鼻腔鼻旁窦癌术后调强放疗、质子双散射放疗以及质子调强放疗的剂量学比较

发布时间：2018-04-21 09:35

本文选题：鼻腔 + 鼻旁　；参考：《广州医科大学》2017年硕士论文

【摘要】：目的:比较鼻腔鼻旁窦癌术后调强放疗(IMRT)、质子双散射放疗(DS-PBT)以及质子调强放疗(IMPT)的靶区以及正常组织的剂量分布。材料和方法:选取2012年10月至2014年5月在佛罗里达质子中心行术后放疗的鼻腔鼻旁窦癌患者8例,其中男性5例,女性3例,中位年龄59岁(43-76岁)。8例患者采用Eclipse治疗计划系统制定质子双散射放疗计划,同时采用Raystation治疗计划系统制定光子调强放疗计划及质子调强放疗计划。对这三种计划的靶区覆盖、靶区剂量最大值(Dmax)、最小值(Dmin)、平均值(Dmean),适形指数(conformal index,CI)、均匀指数(homogeneity index,HI),以及正常组织的平均剂量(Dmean),最大剂量(Dmax)、最小剂量(Dmin)、非靶区(nontargetbody)的剂量体积以及剂量体积关系曲线(DVH)进行比较。结果:IMRT、D-PBTS以及IMPT计划均能提供临床可接受的靶区覆盖:在所有病人中至少95%以上的PTV体积接受95%处方剂量。三种计划的靶区Dmin均大于95%处方剂量,但在IMRT以及DS-PBT计划中,靶区Dmax均明显高于IMPT计划,分别达处方剂量的110%以及111%,而IMPT计划的靶区Dmax仅为处方剂量的106%。对于V107,IMRT以及DS-PBT亦明显高于IMPT计划,分别为26.5%以及29.59%,IMPT仅仅为1.5%。适形指数方面,IMRT最优(CI=0.89),而IMPT在靶区剂量分布的均匀性方面(HI=1.061)最优。大脑、脑干颞叶的受照剂量方面,三种计划均为超出最大限量。IMRT、DS-PBT、IMPT的大脑平均受照剂量为:15.09Gy、5.32CGE、4.42CGE,三者间比较有统计学差异(卡方值:12.3、P0.001),对比IMRT,DS-PBT放疗(P=0.018)以及IMPT放疗(P=0.03)均能明显减少大脑受照平均剂量;IMRT、DS-PBT以及IMPT的脑干平均受照剂量为:33.54Gy、15.18CGE以及8.65CGE,(卡方值:12.3、P0.001),与IMRT比较,DS-PBT计划(P=0.018)、IMPT计划(P=0.03)均明显减少脑干受照射的平均剂量。同侧颞叶,IMRT、DS-PBT以及IMPT平均受照剂量分别为:22.11Gy、13.10CGE、7.11CGE,三者间比较有统计学差异(卡方值:6.0、P=0.049),IMPT相对IMRT能明显降低受照射的平均剂量(P=0.043),IMRT对比DS-PBT以及IMPT对比DS-PBT无明显差异统计学差异(P值均为0.662)。对侧颞叶,IMRT、DS-PBT、IMPT三种计划平均剂量分别为:18.60Gy、0.91CGE、4.83CGE,三者间比较有统计学差异(卡方值:6.0、P=0.049),DS-PBT相对IMRT能明显降低受照射的平均剂量(P=0.043),IMRT对比IMPT以及DS-PBT对比IMPT无明显统计学差异(P均为0.662)。在视觉器官受量方面,同侧视觉器官中的晶体、视神经、视网膜三种计划均超过最大限制剂量。对侧晶体三种放疗计划均已超出最大限制量,对侧视神经最大剂量方面,IMRT、DS-PBT以及IMPT三种计划分别为53.25Gy、36.21CGE以及54.72CGE,三者间比较有统计学差异(卡方值:12.3、P0.01),DS-PBT计划显著低于IMRT(P=0.018)以及IMPT计划(P=0.003)。IMRT、DS-PBT以及IMPT在对侧视神经平均受量分别为:39.00Gy、19.13CGE、38.20CGE,三者间比较有统计学差异(卡方值:12.3、P0.01),DS-PBT计划显著低于IMRT(P=0.003)计划以及IMPT计划(P=0.018)。IMRT、DS-PBT以及IMPT在视交叉的平均受量分别为:46.28Gy、22.53CGE以及35.65CGE,三者间比较有统计学差异(卡方值:13.3、P0.01),DS-PBT计划明显优于IMRT计划(P=0.001),IMRT计划对比IMPT计划无统计学意义(P=0.401),DS-PBT对比IMPT无统计学差异(P=0.073)。肿瘤双侧内耳,同侧腮腺均值、对侧腮腺均值以及V30三种计划均未超出最大限制量,同侧腮腺的V30,DS-PBT计划超出限制量。同侧内耳的平均剂量分别为:38.82Gy、40.14CGE、26.12CGE,三者间比较有统计学差异(卡方值:8.0、P=0.018),IMPT计划显著低于IMRT计划以及DS-PBT计划(P值均为0.023),同侧内耳的最大剂量,三者分别为:42.28Gy、43.47CGE以及32.03CGE,三者间比较有统计学差异(卡方值:12.3、P0.01),IMPT显著低于DS-PBT(P=0.002),IMRT对比IMPT无明显差异(P=0.544),DS-PBT对比IMRT无统计学意义(P=0.098)。IMRT、DS-PBT以及IMPT在对侧内耳平均剂量分别为:30.23Gy、5.45CGE以及19.09CGE,三者间比较有统计学差异(卡方值:12.3、P0.01),DS-PBT显著低于IMRT计划(P0.001),对比IMPT无统计学差异(P=0.184),IMRT与IMPT间比较无统计学差异(P=0.184);在对侧内耳的最大剂量上,三种计划分别为:33.47Gy、9.86CGE以及23.62CGE,三者间比较有统计学差异(卡方值:12.3、P0.01),DS-PBT计划亦显著低于IMRT(P=0.002),对比IMPT计划无明显统计学差异(P=0.544),IMRT与IMPT计划间比较无统计学差异(P=0.098)。同侧腮腺的V30,IMRT、DS-PBT以及IMPT计划分别为:17.70%、55.10%、10.75%,但统计学上三种计划无明显差异(卡方值:5.5、P=0.05)。对侧腮腺的平均受量,IMRT、DS-PBT以及IMPT均未超出最大限制量,分别为:15.82Gy、7.68CGE、14.25CGE,三者间比较有统计学差异(卡方值:9.8、P0.01),DS-PBT计划明显优于IMRT(P=0.008),对比IMPT无统计学意义(P=0.073),IMRT与IMPT间比较亦无统计学意义(P=1)。靶区外受照组织的剂量(nontargetbody),对于在受照剂量低于20Gy时,DS-PBT以及IMPT技术较IMRT计划均明显减少了照射体积(P均0.05),在20至40Gy照射范围IMPT技术较IMRT计划明显减少了照射体积(P0.05),但DS-PBT对比IMRT减少照射体积不明显(P0.05)。结论:鼻腔鼻旁窦癌的IMRT计划、DS-PBT计划、IMPT计划均能提供满足临床的靶区覆盖,IMRT在适形指数方面有优势,IMPT在靶区均匀性方面更有优势。质子放疗的DS-PBT计划以及IMPT计划不同程度地较IMRT计划降低了正常组织平均剂量和最大剂量以及非靶区体积的低剂量照射范围,两种计划在危及器官的剂量限制各有优势。而三种计划均在同侧晶体、视神经以及视网膜,对侧晶体接受的最大剂量超出了限制量。
[Abstract]:Objective: To compare the dose distribution of the target area and normal tissue in the intensity modulated radiotherapy (IMRT), proton double scattering radiotherapy (DS-PBT) and proton intensity modulated radiation therapy (IMPT) after nasal paranasal sinus surgery. Materials and methods: 8 cases of nasal paranasal sinus carcinoma were selected from October 2012 to May 2014 in Florida proton center, 5 of them were male, 3 women, 59 years of age (43-76 years old),.8 patients, using the Eclipse treatment plan system to develop proton double scattering radiotherapy plan, and use the Raystation treatment plan system to develop photon intensity modulated radiotherapy plan and proton intensity modulated radiotherapy plan. The target area coverage of the three plans, the target area dose maximum value (Dmax), the minimum value (Dmin), average value (Dmean), the conformal index (conformal index, CI), the uniform index (homogeneity index, HI), the average dose (Dmean) of the normal tissue, the maximum dose (Dmax), the minimum dose (Dmin), the dose volume of the non target region (nontargetbody) and the dose volume relation curve (DVH) are compared. The target area coverage accepted: at least 95% of the PTV volume in all patients received 95% prescription doses. The target area Dmin of the three plans was greater than the 95% prescription dose, but in the IMRT and DS-PBT programs, the target area Dmax was significantly higher than the IMPT plan, 110% and 111% of the prescription dose, respectively, while the target Dmax of the IMPT program was only 106%. of the prescription dose. For V107, IMRT and DS-PBT is also significantly higher than the IMPT scheme, 26.5% and 29.59% respectively. IMPT is only the 1.5%. conformal index, IMRT optimal (CI=0.89), and IMPT is optimal in the uniformity of dose distribution in the target region (HI=1.061). The three plans are beyond the maximum limit.IMRT, DS-PBT, and the brain stem temporal lobe. The average exposure dose of the brain was 15.09Gy, 5.32CGE, 4.42CGE, and there was a statistically significant difference between the three (chi square: 12.3, P0.001). Compared with IMRT, DS-PBT radiotherapy (P=0.018) and IMPT radiotherapy (P=0.03), the average dose of the brain was significantly reduced; IMRT, DS-PBT, and IMPT (chi square) Value: 12.3, P0.001), compared with IMRT, DS-PBT program (P=0.018), IMPT plan (P=0.03) obviously reduced the average dose of the brain stem irradiated. The average exposure dose of the same lateral temporal lobe, IMRT, DS-PBT, and IMPT are: 22.11Gy, 13.10CGE, 7.11CGE, and there is a statistically significant difference between the three groups (the chi square value: 6). The average dose (P=0.043), IMRT contrast DS-PBT and IMPT compared to DS-PBT had no significant difference (P value was 0.662). The three planned average doses for the lateral temporal lobe, IMRT, DS-PBT, and IMPT were respectively 18.60Gy, 0.91CGE, 4.83CGE, and there was a statistically significant difference between the three groups (6 The average dose (P=0.043), IMRT contrast IMPT and DS-PBT compared to IMPT had no significant statistical difference (P was 0.662). In the visual organ volume, the crystal, optic nerve, and retina in the visual organ were all over the maximum limit dose. The three kinds of radiotherapy plans in the contralateral lens have exceeded the maximum limit and the maximum dose of the lateral optic nerve. In terms of quantity, the three schemes of IMRT, DS-PBT and IMPT were 53.25Gy, 36.21CGE and 54.72CGE respectively. There was a statistical difference between the three (12.3, P0.01). The DS-PBT plan was significantly lower than IMRT (P=0.018) and IMPT plan (P=0.003). There were statistical differences (12.3, 12.3, P0.01), and the DS-PBT plan was significantly lower than the IMRT (P=0.003) plan and IMPT plan (P=0.018).IMRT, DS-PBT and IMPT were respectively 46.28Gy, 22.53CGE, and 35.65CGE. There were statistical differences between the three. .001), the IMRT program had no statistical significance (P=0.401) compared to the IMPT program, and there was no statistical difference between DS-PBT and IMPT (P=0.073). Both the bilateral inner ear, the mean of the parotid gland, the mean parotid gland in the contralateral parotid gland and the V30 three plans were not beyond the maximum limit, and the V30 of the parotid gland in the ipsilateral parotid gland was beyond the limit. The average dose of the ipsilateral inner ear was: 38.82G Y, 40.14CGE, 26.12CGE, there were statistically significant differences (chi square value: 8, P=0.018), IMPT plan was significantly lower than IMRT plan and DS-PBT program (P value was 0.023), and the maximum dose of the same side inner ear, three were 42.28Gy, 43.47CGE and 32.03CGE, the three were statistically different (12.3, 12.3, P0.01). P=0.002), there was no significant difference between IMRT and IMPT (P=0.544), and DS-PBT compared to IMRT without statistical significance (P=0.098).IMRT, DS-PBT and IMPT in the contralateral inner ear were respectively: 30.23Gy, 5.45CGE, and, there was a statistically significant difference between the three (chi square value: 12.3). There was no statistical difference (P=0.184) between IMRT and IMPT (P=0.184). In the maximum dose of the lateral inner ear, the three schemes were 33.47Gy, 9.86CGE and 23.62CGE respectively. There was a statistically significant difference between the three (chi square value: 12.3, P0.01), and the DS-PBT program was significantly lower than IMRT (P=0.002), and there was no significant difference in the IMPT plan. There was no statistical difference compared with the IMPT plan (P=0.098). The V30, IMRT, DS-PBT, and IMPT plans of the parotid gland were 17.70%, 55.10%, 10.75% respectively, but there was no significant difference between the three plans (5.5, P=0.05). The average amount of the parotid gland, IMRT, DS-PBT, and IMPT were not beyond the maximum limit, respectively 15.82Gy, 7.68CGE, 14.2. 5CGE, there were statistically significant differences between the three (chi square: 9.8, P0.01), DS-PBT plan was significantly better than IMRT (P=0.008), there was no statistical significance between IMPT (P=0.073), IMRT and IMPT were not statistically significant (P=1). The volume of irradiation (P 0.05) was significantly reduced. The radiation volume (P0.05) was significantly reduced by IMPT technique compared with IMRT in the range of 20 to 40Gy, but DS-PBT contrasted IMRT to reduce the volume of irradiation (P0.05). Conclusion: the IMRT plan, DS-PBT plan, IMPT plan of nasal paranasal sinus carcinoma can provide the target coverage of the clinic, IMRT is in the conformal index. There are advantages. IMPT has a better advantage in the uniformity of target area. The DS-PBT plan of proton radiotherapy and the IMPT program have different degrees of IMRT plan to reduce the average dose and maximum dose of normal tissue and the low dose radiation range of the non target volume. The two plans have advantages in the dose restriction endanger organs. The three plans are all at the same time. The maximum dose accepted by the contralateral lens, optic nerve and retina is beyond the limit.

【学位授予单位】：广州医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.62;R730.55

【参考文献】