【作者】 杨林；

【导师】 叶冬青；

【作者基本信息】 安徽医科大学 ， 流行病与卫生统计学， 2009， 硕士

【摘要】 研究背景:食管癌放射治疗后失败的原因为原发部位的残存占75%～95%。即使是采用较为强烈的同期放化疗或后程加速超分割放疗,局部失败率仍然高达45%左右。提高肿瘤局部放疗剂量就有可能提高局控率。近年来,三维适形放疗明显减少了周围正常组织的剂量。这使得在不增加正常组织并发症的前提下,提高食管癌靶区剂量成为可能。此研究的目的在于:试图从常规(一前二后斜野)、三维适形、适形调强3种放疗方法中获得一种食管癌局部最大耐受剂量,周围正常组织受量最少的最佳方案,并观察疗效。目的:比较中段食管癌常规三野放疗与三维适形、调强放疗对危及器官剂量学的影响,探讨3种治疗方法在胸中段食管癌根治性放疗中重要器官受保护的优劣,从中寻找食管癌放射治疗理想的计划模式。方法:40例经病理证实胸中段食管鳞癌患者,行模拟定位,CT扫描成像传输到治疗计划系统(TPS),进行三维重建并勾画肿瘤体积(GTV)、临床靶体积(CTV)和危及器官(OAR)。40例病例均做常规放疗(前垂直野、后两等中心野),三维适形(3DCRT)和调强计划。评估、优化后比较三种计划对危及器官剂量学的影响。结果:常规三野放疗和三维适形、调强放疗脊髓最大受量分别:Dmax:4289.37±508.85 , 3818.31±415.16 , 3595.30±574.12 ,心脏V50 : 46.55±17.56 , 34.60±17.11 , 13.30±7.71检验结果有统计学意义( P<0.001 ),左肺V5 : 66.66±18.72 , 57.58±16.66 , 59.81±16.52 V10 : 57.94±15.45 , 46.81±14.26 ,46.71±13.16 V20:36.17±12.33,26.25±8.65,21.01±7.35 V30:19.02±11.38,12.45±7.63,7.39±3.29右肺V5:65.90±14.96,54.37±14.58,54.31±14.48 V10:53.51±14.76,42.29±12.43,40.05±10.97 V20: 31.34±11.40,22.06±8.37,15.86±5.75V30:15.90±10.58,10.71±7.92,5.68±3.11,三组之间V5~V10的比较,除了V5和V10在3D和TMRT两组之间差异无统计学意义外(P>0.016),其它指标在不同组间差异均有统计学意义。结论:胸中段食管鳞癌,长度4~7cm放射治疗,常规三野放疗与三维适形、调强放疗对危及器官剂量学的影响有明显差异的,同一部位的肿瘤受到相同的剂量照射情况下,调强放疗对危及器官的影响明显比常规、三维适形放疗方式小。更多还原

【Abstract】 Objective To compare the dose influence in the organs at risk (OAR) between the conventional radiotherapy and 3-dimentional conformal and Intensity-modulated radiotherapy for Midpiece esophageal cancer.Methods 40 patients Midpiece esophageal carcinoma were simulation in the localize, After CT scanning, the images were transferred to the treatment planning system (Topslane) , and gross tumor volume (GTV) , clinical target volume(CTV) and organs at risk (OAR) , were the conventional radiotherapy and 3DCRT and Intensity-modulated plans, were designed for 40 patients to compare the dose distribution. After the appraisal, the optimization compares three kind of plans to endanger the organ dosimetry the influence.Results Conventional three wild radiotherapies and 3DCRT and Intensity-modulated radiotherapy distinctions: Spinal cord max: 4289.37±508.85 , 3818.31±415.16 ,3595.30±574.12, the heart V50: 41.124±13.3381,26.2340±12.2242,12.2820±5.1867 Check that difference has notable(P<0.001). Left lung V5: 71.20±15.41,58.54±16.72,62.92±15.67,V10:60.28±14.38,46.89±13.55,47.71±13.38, V20:36.6±10.13,27.26±10.91,19.91±7.02, V30: 17.33±10.50,10.52±5.19,6.99±3.35 Right lungs V5:68.54±13.88,56.17±13.90,57.64±14.06,V10:55.75±13.64,41.54±12.11,42.54±12.11,V20:31.42±9.65,21.66±7.97,14.78±6.12,V30:12.07±9.13,7.18±5.06,4.82±2.29, three group V5 ~ V10 comparison,except difference has no notable outside V10 between 3D and IMRT(P> 0.05) ,the index has notable other equally in different group difference.Conclusion The Midpiece esophageal cancer radiotherapy,the conventional three wild radiotherapies and 3CDRT And IMRT to endanger the organ dosimetry the influence are very obvious,in the same location same level dosage illumination situation,IMRT to endanger the organ the influence conventional,the three dimensional suitable shape radiotherapy way is obviously smaller than.更多还原