對於大型肝癌腫瘤使用非共平面體積調控弧形治療射束之評估

Evaluation of non-coplanar volumetric modulated arc therapy for large hepatocellular carcinoma

張鳳翎(FENG-LING CHANG)

指導教授 ： 陳信雄

中臺科技大學/健康科學院/醫學影像暨放射科學系暨研究所/碩士(2019年)

摘要

本研究之目的為討論大型之肝癌腫瘤使用非共平面體積調控弧形治療射束對於正常肝臟組織的保留之評估，大型之肝癌腫瘤定義為等效球型直徑(Equivalent Spherical Diameter, ESD)大於9公分。本研究選取三組腫瘤位置:肝右葉S5-8(S5,6,7,8)、肝左葉S1-4(S1,2,3,4)、肝門靜脈阻塞(S4,8+PVT)，分別從增加1至3個非共平面弧形治療射束，製作治療計畫。治療總次數為20次，醫囑劑量為50Gy，評估方法為100%醫囑劑量包覆95%的計畫靶體積時正常肝臟組織15Gy之體積變化。治療計畫評估參數如:順形度指標、均勻度指標、梯度測量，危急器官之劑量如:脊髓、胃、左和右側腎臟、十二指腸、升結腸及橫結腸、正常肝臟組織。統計方式:成對樣本單尾T檢定。適當的非共平面弧形治療射束之應用，可以幫助降低正常肝臟組織所接受到之劑量。

關鍵字

非共平面體積調控弧形治療射束 ； 肝臟組織 ； 大型之肝癌腫瘤

並列摘要

he purpose of this study was to evaluate normal liver tissue reserve using non-coplanar volumetric modulated arc therapy for large hepatocellular carcinoma. Large hepatocellular carcinoma were defined as equivalent spherical diameters greater than 9 cm. This study selected three groups of tumor locations: right lobe (S5,6,7,8), left lobe (S1,2,3,4) and hepatic portal vein thrombosis (S4,8+PVT), and additional 1 to 3 non-coplanar arcs was added to create treatment plan. All of plans were designed with a prescribed dose 50 Gy in 20 fractions. The evaluation criteria was the volume of normal liver tissue covered by 15Gy isodose curve under the prescribed dose covered 95% PTV. The plan evaluation indexs, such as: dose conformity, dose homogeneity and gradient measurement were evaluated. The doses of spinal cord, stomach, left and right kidneys, duodenum, ascending colon, transverse colon and normal liver tissue would be collect and analyzed by One-tailed T-test for paired samples. Appropriate non-coplanar arcs can reduce the dose of the normal liver tissue.

並列關鍵字

non-coplanar volumetric-modulated arc therapy (VMAT) ； liver tissue ； large hepatocellular carcinoma

參考文獻

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