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研究生:郭柏辰
研究生(外文):Kuo Po-Chen
論文名稱:子宮頸癌放射治療之劑量及誘發二次癌症風險評估
論文名稱(外文):Estimation of doses and secondary cancer risks of cervical cancer radiotherapy
指導教授:游澄清許芳裕
指導教授(外文):Yu Cheng-ChingHsu Fang-Yu
學位類別:碩士
校院名稱:元培科技大學
系所名稱:放射技術研究所
學門:醫藥衛生學門
學類:醫學技術及檢驗學類
論文種類:學術論文
畢業學年度:99
語文別:中文
論文頁數:68
中文關鍵詞:子宮頸癌近接治療假體強度調控放射治療體積調控弧形治療二次癌症風險
外文關鍵詞:cervical cancerbrachytherapy self-made phantomintensity modulated radiotherapyvolumetric modulated arc therapysecondary cancer risk
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由於近年來的研究調查發現女性子宮頸癌有罹患率年齡層降低、腫瘤治療控制率提高、病患存活率提高等趨勢。故患者接受放射治療時其照野內劑量正確性的驗證和治療後照野外可能誘發全身二次癌症風險的機率評估也相對變的愈趨重要。
  本研究使用女性侖道假體結合自製下腹腔假體,以熱發光劑量計進行劑量量測,針對不同大小的腫瘤所設計七照野和九照野的傳統強度調控放射治療計畫和體積調控弧形放射治療計畫,並且合併計算近接治療劑量,做為模擬子宮頸癌患者接受完整放射治療劑量之分析評估。
  考慮臨床上遠隔治療所給予總劑量5040 (cGy),合併近接治療總劑量2400 (cGy),評估一位子宮頸癌患者進行整個臨床放射治療療程所造成平均全身之健康(照野外)組織有效劑量與誘發二次癌症風險之機率。治療標的若為大腫瘤,其照野外平均有效劑量為427.45 ±4.59 mSv(IMRT合併近接治療)及269.60±1.46 mSv (VMAT合併近接治療);平均誘發二次癌症風險為2.14±0.03 % (IMRT合併近接治療)及1.35±0.01 % (VMAT合併近接治療)。治療標的若為小腫瘤,其平均有效劑量為57.45±0.35 mSv (IMRT合併近接治療)及63.70±0.46 mSv (VMAT合併近接);平均誘發二次癌症風險為0.29±0.01 % (IMRT合併近接治療)及0.32±0.01 % (VMAT合併近接治療)。
根據本研究結果,治療照野大小和治療計畫所給予的總監控單位多寡,為影響誘發二次癌症風險機率之主要因子。未來在提供臨床放射治療計畫於危急器官劑量的上限設定標準時,建議能做更全面的考量,以降低接受放射治療患者在治癒後發生二次癌症之風險,使其有更良好的生存品質。

Nowadays, radiotherapy is one of the clinically recommended treatments of cervical cancer. In recent studies, the average incidence age of cervical cancers is decreased, the control rate of tumor treatment is increased, and patients’ survival rate is improved. Therefore, for clinical radiotherapy patients, it’s increasingly important to verify the effective dose and assessment the probability of out-field second cancer risk of the whole body after the treatment.
In this work, a Rando and a self - made pelvic phantoms were used for simulating the cervical cancer patients treated by the radiotherapy externally and internally, respectively. The individual organ doses were estimated by means of the TLD-100 chips for differ treatment plans design that include different intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) techniques.
This study considered total dose of 5040 cGy given by teletherapy (IMRT and VMAT) combined with a total dose of 2400 cGy by brachytherapy to assess the effective doses and secondary cancer risks. For large tumor, the mean effective dose of 427.50 ± 4.59 (mSv) and 269.60 ± 1.46 (mSv) were estimated for IMRT combined brachytherapy and VMAT combined brachytherapy, respectively. The mean risks of inducing secondary cancer were 2.14 ± 0.03 (%) and 1.35 ± 0.01 (%) for using IMRT combined brachytherapy and VMAT combined brachytherapy, respectively. For small tumor, the mean effective dose of 57.50 ± 0.35 (mSv) and 63.70 ± 0.46 (mSv) were estimated for IMRT combined brachytherapy and VMAT combined brachytherapy, respectively. The mean risks of inducing secondary cancer were 0.29 ± 0.01 (%) and 0.32 ± 0.01 (%) for using IMRT combined brachytherapy and VMAT combined brachytherapy, respectively.
According to the results of this study, the field sizes and total monitor units were the main factors of affecting the probability of secondary cancer risk. A more comprehensive consideration is recommended to make to provide better life quality for patients after radiotherapy in their long-term survival period, by means of the proper setting of dose criterion for critical organs of treatment plan.

第一章 緒論………………………………………………………… 1
1.1研究背景與動機…………………………………………… 1
1.2研究目的…………………………………………………… 6
1.3文獻回顧…………………………………………………… 8
1.4實驗流程…………………………………………………… 11
第二章 實驗理論…………………………………………………… 12
2.1 輻射致癌原理……………………………………………... 12
2.2 二次癌症風險……………………………………………... 12
2.3 劑量及風險計算…………………………………………... 13
2.4 熱發光原理………………………………………………... 15
第三章 實驗器材與設備…………………………………………… 16
3.1 熱發光劑量計及計讀儀…………………………………... 16
3.2 熱發光計讀儀操作條件…………………………………... 18
3.3 熱發光劑量計回火程序…………………………………... 19
3.4 直線加速器………………………………………………... 19
3.5 遙控式後荷近接治療機…………………………………... 21
3.6 放射治療技術……………………………………………... 24
3.7 侖道假體與自製假體……………………………………... 26
第四章 實驗方法…………………………………………………… 28
4.1 熱發光劑量計穩定性篩選………………………………... 28
4.2 劑量校正曲線……………………………………………... 30
4.3 假體佈點方式……………………………………………... 33
4.4 遠隔治療照射之器官劑量評估….……………………….. 34
4.5 近接治療照射之器官劑量評估……………………………34

4.6 遠隔治療之治療計畫…………………………………….... 36
4.7近接治療之治療計畫……………………...………………...39
第五章 研究結果與討論…………………………………………… .41
5.1 近接治療照射之劑量評估……………………………….....41
5.2 遠隔治療照射之劑量評估………………………………….42
5.3 遠隔治療合併近接治療之平均有效劑量及二次癌症風險
評估………………………………………………………….45
5.4 照野內特定危急器官劑量正確性驗證(遠隔治療).……….50
5.5 近接治療劑量正確性驗證(自製假體)..……..…..…………51
5.6 小結…………………….…………………………………....52
第六章 結論………………………………………………………… .53
第七章 參考文獻…………………………………………………… .55

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