左乳腺癌改良根治术后胸壁电子线照射、三维适形放疗、X线和电子线混合三维适形放疗的临床剂量学研究

发布时间：2018-03-17 17:38

本文选题：乳腺癌　切入点：改良根治术　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]:比较左乳腺癌改良根治术后胸壁电子线照射、三维适形放疗、X线和电子线混合三维适形放疗三种治疗方法的剂量学特点。[方法]:选取2014年1月至2015年5月昆明医科大学第三附属医院收治的女性中晚期左侧乳腺癌改良根治术后患者15例,左胸壁表面垫0. 5cm厚的等效填充物,热塑体膜固定后行CT定位,用Pinnacle3 9. 10三维调强治疗计划系统对每位患者分别设计三种胸壁放射治疗计划:电子线照射计划(E计划)、3D-CRT照射计划(3D-CRT计划)、X线和电子线混合3D-CRT照射计划(3D-CRT+E计划),并对三种计划靶区的剂量学参数如:PTV: V90、V95、V100、V105、V110、Dmax、Dmin、Dmean、D5、D95、CI、HI 和危及器官:左肺:V5、V10、V15、V20、V30、V40、Dmean;心脏:V5、V1o、V15、V20、V30、V40、Dmean;右肺:Dmean进行评估和比较。[结果]:1. E计划vs 3D-CRT计划:(1)靶区剂量学比较:V90、V95、V100、V110、Dmax、Dmin、Dmean、D95、CI、HI 两组比较差异均有统计学意义(P0.05) ; V105、D5两组比较差异均无统计学意义(P0.05)。(2)危及器官剂量学比较:左肺:V5、V10、V15、V20,、V30、V40、Dmean、心脏:V5、V10、V15两组比较差异均有统计学意义(P0. 05);右肺:Dmean、心脏:V20、V30、V40、Dmean两组比较差异均无统计学意义(P0. 05)。2. E 计划 vs 3D-CRT+E 计划:(1)靶区剂量学比较:V90 V95、V100、V110、Dmax、Dmin、Dmean、D5、D95、CI、HI 两组比较差异均有统计学意义(P0. 05) ; V105两组比较差异无统计学意义(P0.05)。(2)危及器官剂量学比较:左肺:V5、V10、V15、V20、V30、V40、Dmean、心脏:V5、V10、V15两组比较差异均有统计学意义(P0.05);右肺Dmean、心脏:V20、V30、V40、Dmean两组比较差异均无统计学意义(P0.05)。3. 3D-CRT 计划 vs 3D-CRT+E 计划:(1)靶区剂量学比较:V105、Dmax、D5、CI两组比较差异均有统计学意义(P0.05) ; V90、V95、V100、V110、Dm10、Dmmin、Dmean、D95、HI 两组比较差异均无统计学意义(P0. 05)。(2)危及器官剂量学比较:左肺:V5、V10、心脏V5两组比较差异均有统计学意义(P0.05);左肺:V15、V20、V30、V40、Dmean、右肺 Dmean、心脏:V10、V15、V20、V30、V40、Dmean两组比较差异均无统计学意义(P0.05)。[结论]:胸壁单纯电子线放疗尽量不推荐常规使用。三维适形放疗靶区的适形性、均匀性及对危及器官的保护方面均较单纯电子线计划有明显提高,且临床容易实施。3D-CRT+E计划并没有显示出混合射线的明显优势。因此,乳腺癌术后胸壁放疗建议根据患者的实际情况制定个体化治疗方案。
[Abstract]:[objective]: to compare the electron irradiation of chest wall after modified radical mastectomy for left breast cancer. Dosimetric characteristics of three dimensional conformal radiotherapy combined with three-dimensional conformal radiotherapy. [methods]: from January 2014 to May 2015, the left breast of female patients admitted to the third affiliated Hospital of Kunming Medical University was selected. There were 15 patients with adenocarcinoma after modified radical mastectomy. The thickness of the left chest wall was 0.5 cm thick. The thermoplastic membrane was fixed with CT. Three kinds of chest wall radiotherapy plans were designed for each patient by using Pinnacle3 910 three dimensional intensity modulated treatment plan system: electron line irradiation plan E plan 3D-CRT radiation plan 3D-CRT plan 3D-CRT radiation plan and 3D-CRT hybrid 3D-CRT radiation plan 3D-CRT plan. Dosimetric parameters of three planned target areas such as: V90V95V95V100V105V110DmaxDminD5D95CIHI and dangerous organs: left lung: V5V10V10V15V20V30V40Dmean; heart V5V1: V15V20V30V40Dmean; right lung Dmean. [results] 1e vs 3D-CRT. No significant difference was found between the two groups (P < 0.05); there was no significant difference between the two groups (P 0.05). 2) the dosimetry comparison of the organs of the two groups was not statistically significant. There was no significant difference between the two groups (P 0. 05). There was no significant difference between the two groups (P 0. 05), and there was no significant difference between the two groups (P 0. 05). The difference between the two groups was not statistically significant (P 0. 05), but there was no significant difference between the two groups (P < 0. 05). Comparison of dosimetry of target area between the two groups: 1: V90 V95N V100 D110DmaxDmin Dmean D5D95CIHI); V105 has no significant difference between the two groups (P0.05. 2) comparison of organ dosimetry: left lung V5V10V15 V20V30V40Dmean, heart V5V10V10V15 compared with V10V15V30V40Dmean, heart V5V10V10V15 compared with V10V15V10V30V40Dmean, heart V5V10V10V15 compared with V10V15V10V30V40Dmean, V10V15 V10V15 compared with V10V15V30V40Dmean, V10V10V15 V10V15 compared with V10V15V30V40Dmean, V10V10V15. There was no significant difference between the two groups in Dmean of right lung, Dmean of right lung, V30 / V20 / V40Dmean of the right lung. There was no significant difference between the two groups in Dmean (P0.05) .3.3D-CRT vs V3D-CRE (1)) the difference of dosimetry in target area between the two groups was significant (P0.05); there was significant difference between the two groups (P < 0.05); There was no significant difference in dosimetry between the two groups. There was no significant difference between the two groups (P < 0.05). There was no significant difference between the two groups (P < 0.05). There was no significant difference between the two groups. [conclusion] there was no significant difference between the two groups. [conclusion]: the left lung: V15V20 V30 V40Dmean, the right lung Dmean, the heart V10V15V15V20V30V40Dmean have no statistical significance. [conclusion]: the chest wall is pure. Electron line radiotherapy is not recommended for conventional use as far as possible. Conformability of three-dimensional conformal radiotherapy target, The uniformity and protection of organ endangering organs were significantly improved than those of the simple electron line program, and the clinical easy implementation of the .3D-CRT E program did not show the obvious advantages of mixed radiation. Postoperative chest wall radiotherapy for breast cancer suggests individualized treatment according to the actual conditions of the patients.
【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】：R737.9

【参考文献】