopenia and above were not significantly different from those of TOMO plan. There was a positive correlation between V25 and V25 in pelvis and 2 degree and above thrombocytopenia in pelvis and V20 in pelvis. 2 degree and above neutropenia were positively correlated with V10 in vertebrae. There was a positive correlation between V5 and leukopenia in the total bone of the patients, and there was a positive correlation between the dose volume of the total bone and the platelet, neutrophils, and neutrophils of the total bone. There was no correlation between hemoglobin reduction. There was a positive correlation between the V10 / V15V15 / V25 Dmean of Body and leukopenia of degree 2 or above, while the volume index of each dose of the contour was positively correlated with platelet and neutrophils of degree 2 and above. There was no correlation between hemoglobin reduction. In this study, there was no significant difference in the dose volumes of vertebrae and pelvis between patients with VMAT plan and TOMO plan.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R730.55

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