新辅助化疗对局部晚期鼻咽癌自适应放疗的影响

发布时间：2018-01-16 01:16

  本文关键词：新辅助化疗对局部晚期鼻咽癌自适应放疗的影响　出处：《医学研究杂志》2017年08期 　论文类型：期刊论文

  更多相关文章： 鼻咽癌 新辅助化疗 自适应放疗

【摘要】：目的研究局部晚期鼻咽癌新辅助化疗前后肿瘤体积变化,对调强放疗鼻咽癌患者腮腺、脑干、脊髓等剂量分布的影响,进而明确新辅助化疗在自适应放疗中的影响。方法选取2014年5~9月期间15例福建省肿瘤医院收治的鼻咽癌患者,均接受新辅助化疗、同步放化疗,放疗采用调强放射治疗。治疗前和第2周期新辅助化疗结束2周后分别行定位CT扫描,分别进行靶区勾画。根据两次CT制定plan1和plan2,将plan1映射到化疗后CT上获得新的计划plan1',分别对比plan1、plan1'、plan2,分析其解剖学及剂量学分布改变。结果 2周期新辅助化疗结束,GTVnx(P=0.000)及GTVnd(P=0.000)平均体积均明显缩小。将plan1和plan1'对比,颈部转移淋巴结最大层面最短径≥3cm(N≥3cm)的患者,其腮腺的Dmean、D50剂量明显升高(P0.05)。将plan1'和plan2对比,脊髓的Dmax、D1cc剂量降低,腮腺(N≥3cm)组Dmean、D50剂量明显降低(P0.05)。将6例原发肿瘤靠近脑干的患者进行剂量分析发现,plan1'和plan2对比,脑干Dmax(P=0.001)及D1cc(P=0.038)均降低。结论新辅助化疗后鼻咽肿瘤体积明显缩小,减少放射治疗过程中的解剖学和剂量学分布改变,从而减少放疗过程中实际剂量分布与计划剂量分布的差异,有助于减少自适应放疗过程中修正治疗计划的次数。新辅助化疗有助于N≥3cm的鼻咽癌患者腮腺的保护,也可降低肿瘤靠近脑干患者的脑干损伤。
[Abstract]:Objective to study the effects of neoadjuvant chemotherapy on the dose distribution of parotid gland, brain stem and spinal cord in patients with nasopharyngeal carcinoma (NPC) treated by intensity modulated radiotherapy (IMRT). Methods from 2014 to September, 15 patients with nasopharyngeal carcinoma treated in Fujian Provincial Cancer Hospital received neoadjuvant chemotherapy and concurrent radiotherapy and chemotherapy. Radiotherapy was performed with intensity modulated radiotherapy. Before and 2 weeks after the end of the second cycle of neoadjuvant chemotherapy, the localization CT scan was performed, and the target area was delineated respectively. Plan1 and plan2 were determined according to twice CT. New plan1s were obtained by mapping plan1 to CT after chemotherapy and compared with plan1 / plan1and plan2 respectively. Results 2 cycles of neoadjuvant chemotherapy were completed. Plan1 and plan1 'were compared with plan1. The Dmean of parotid gland was found in patients with the shortest diameter of the largest layer of cervical metastatic lymph nodes 鈮，

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