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    National Tsing Hua University Institutional Repository > 原子科學院  > 核子工程與科學研究所 > 博碩士論文  >  復發性頭頸癌BNCT臨床試驗的治療計畫計算與分析


    Please use this identifier to cite or link to this item: http://nthur.lib.nthu.edu.tw/dspace/handle/987654321/86129


    Title: 復發性頭頸癌BNCT臨床試驗的治療計畫計算與分析
    Authors: 張芝庭
    Description: GH02101013515
    碩士
    核子工程與科學研究所
    Date: 2014
    Keywords: 硼中子捕獲治療(BNCT);復發性頭頸癌臨床試驗;治療計畫
    Abstract: 清華大學研究團隊與台北榮民總醫院合作,於2010年8月11日開始進行國內首例硼中子捕獲於復發頭頸癌之治療,BNCT第一階段臨床試驗於2014年1月共完成十七位病人的照射。本研究目的在製作治療計畫的經驗分享、照射時所使用之外加裝置大小及厚度對超熱中子束的影響、以及第二階段臨床試驗劑量轉換的比較驗證。
    臨床治療案例研究發現,對於深部與淺部腫瘤之最佳照射的方式並不相同。對淺部腫瘤使用外加匯聚能夠給予匯聚照野內的組織較高的通率,並保護位於照野外的組織。深部腫瘤則不需使用外加匯聚,可以考慮在射束出口外貼附lithium pad以保護皮膚組織。
    當遇到腫瘤中間曾經開刀切除的案例,將切除區域定義為不同組織,如空氣、水或腫瘤,會對劑量計算造成影響。在切除區域體積不大的時候沒有明顯差異,但劑量差距會隨著切除區域體積之增加而上升。
    在照射時所使用的外加裝置,例如貼附在射束出口的lithium pad,其大小只要足夠阻擋射束出口就能對正常組織產生保護的效果。另外為了定位的方便,可以在射束出口的區域外圍以框架固定lithium pad。目前使用的lithium pad為2.5公分厚natural lithium+0.5公分厚enriched lithium,其對皮膚組織的保護效果會與厚度為3公分的natural lithium差不多。
    在第十一至十七位病人共十三次照射中,腫瘤反應為完全消失的有三位,這些腫瘤劑量分佈的均勻度平均有0.5以上,兩次照射的最小劑量總和大於21 Gy-eq,最小物理劑量平均約在4 Gy以上。腫瘤對BNCT的反應跟平均接受到的劑量並沒有絕對的關係,但腫瘤接受到的最小劑量越高,治癒的機率越大。
    BNCT第二階段臨床試驗於2014年開始,照射方式為在清華大學進行一次BNCT照射後再到台北榮總進行一套光子療程。治療計畫程式所產生的劑量在經RTDOSE程式轉為RS劑量後,醫院治療計畫軟體可以讀取到相近的組織體積及劑量。
    Under the collaboration between National Tsing Hua University (NTHU) and Taipei Veterans General Hospital (TVGH), clinical trial of recurrent head-and-neck cancer by Boron Neutron Capture Therapy (BNCT) at Tsing Hua open-pool reactor (THOR) started on 2010. Up to January of 2014, 17 patients were treated. This study is focus on the experience of treatment plannings, the influences on epithermal neutron beam under different size and thickness of treatment setup, as well as the comparison and verification of the transformation of dose file for the protocol 2. The treatment plannings in this study is performed by the in-house designed treatment planning system THORplan.
    Based on experiences of clinical treatment, different setup should be applied for superficial and deep-seated tumors. For superficial tumors, using collimator gives tissues located inside the irradiation field higher fluxes, and can protect tissues located outside the irradiation field. For deep-seated tumors, there is no need for using collimator. Lithium pad can be used at the beam exit to protect the skin.
    For tumor after surgical resection, the effect of material assignment of the cavity inside the tumor on the calculational result is investigated. The resulting dose difference is not apparent if the cavity is small. It becomes larger as the size of cavity increases.
    Different treatment setups, such as lithium pad, can be used to provide skin protection. Currently used lithium pad is composed of 2.5 cm natural lithium and 0.5 cm enriched lithium. A 3 cm-natural lithium can provide similar protection effect.
    Among Patient 11 to Patient 17 of protocol 1, 3 patients are complete response. The corresponding doses of these tumors have homogeneity index > 0.5, sum of minimum dose > 21 Gy-eq, and sum of average minimum physical dose > 4 Gy. There is no apparent correlation between tumor response and the average dose received. But the minimum dose seems to be an important factor.
    Protocol 2 of BNCT clinical trial was started on 2014. After receiving one BNCT treatment at NTHU, photon therapy will be performed at TPEVGH. Dose of THORplan can be transformed to RS dose by using RTDOSE code, which can later be read by treatment planning system used in hospital for dose adding purpose. Compared with THORplan3, THORplan4 generates more consistent tissue volumes and dose for dose adding.
    URI: http://nthur.lib.nthu.edu.tw/dspace/handle/987654321/86129
    Source: http://thesis.nthu.edu.tw/cgi-bin/gs/hugsweb.cgi?o=dnthucdr&i=sGH02101013515.id
    Appears in Collections:[核子工程與科學研究所] 博碩士論文

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