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題名 | Application of a Spacer Medial to the Left Parotid Gland to Improve Dosimetry for Head and Neck Radiotherapy--A Swine Model=運用隔離物隔離左側腮腺內側以改善頭頸癌放射線治療之劑量分佈--豬研究模式 |
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作者 | 謝佩珊; 傅曉梅; 戴坤耀; 呂宜興; 吳孟浩; 戴宏旗; 陳裕仁; Chia, Pei-san; Fu, Hsiao-mei; Dai, Ku-yao; Leu, Yi-shing; Wu, Meng-hao; Tai, Hung-chi; Chen, Yu-jen; |
期刊 | 放射治療與腫瘤學 |
出版日期 | 20141200 |
卷期 | 21:4 2014.12[民103.12] |
頁次 | 頁285-294 |
分類號 | 418.94 |
語文 | eng |
關鍵詞 | 隔離物; 腮腺; 放射線治療; 劑量參數; Spacer; Parotid gland; Radiotherapy; Dosimetry; |
中文摘要 | 目的:放射線治療是頭頸癌之重要療法。因鄰近靶體積,腮腺、頜下腺與小唾液腺經常會接受到放射線照射。放射線治療技術的進步大幅度地減少了正常組織的劑量分佈,然而腮腺仍會接受到高劑量放射線,進而引起相關的併發症─口乾症。本研究透過於左側腮腺內側置入一隔離物,藉此隔開靶體積與腮腺,期望減少腮腺的放射線劑量。材料與方法:我們以最低傷害手術方式在實驗豬的左側腮腺內側製造一空腔,再置入一個隔離物並縫合固定。以電腦斷層掃描定位機與放射線治療計畫系統,進行模擬可見腫瘤、高風險臨床靶體積與腮腺等其他正常組織的劑量分佈分析。之後以配對t檢定進行統計分析,比較在腮腺內側置入隔離物前後所造成的各劑量參數上的差異。結果:在手術前後之模擬可見腫瘤計畫靶體積(PTV_(70):70 Gy,一次2 Gy)與高風險靶區域(PTV_(63):63 Gy)的計畫靶體積有相似的包覆性與順型性之基礎下,本研究證實了腮腺的放射線劑量可因置入隔離物而大幅減少。手術進行前,左側與右側腮腺的平均劑量分別為2808 ± 205cGy與2901 ± 189 cGy。在左側的腮腺內側置入一隔離物後,左側與右側腮腺的平均劑量分別為2027 ± 364 cGy與2972 ± 114 cGy。在同側(左側)腮腺內側置入隔離物會使得劑量有顯著差異(p=0.003),但不影響對側(右側)唾液腺的劑量(p=0.36)。結論:藉由置入隔離物隔離腮腺與靶體積,我們發展出一套可大幅減少腮腺劑量分佈的實驗模式,往後需進一步驗證動物腮腺長期與短期功能之影響。 |
英文摘要 | Purpose: Radiation therapy is an important treatment method for head and neck cancer. The parotid gland, submandibular gland and minor salivary gland are often irradiated due to being adjacent to the target volumes. Although advancing radiotherapy techniques have reduced the dose of radiation to normal tissues and toxicity, the radiation dose distributed to the parotid gland remains high, causing a considerable amount of xerostomia. The aim of this study is to reduce the dose of radiation to the left parotid gland by inserting a spacer into the medial parotid space and separating it from the target volume. Materials and Methods: A minimally invasive procedure was developed to create a space medial to the left parotid gland in experimental swine, and a spacer was inserted into this space. A computed tomography simulator and radiation therapy planning system was used to analyze the distribution of the radiation dose to the putative gross disease, high risk clinical target volume, and parotid glands. Statistics obtained by using a paired t test were used to compare the dosimetry parameters with or without the insertion of the spacer. Results: The dose of radiation to the parotid glands was found to be significantly reduced by the demand for a similar coverage and conformity of the putative target volume for the gross disease (PTV 70 Gy) and high risk nodal region (PTV 63 Gy) with 2 Gy per fraction. Before the space was created, the left and right parotid glands were estimated to receive a mean dose of 2808 ± 205 cGy and 2901 ± 189 cGy, respectively. After the spacer was inserted into the left medial parotid gland space, the left and right parotid glands were estimated to receive a mean dose of 2027 ± 364 cGy and 2972 ± 114 cGy respectively. Therefore, the spacer had made a significant difference in the dose to the ipsilateral (left) parotid gland (p=0.003) without affecting the contralateral (right) one (p=0.36). Conclusion: An experimental model was developed by using spacers to create a space between the left parotid gland and the target volume, which markedly reduced the dose to the left parotid gland. Both short and long term functional assays for parotid damage in animals is warranted. |
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