全脑全脊髓简单调强方法研究

发布时间：2018-11-13 19:28

【摘要】：全脑全脊髓放射治疗是原发中枢神经系统肿瘤治疗流程中一个重要的组成部分。本论文首先回顾国内外的文献资料，大部分研究只是对全脑全脊髓常规放射治疗方法的改进，包括使用半野衔接技术，静态调强技术，非共面野衔接技术，对靶区射野衔接处剂量作局部改进，在治疗过程中需要多次旋转治疗床，准直器等，使治疗流程过于复杂，在治疗过程中引入误差，造成治疗失败，甚至造成治疗事故。本研究选取5名已行全脑全脊髓放疗患者，为每位患者设计3DCRT计划，3野sIMRT(sIMRT_(3f))计划和5野sIMRT(sIMRT_(5f))计划。计划靶区（PTV）处方剂量是36Gy分20次。利用剂量分布、剂量体积直方图（DVH）评价不同照射技术的靶区和正常器官的照射剂量、靶区剂量均质指数，通过总的机器跳数（MU）间接比较不同照射技术的治疗时间。结果3DCRT在射野衔接处有只有处方剂量的70%。计划靶区后缘的正常组织（NT）接受的剂量达到处方剂量的140%；3DCRT计划，sIMRT3f计划和sIMRT5f计划靶区均质指数（HI）分别为0.18±0.02、0.09±0.01、0.08±0.01(t=7.8、7.65,P0.05)；各计划心脏V10分别为36±6.0，8.4±1.9，8.4±2.0（t=13.3、13.0,P0.05），甲状腺V20分别69.4±5.7，2.4±1.5，12.4±1.6（t=26.3、26.4，P0.05），喉V20分别为89.4±7.0，17.2±1.2，17.9±1.5，（t=25.5、26.5，P0.05），靶区后缘正常组织（NT）V30分别为31.9±6.1，4.4±1.4，4.9±1.9（t=8.5,10.1，P0.05），，各计划的平均机器跳数（MU）分别为640±78MU、1100±106MU、1160±129MU.用Delta4三维验证系统对sIMRT计划验证，通过率98%，射野衔接处没有出现过高或过低区域。 sIMRT计划在剂量分布，危及器官保护，靶区剂量均质指数等方面都明显好于3D-CRT计划，特别是在射野衔接处，会有较好的剂量分布，值得在临床得到广泛应用。
[Abstract]:Whole-brain whole-spinal cord radiotherapy is an important part of the primary central nervous system tumor treatment process. In this paper, we first reviewed the literature at home and abroad. Most of the studies were only about the improvement of conventional radiotherapy for whole brain spinal cord, including the use of hemi-field convergence, static intensity modulation, non-coplanar convergence. The local improvement of the dose at the junction of the projectile field in the target area requires many times rotation of the treatment bed and collimator in the course of treatment, which makes the treatment process too complicated, and introduces errors in the treatment process, resulting in the failure of treatment and even the treatment accident. In this study, 5 patients who had received whole brain whole spinal cord radiotherapy were selected to design 3DCRT plan, 3 field sIMRT (sIMRT_ (3f) plan and 5 field sIMRT (sIMRT_ (5 f) plan) for each patient. The prescribed dose of (PTV) in the planned target area was 36Gy 20 times. Dose distribution and dose volume histogram (DVH) were used to evaluate the dose of target and normal organs of different irradiation techniques, and the dose homogeneity index of target area. The therapeutic time of different irradiation techniques was indirectly compared by total machine hops (MU). Results there were only 70 doses of 3DCRT in the field junction. The dose of (NT) in normal tissue at the posterior edge of the planned target area was 140 / 3DCRT of the prescribed dose. The target area homogeneity index (HI) of sIMRT3f plan and sIMRT5f plan was 0.18 卤0.02 卤0.09 卤0.010.08 卤0.08 卤0.08 卤0.08 卤0.08 卤0.08 卤0.08 卤0.08 卤0.08 卤0.08 卤0.08 卤0.08 卤0.08 卤0.08 卤0.08 卤0.08 卤0.08 卤0.08 卤0.08 卤 The V10 of heart and thyroid were 36 卤6.0 卤8.4 卤1.9 卤2.0 and 69.4 卤5.724 卤1.5 卤12.4 卤1.6 respectively (P 0.05). The V20 of larynx was 89.4 卤7.0 卤17.2 卤1.2 卤17.9 卤1.5, respectively (t 25. 5 / 26. 5), and the (NT) V30 of the posterior edge of the target was 31. 9 卤6. 1 / 4 卤1. 4 卤4. 4 卤1. 9 (t = 8. 5 ~ 10. 1), respectively, and that of the normal tissue of the posterior edge of the target area was 39. 9 卤6. 1 卤1. 4 卤1. 9 respectively. The average machine hops of each program were 640 卤78MUU 1100 卤106MUU 1160 卤129MU, respectively. The Delta4 three dimensional verification system is used to verify the sIMRT plan. The pass rate is 98. There are no high or too low areas in the field junction. The dose distribution, organ protection and target dose homogeneity index of sIMRT plan are obviously better than that of 3D-CRT plan, especially in the junction of field, which is worthy of extensive clinical application.
【学位授予单位】：清华大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R730.55

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