等效均匀剂量在胸部肿瘤调强放射治疗中的临床应用研究

发布时间：2018-03-27 18:47

本文选题：调强放射治疗（IMRT）　切入点：生物优化　出处：《南华大学》2013年硕士论文

【摘要】：目的探讨等效均匀剂量（EUD，Equivalent Uniform Dose）在胸部肿瘤调强放射治疗（IMRT）计划设计优化过程中的作用。做两组计划，分别是基于单纯剂量-体积（DV）物理优化的计划和在DVH物理优化基础上使用EUD优化的计划，通过对这两组计划的比较，寻找两者在剂量特性上的优化结果差异。方法选取在胸部中有代表性的各部位的病种：肺癌、乳腺癌。各病种分别随机选取100例病人，各选取10例符合常规放疗条件的患者入组分析。患者影像经GE高速大孔径CT模拟机扫描后经局域网传入ADAC治疗计划系统，根据ICRU62号报告勾画靶区和危及器官。胸部代表性危及器官为肺、心脏、脊髓。然后分别用基于DVH优化和EUD优化的方法进行调强计划设计(在两种优化方法中能量、主照射野个数和入射方向、子野数均相同)，对计划的剂量分布、危及器官保护、约束条件复杂性进行比较。结果用等剂量曲线分布及剂量体积直方图曲线数据评估治疗计划，，非小细胞肺癌患者计划中，基于DV优化的IMRT计划与基于EUD优化的IMRT计划靶体积（PTV）100%处方剂量包绕体积分别为97%和96%，最大剂量（D1%）均为68Gy，最小剂量（D99%）均为55Gy,平均剂量分别为58Gy和57Gy，脊髓的最大剂量分别均为43Gy，全肺平均剂量分别为15%和12%；全肺的V30为18%和14%；而全肺的V20为27%和21%。而在乳腺癌患者计划中，基于DV优化的IMRT计划与基于EUD优化的IMRT计划靶体积的适形度和均匀性均无明显差异。心脏的剂量受量对比明显，其中基于EUD优化的计划中，V40降低了4%；平均剂量降低了6%。结论：调强计划中靶区中等效均匀剂量(EUD)优化方法的应用比一般纯物理约束限制调强计划能更好的保护危及器官。在适形度方面没有明显改善，但是在基于EUD优化的计划中，EUD的合理使用能减少心脏和肺组织的剂量受量。从而可以有效地减少放疗并发症。
[Abstract]:Objective to investigate the effect of equivalent dose of equivalent Uniform in the design optimization of intensity modulated radiotherapy (IMRT) for chest tumors. The plan is based on the pure dose-volume VV) physical optimization plan and the EUD optimization plan based on the DVH physical optimization. Through the comparison of the two groups of plans, the difference of the optimization results in the dose characteristics between the two groups is found. Methods 100 cases of lung cancer and breast cancer were selected randomly. Ten patients who were in accordance with conventional radiotherapy were selected. The images of the patients were scanned by GE high speed large aperture CT simulator and then introduced into the ADAC treatment planning system via local area network (LAN). The chest representative organs are lung, heart and spinal cord. Then the intensity modulation plan is designed based on DVH optimization and EUD optimization, respectively. The number of main irradiating fields, the direction of incidence and the number of sub-fields are all the same. The planned dose distribution, organ protection endangering and the complexity of constraint conditions are compared. Results the data of isodose curve distribution and dose volume histogram curve were used to evaluate the treatment plan and the plan for patients with non-small cell lung cancer (NSCLC). The target volume of IMRT plan based on DV optimization and that of IMRT plan based on EUD optimization are 97% and 96%, respectively, and the maximum dose of D1 is 68 Gy, the minimum dose is 55 Gy, the average dose is 58Gy and 57 Gy, and the maximum dose of spinal cord is 57 Gy. They were 43 Gy, with an average dose of 15% and 12% for the whole lung, 18% and 14% for the whole lung, 27% and 21% for the whole lung, and 27% and 21% for the whole lung, respectively. There was no significant difference in the conformability and uniformity of the target volume between the IMRT plan based on DV optimization and the IMRT plan based on EUD optimization. Conclusion: the application of equivalent uniform dose (EUD) optimization method in target area of intensity modulation plan can better protect the organ from danger than that of general physical restriction intensity modulation plan, but it has no obvious improvement in shape conformability. However, the rational use of EUD in the plan based on EUD can reduce the dose to the heart and lung tissue, which can effectively reduce the complications of radiotherapy.
【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R730.55

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