胃癌术后放疗靶区偏移定量分析及三维适形和调强照射剂量学比较
发布时间：2019-01-24 10:01
【摘要】：目的:确定胃癌术后放疗靶区移动度及比较三维适形和调强两种放疗技术靶区的剂量学分布,为临床应用提供参考。方法:(1)选取15例在南昌大学一附院行胃癌D2根治术的胃癌患者,进行CT扫描定位,患者空腹3小时,放疗定位前5分钟饮400ml水,使胃充盈,然后进行CT模拟扫描定位,在Pinnacle计划系统上勾画靶区及周围正常组织,物理师计划制定,临床医师确认。(2)计划验证前5分钟患者空腹饮400ml水+10ml泛影葡胺,模拟机下观察胃靶区移动度,采用同样方法在放疗中、放疗结束前再次观察胃靶区移动度。(3)选取上述5例胃癌术后患者分别设计三维适形放疗(3DCRT)和调强放疗(IMRT)两组计划进行对比,95%的PTV的处方剂量为45Gy,99%的PTV处方剂量42.75 Gy,用等剂量曲线和剂量体积直方图(DVH)评价治疗计划,评价参数包括V95%,适形度指数(conformal index,CI),均匀性指数(homogeneity index,HI)及肝肾、脊髓的照射剂量。结果:(1)在头脚方向上胃癌靶区移动度移动度最大,为11.76±0.46mm;左右方向上最小,为5.24±0.20mm;腹背方向为7.71±0.28mm。计划验证、放疗中、放疗结束前等不同时间点靶区移动度差异未达到统计学意义。(2)三维放疗与调强放疗两组计划比较,V95%的差异无统计学意义(P0.05),IMRT的CI、HI均优于3DCRT(P0.05);对于肝脏,IMRT的肝脏D1/3和Dmean比3DCRT低(P0.05),差异有显著统计学意义;对于肾脏,IMRT和3DCRT的D1/3均满足肾脏的剂量学要求,两组计划对比肾脏D1/3差异无统计学意义。3DCRT右肾D1/2低于IMRT,3DCRT与IMRT比较能降低右肾D1/2(P0.05),对于左肾D1/2,3DCRT与IMRT无统计学差异。脊髓Dmax:3DCRT脊髓Dmax低于IMRT。结论:(1)胃癌术后放疗靶区移动度在头脚方向上移动度最大,为11.76±0.46mm,左右方向上最小,为5.24±0.20mm;腹背方向为7.71±0.28mm。(2)在胃癌术后放疗中,IMRT在靶区适形性、均匀性上优于3DCRT;IMRT对肝脏的照射剂量低于3DCRT;在降低肾脏剂量上两组计划无统计学意义;3DCRT脊髓Dmax低于IMRT,但IMRT脊髓Dmax也在正常剂量范围。
[Abstract]:Objective: to determine the target area mobility after operation for gastric cancer and to compare the dosimetric distribution between three dimensional conformal and intensity modulated radiotherapy techniques, so as to provide reference for clinical application. Methods: (1) Fifteen patients with gastric cancer undergoing D2 radical gastrectomy in an affiliated hospital of Nanchang University were selected to perform CT scanning and localization. The patients had 3 hours of fasting, and 5 minutes before radiotherapy, they drank 400ml water to fill the stomach, and then CT simulated scanning localization was performed. Drawing the target area and normal tissue around the Pinnacle planning system, the physicist made the plan, the clinician confirmed it. (2) the patient drank 10ml diatrizoate on an empty stomach 5 minutes before the plan validation. The motility of the gastric target area was observed under the simulator. The motility of gastric target was observed again before the end of radiotherapy with the same method. (3) the three dimensional conformal radiotherapy (3DCRT) and intensity modulated radiotherapy (IMRT) were designed in 5 patients with gastric cancer after operation respectively to compare the three dimensional conformal radiotherapy (3DCRT) and intensity modulated radiotherapy (IMRT). The prescription dose of 95% PTV was 45 Gy ~ 99% PTV prescription dose was 42.75 Gy,. The treatment plan was evaluated with isodose curve and dose volume histogram (DVH). The evaluation parameters included V95g, conformability index (conformal index,CI), conformability index (conformal index,CI). Uniformity index (homogeneity index,HI) and irradiation dose of liver, kidney and spinal cord. Results: (1) in the direction of head and foot, the moving degree of the target area of gastric cancer was 11.76 卤0.46 mm, the smallest in the left and right directions was 5.24 卤0.20 mm, and the direction of dorsal abdomen was 7.71 卤0.28 mm. The difference of target mobility at different time points before the end of radiotherapy was not statistically significant. (2) there was no significant difference in V95% between three dimensional radiotherapy and intensity modulated radiotherapy (P0.05), IMRT CI,). HI was better than 3DCRT (P0.05). For liver, D1 / 3 and Dmean of IMRT were lower than that of 3DCRT (P0.05), the difference was statistically significant. For the kidney, D1 / 3 of IMRT and 3DCRT met the dosimetry requirements of kidney. There was no significant difference between the two groups in kidney D1 / 3.The right kidney D1 / 2 of 3DCRT was lower than that of IMRT,3DCRT and IMRT (P0.05). There was no significant difference between 3 D CRT and IMRT for left kidney D 1 / 2 D CRT. Spinal cord Dmax:3DCRT Dmax lower than IMRT. Conclusion: (1) after operation of gastric cancer, the moving degree of the target area in the head and foot direction is the highest, 11.76 卤0.46 mm and 5.24 卤0.20 mm in the left and right directions, respectively. The abdominal dorsal direction was 7.71 卤0.28 mm. (2) in post-operation radiotherapy for gastric cancer, IMRT was superior to 3DCRTIMRT in shape conformability and homogeneity in target area, but the dose of 3DCRT in liver was lower than that in 3DCRT, but there was no significant difference between the two groups in reducing the dose of kidney. 3DCRT spinal cord Dmax was lower than IMRT, but IMRT spinal cord Dmax was also in the normal dose range.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R735.2
本文编号：2414375
[Abstract]:Objective: to determine the target area mobility after operation for gastric cancer and to compare the dosimetric distribution between three dimensional conformal and intensity modulated radiotherapy techniques, so as to provide reference for clinical application. Methods: (1) Fifteen patients with gastric cancer undergoing D2 radical gastrectomy in an affiliated hospital of Nanchang University were selected to perform CT scanning and localization. The patients had 3 hours of fasting, and 5 minutes before radiotherapy, they drank 400ml water to fill the stomach, and then CT simulated scanning localization was performed. Drawing the target area and normal tissue around the Pinnacle planning system, the physicist made the plan, the clinician confirmed it. (2) the patient drank 10ml diatrizoate on an empty stomach 5 minutes before the plan validation. The motility of the gastric target area was observed under the simulator. The motility of gastric target was observed again before the end of radiotherapy with the same method. (3) the three dimensional conformal radiotherapy (3DCRT) and intensity modulated radiotherapy (IMRT) were designed in 5 patients with gastric cancer after operation respectively to compare the three dimensional conformal radiotherapy (3DCRT) and intensity modulated radiotherapy (IMRT). The prescription dose of 95% PTV was 45 Gy ~ 99% PTV prescription dose was 42.75 Gy,. The treatment plan was evaluated with isodose curve and dose volume histogram (DVH). The evaluation parameters included V95g, conformability index (conformal index,CI), conformability index (conformal index,CI). Uniformity index (homogeneity index,HI) and irradiation dose of liver, kidney and spinal cord. Results: (1) in the direction of head and foot, the moving degree of the target area of gastric cancer was 11.76 卤0.46 mm, the smallest in the left and right directions was 5.24 卤0.20 mm, and the direction of dorsal abdomen was 7.71 卤0.28 mm. The difference of target mobility at different time points before the end of radiotherapy was not statistically significant. (2) there was no significant difference in V95% between three dimensional radiotherapy and intensity modulated radiotherapy (P0.05), IMRT CI,). HI was better than 3DCRT (P0.05). For liver, D1 / 3 and Dmean of IMRT were lower than that of 3DCRT (P0.05), the difference was statistically significant. For the kidney, D1 / 3 of IMRT and 3DCRT met the dosimetry requirements of kidney. There was no significant difference between the two groups in kidney D1 / 3.The right kidney D1 / 2 of 3DCRT was lower than that of IMRT,3DCRT and IMRT (P0.05). There was no significant difference between 3 D CRT and IMRT for left kidney D 1 / 2 D CRT. Spinal cord Dmax:3DCRT Dmax lower than IMRT. Conclusion: (1) after operation of gastric cancer, the moving degree of the target area in the head and foot direction is the highest, 11.76 卤0.46 mm and 5.24 卤0.20 mm in the left and right directions, respectively. The abdominal dorsal direction was 7.71 卤0.28 mm. (2) in post-operation radiotherapy for gastric cancer, IMRT was superior to 3DCRTIMRT in shape conformability and homogeneity in target area, but the dose of 3DCRT in liver was lower than that in 3DCRT, but there was no significant difference between the two groups in reducing the dose of kidney. 3DCRT spinal cord Dmax was lower than IMRT, but IMRT spinal cord Dmax was also in the normal dose range.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R735.2
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