鼻咽癌调强放疗低危危及器官勾画临床意义

发布时间：2018-01-24 08:17

  本文关键词： 鼻咽癌 调强放疗 咽缩肌 喉 剂量分布　出处：《中华肿瘤防治杂志》2017年04期 　论文类型：期刊论文

【摘要】：目的鼻咽癌高危危及器官的勾画和限量受到广泛重视,但低危危及器官的勾画常被放疗医师忽视。为此本研究探讨中下咽缩肌、喉及主支气管勾画对其剂量分布的影响,以及与放疗期间咳嗽反应间的关系。方法回顾性分析2014-06-01-2015-08-30海南省人民医院放疗科收治的68例N2期鼻咽癌的治疗计划及放疗期间的咳嗽反应,根据是否勾画中下咽缩肌、喉及主支气管分为勾画组和未勾画组,两组均为34例。通过剂量-体积直方图(dosse volume histograms,DVH)评估计划靶区(the planning target volume,PTV,包括PTV1、PTV2和PTVnd)和危及器官(organs at risk,OAR,包括咽缩肌、喉、主支气管及甲状腺)剂量分布,以及两组间的咳嗽反应差异。结果两组靶区(PTV1、PTV2和PTVnd)剂量分布差异无统计学意义。勾画组与未勾画组PTV2的适形指数(conformity index,CI)分别为0.97±0.24和0.93±0.02,P0.001。勾画组的咽缩肌V_(55)(t=3.881,P=0.004)、V_(50)(t=5.102,P=0.001)和V_(40)(t=34.028,P0.001)均小于未勾画组,两组比较差异均有统计学意义;V_(30)、V25两组比较差异无统计学意义,P0.05。勾画组的喉及主支气管接受55Gy照射的体积V_(55)(t=2.266,P=0.038)、V_(50)(t=6.734,P0.001)、V_(40)(t=17.056,P0.001)和V_(30)(t=47.28,P0.001)小于未勾画组,两组比较差异均有统计学意义;V20、V15两组比较差异无统计学意义,P0.05。未勾画组更容易发生3级咳嗽反应。限定主支气管剂量可显著降低甲状腺V_(40)(t=8.728,P0.001)、V_(50)(t=9.153,P0.001)和V_(60)(t=8.467,P0.001)。结论勾画咽缩肌、喉及主支气管可显著降低其高剂量段(40~55Gy)的受照体积,提高PTV2的适形度,并减轻咳嗽反应,同时可减少甲状腺照射剂量以及40~60Gy的受照体积。低危OAR的勾画和剂量限定应受到重视。
[Abstract]:Objective the drawing and limitation of high risk organs of nasopharyngeal carcinoma (NPC) have been paid more attention to, but the sketches of low risk organs are often ignored by radiotherapy doctors. Effects of laryngeal and main bronchus drawing on dose distribution. Methods retrospective analysis of 68 patients with N2 stage nasopharyngeal carcinoma treated by Department of radiotherapy, Hainan Provincial people's Hospital, 2014-06-01-2015-08-30. Cough reaction during stroke and radiotherapy. According to whether or not to draw the hypopharyngeal contraction muscle, larynx and main bronchi were divided into sketching group and unsketched group. There were 34 cases in both groups. Dosse volume histograms was obtained by dose-volume histogram. Planning target volume PTVs, including PTV1. The dose distribution of PTV2 and PTVnd and the organ at riskard, including pharyngeal contractile muscle, larynx, main bronchus and thyroid gland. Results PTV1 was found in the target area of the two groups. There was no significant difference in dose distribution between PTV2 and PTVnd.The conformal index of PTV2 was conformity index. The CIs were 0.97 卤0.24 and 0.93 卤0.02 P0.001 respectively. There were significant differences between the two groups (P < 0.05) and V _ (40) (P _ (0.001)) were significantly lower than those of the unpainted group (P _ (0.001)). There was no significant difference between the two groups (P 0.05). P0. 038 / V / T / T 6.734 / P 0.001 / V / T / T / T 17.056. P0.001) and VACTH 47.28 (P0.001) were significantly lower than those of unpainted group (P 0.001), and there were significant differences between the two groups. There was no significant difference between V20 and V15 groups. P0.05. the undelineated group was more likely to develop grade 3 cough. Limiting the dose of the main bronchus could significantly reduce the thyroid Vastitis (8.728% P0.001). Conclusion the pharyngeal contractile muscle is delineated. Larynx and main bronchus could significantly reduce the irradiation volume of PTV2, improve the conformability of PTV2, and relieve cough reaction. At the same time, the irradiation dose of thyroid gland and the irradiation volume of 40g / 60Gy were reduced. The outline and dose limit of low-risk OAR should be paid more attention to.
【作者单位】： 海南省人民医院放疗科;
【分类号】：R730.55;R739.63
【正文快照】： 中华肿瘤防治杂志,2017,24(4):252-256Chin J Cancer Prev Treat,2017,24(4):252-256鼻咽癌放疗期间的急性反应如吞咽疼痛、咳嗽与放疗引起的急性咽炎、主气管炎有关,而咽喉及主支气管的黏膜炎与受照剂量有关[1-2]。关于勾画咽缩肌和主支气管对其剂量分布的影响、以及与急性咳，

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