乳腺癌保乳术后选择eComp放疗技术的影像学几何参数研究

发布时间：2018-03-17 01:38

  本文选题：乳腺癌　切入点：放射治疗　出处：《重庆医科大学》2016年博士论文　论文类型：学位论文

【摘要】：第一部分早期乳腺癌保乳术后3DCRT和eComp放疗的剂量学比较目的:比较早期乳腺癌保乳术后3DCRT和eComp两种不同放疗技术的剂量学特点,确定是否有必要进一步探讨哪些患者最大可能从eComp技术获益。材料与方法:60例早期乳腺癌保乳术后放疗患者,分别设计三维适形放疗计划(3DCRT)和电子组织补偿放疗计划(eComp)。放疗计划的基本剂量标准为95%的处方剂量覆盖95%以上的PTV(D95≥95%),同时尽可能降低肺、心脏受照射剂量。在两种放疗计划之间比较设计计划的时间、辐射剂量机器监测单位(MU)以及肿瘤靶区剂量覆盖和正常组织器官受照射剂量等参数。结果:两种放疗计划平均完成时间eComp约比3DCRT多10分钟,但没有统计学差异。3DCRT和eComp的平均MU分别为274±82、302±56(P=0.102)。两种方案都能满足肿瘤靶区的剂量覆盖标准;采用eComp计划,肺V20和皮肤平均剂量比3DCRT计划更低,差异有统计学意义;心脏平均剂量,两种方案之间没有统计学差异。结论:在保证肿瘤靶区得到足量照射,即不影响肿瘤控制的前提下,eComp可以降低肺和皮肤的受照射剂量,但并非在所有乳腺癌保乳术后放射治疗的患者中,eComp都优于3DCRT,因此,有必要进一步探讨哪些病人最大可能从eComp技术获益。第二部分影像学几何参数与3DCRT和eComp剂量-体积参数的关系目的:分析早期乳腺癌保乳术后放疗患者影像学解剖特征与3DCRT和eComp剂量-体积参数之间的关系,探讨基于影像学解剖参数选择不同放疗技术的可行性。方法:60例早期乳腺癌保乳术后放疗患者,分别设计三维适形放疗计划(3DCRT)和电子组织补偿放疗计划(eComp)。放疗计划的基本剂量标准为95%的处方剂量覆盖95%以上的PTV(D95≥95%),最大剂量Dmax不超过110%处方量,同时尽可能降低肺、心脏受照射剂量。统计学分析两种放疗技术对应的危及器官受照射剂量与影像学解剖参数之间的关系;影像学解剖参数包括中心肺厚度(central lung distance,CLD),最大心脏距离(maximal heart distance,MHD),最大心脏长度(maximal heart length,MHL)以及乳房内外界间距(breast separation,BS)。结果:乳房更大的患者最大可能从eComp放疗技术获益,如果要将同侧肺V20控制在20%以下、平均肺剂量控制在10Gy以下、皮肤平均剂量控制在85%处方剂量以下,CLD超过2.3厘米或/和BS超过22.5厘米是决定选择eComp放疗方案而不宜再选用3DCRT放疗方案的预测参数指标。结论:本研究的结果为我们的临床工作提供了一个方便、快速的剂量评估工具。乳腺癌保乳术后开始设计放疗计划之前,可根据本研究所确定的参数-剂量关系,快速地在不同放疗技术之间选择合适的放疗方案。第三部分eComp技术减轻了乳腺癌放射治疗急性皮肤毒性反应目的:我们前期的研究结果已经证实eComp技术是乳房分离间距(BS)超过22.5cm的乳腺癌患者保乳术后首选的放疗方案。本部分根据这一影像学解剖参数标准选择病例进行随机对照研究,比较eComp和3DCRT技术应用于乳腺癌全乳放疗急性皮肤毒性反应的差异。材料与方法:总共69例0-Ⅱ期、BS超过22.5cm的早期乳腺癌保乳术后需全乳放疗的患者纳入本研究。所有患者均根据放疗前的模拟CT图像设计放疗计划。35例(50.7%)采用eComp技术,34例(49.3%)采用3DCRT技术。开始放疗前及放疗期间每周拍摄双侧乳房正位照片用于研究评估。放疗期间至结束后6周,每周评估1次急性放射性皮肤毒性反应。结果:相比较于3DCRT技术,eComp明显减少了2级急性放射性皮炎的发生率(67.6%vs.42.9%,P=0.038)。eComp组无患者发生3级急性放射性皮炎,与之相对应的3DCRT组有2例发生。两组间急性放射性乳房水肿没有统计学差异(P=0.754)。eComp减少了3级乳房疼痛的发生率(P=0.019)。多变量分析结果显示,不同放疗技术和BS是急性放射性皮炎的影响因素(P=0.045,0.026),不同放疗技术是放射性乳房疼痛的影响因素(P=0.036)。结论:根据我们之前所确定的乳腺癌保乳术后选择eComp放疗技术的影像学几何参数标准,对于患侧乳房分离间距(BS)大于22.5cm的早期乳腺癌保乳术后患者,在不影响肿瘤控制的前提下,采用eComp技术,相比较于3DCRT,可以明显降低急性放射性皮肤毒性。
[Abstract]:The first part for early breast cancer after breast conserving surgery and radiotherapy 3DCRT eComp objective to compare the breast conserving surgery for early breast cancer after 3DCRT and eComp of two different radiotherapy dosimetric characteristics to determine whether it is necessary to further explore which patients may benefit from eComp technology. Materials and methods: 60 cases of patients with early breast radiotherapy after breast conserving surgery, were designed for 3-dimensional conformal radiotherapy (3DCRT) and electronic compensation Organization (eComp). The basic plan of radiotherapy dose standard radiotherapy for covering more than 95% of the prescription dose of PTV 95% (D95 = 95%), at the same time as far as possible to reduce the lung, heart dose. The planned time comparison design between the two radiotherapy, radiation dose (MU) and machine monitoring unit dose of tumor target coverage and normal tissue dose parameters. Results: two radiotherapy plans the average completion time about eComp 10 more than 3DCRT minutes, but no significant difference in average MU.3DCRT and eComp were 274 + 82302 + 56 (P=0.102). The two schemes can meet the tumor target dose coverage criteria; using the eComp plan, the average dose of V20 lung and skin than the 3DCRT plan is lower, the difference was statistically significant; the average dose the heart, no statistically significant differences between the two methods. Conclusion: in which the tumor target get enough exposure, that does not affect the premise of tumor control, eComp can reduce the radiation dose to the lung and skin, but not all the radiation therapy in breast cancer after breast conserving surgery in patients with eComp are better than 3DCRT, therefore and it is necessary to further explore which patients may benefit from the largest eComp. The relationship between the geometric parameters and 3DCRT and eComp dose volume parameters of the second part imaging: analysis of early breast conserving surgery after radiotherapy were imaging anatomy The relationship between the feature and the 3DCRT and eComp dose volume parameters, evaluate the imaging anatomy parameter selection technique based on the feasibility of different radiotherapy. Methods: 60 cases of radiotherapy in patients with early breast cancer after breast conserving surgery, were designed for 3-dimensional conformal radiotherapy (3DCRT) and electron radiotherapy (eComp) tissue compensation standard radiotherapy dose. The plan for covering more than 95% of the prescription dose of PTV 95% (D95 = 95%), the maximum dose of Dmax is not more than 110% prescriptions, as well as reduce the lung, heart dose. Statistical analysis of the relationship between the two radiotherapy techniques corresponding organ radiation dose and imaging anatomy parameters; imaging anatomy parameters including the center of lung (central lung distance, thickness CLD), maximum distance (maximal heart heart distance, MHD), the maximum length of the heart (maximal heart length, MHL) and milk in the room outside space (breast separati On, BS). Results: the maximum possible breast patients greater benefit from eComp radiotherapy, if the ipsilateral lung V20 below 20%, the mean lung dose below 10Gy, the average dose of skin in 85% prescription dose, CLD more than 2.3 cm or / and BS more than 22.5 cm is decided while not using 3DCRT radiotherapy prediction parameters eComp radiotherapy. Conclusion: This study provides a convenient results for our clinical work, dose assessment tools quickly. Before the start of breast cancer radiotherapy plan design, according to the parameters of the study and determination of the dose relationship to select a suitable treatment plan between different radiotherapy techniques. In the third part, eComp technology reduces the radiation therapy for breast cancer acute skin toxicity Objective: our previous studies have demonstrated that eComp technology is the separation of breast 闂磋窛(BS)瓒呰繃22.5cm鐨勪钩鑵虹檶鎮ｈ，

本文编号：1622612