急性淋巴细胞白血病造血干细胞移植前行全身放疗的靶区及临床对比

发布时间：2018-06-03 08:47

本文选题：急性淋巴细胞白血病 + 造血干细胞移植　；参考：《郑州大学》2017年硕士论文

【摘要】：目的:通过对10例急性淋巴细胞白血病患者造血干细胞移植前行两种不同方案的全身放疗(TBI,TMLI),对比两种放疗计划之间的靶区、计划及临床反应和临床效果的差异,比较两种放疗方案在临床治疗中的利弊,为临床治疗提供理论依据。方法:选取自2016年5月-2016年12月郑州大学第一附属医院收治的10例急性淋巴细胞白血病造血干细胞移植前行全身放疗的病例,均符合以下要求:均行骨髓穿刺活检,病理诊断明确,为急性淋巴细胞白血病;放疗前已行大剂量化疗及鞘内注射化疗。将CT定位扫描图像资料导入Eclipse工作站,在CT图像上勾画临床靶区体积(CTV);包括TBI、TMLI两种不同靶区。其中,TBI的CTV为除外正常危及器官的全身;TMLI的CTV范围包括全身骨骼、主要淋巴结链及脾脏,考虑保留患者生育功能,原则上不将睾丸作为靶区照射,但实际治疗时需要结合化疗方案和患者及其家属的意愿。两种靶区需要评价的危及器官均包括双侧晶体及双侧肺。计划处方由CTV外扩0.5cm得到的PTV,统一给予12Gy/6F。靶区的剂量学评价指标如下:PTV的Dmax、Dmean、D98、D95、D50、D02、V12;危及器官:双侧肺的Dmax、Dmean、V5,双侧晶体的Dmax、Dmin。比较不同放疗计划的临床不良反应(恶心、呕吐、纳差、口干、发热、腹泻、皮疹)及临床效果(移植结果)的不同。结果:1.靶区TMLI和TBI两者的靶区适形度都比较高,能满足处方剂量的要求,12Gy的剂量分布均匀。2.危及器官两种靶区的危及器官均能控制在正常范围内,就肺受量来说,TMLI的肺平均受量要低于TBI。3.不良反应TMLI和TBI的不良反应没有明显差异,患者治疗时比较明显的不良反应主要有恶心、呕吐(均为I-II级),纳差,口干,腹泻,发热、皮疹,治疗时配合止吐药、止泻、补液等药物对症治疗后均有好转,患者均可耐受。4.临床效果TBI6例患者全部移植成功,1例死亡(移植成功后出现严重排异反应,死于严重感染),TMLI 4例患者均移植成功,未见移植排异反应。结论:1.TBI和TMLI两种方案均可满足靶区剂量覆盖、均匀性和适形性的要求,D95基本可以满足处方剂量12Gy的要求,同时危及器官受量较低,对于肺的保护,TMLI可使肺平均受量更低,但两种方案危及器官受量都在正常范围内。2.TBI和TMLI临床不良反应类似,均为轻中度恶心、呕吐、纳差及口干等,配合对应药物应用后患者均可耐受。3.TBI和TMLI近期移植效果类似,患者均能成功移植。
[Abstract]:Objective: to compare the difference of target area, plan, clinical response and clinical effect between 10 patients with acute lymphoblastic leukemia before hematopoietic stem cell transplantation. To compare the advantages and disadvantages of two radiotherapy schemes in clinical treatment and provide theoretical basis for clinical treatment. Methods: ten patients with acute lymphoblastic leukemia before hematopoietic stem cell transplantation were selected from the first affiliated Hospital of Zhengzhou University from May 2016 to December 2016. The pathological diagnosis was confirmed as acute lymphoblastic leukemia and high dose chemotherapy and intrathecal chemotherapy were performed before radiotherapy. The CT localization scanning image data were imported into the Eclipse workstation, and the volume of clinical target area was delineated on the CT image, which included two different target areas: TBI and TMLI. The CTV of TBI is the CTV range of TMLI, including the whole body skeleton, the main lymph node chain and the spleen, except for the normal organ. It is considered that the patient's fertility function should be preserved, and the testis should not be irradiated as a target area in principle. But actual treatment needs to be combined with chemotherapy and the will of patients and their families. Both target areas need to be evaluated for both organs including bilateral lens and bilateral lung. The plan prescription was obtained by CTV expanding 0.5cm, and was given 12 Gy / 6 F uniformly. The dosimetric evaluation indexes of the target area are as follows: Dmaxn Dmean D98 D95N D50 D02V12 of 1: PTV, Dmaxus DmeanV5 of bilateral lung and DmaxDmin. of bilateral crystal. Clinical adverse reactions (nausea, vomiting, anorexia, dry mouth, fever, diarrhea, rash) and clinical outcomes (transplant results) were compared between different radiotherapy plans. The result is 1: 1. Both TMLI and TBI have high target conformability and can meet the requirement of prescribed dose. The dose distribution of 12Gy is even. 2. The two target regions of the endangered organs can be controlled within the normal range, and the average lung intake of TMLI is lower than that of TBI.3in terms of lung recipient. There was no significant difference in adverse reactions between TMLI and TBI. The main adverse reactions during treatment were nausea and vomiting (I-II grade, anorexia, dry mouth, diarrhea, fever, rash, antiemetic drugs, diarrhea, rash, diarrhea, diarrhea and diarrhea). Rehydration and other drugs have improved after symptomatic treatment, patients can tolerate. 4. Clinical results 1 case died after successful transplantation (severe rejection occurred after transplantation and 4 cases died of severe infection). No transplant rejection was found in all patients. Conclusion both TBI and TMLI can meet the requirements of target dose coverage, uniformity and conformability can basically meet the requirement of prescription dose 12Gy, at the same time the organ acceptance is low, and the lung protection TMLI can make the lung average dose lower. However, both of the two regimens were in the normal range. 2. The adverse effects of TBI and TMLI were similar, which were mild and moderate nausea, vomiting, anorexia and dry mouth, etc. The patients who were treated with corresponding drugs could tolerate the effects of recent transplantation of TMLI and TBI. 3. All patients were successfully transplanted.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R733.71

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