局部晚期鼻咽癌自适应调强放疗颞叶损伤的临床剂量学初步研究

发布时间：2018-03-30 05:02

本文选题：鼻咽癌　切入点：调强放疗　出处：《广西医科大学》2012年硕士论文

【摘要】：研究背景：鼻咽癌是较为常见的头颈部肿瘤,尤其在中国南方及东南亚各国发病率较高,放疗是其主要治疗手段。鼻咽癌的局部控制率与靶体积的照射剂量呈正相关。近年来由于IMRT等放疗技术的逐渐开展,疗效不断改进,患者生存时间也越来越长,对生存质量的要求也越来越高。而放射性脑损伤是影响鼻咽癌患者生存质量的重要并发症之一。近来有研究指出头颈部肿瘤放疗中会出现明显的解剖位置变化,因此多程放疗计划可能会导致靶区和正常组织器官所受剂量发生改变。自适应放疗是指在治疗过程中对患者的CT/MRI影像进行重新计划设计,解决靶区及正常组织器官改变引起的剂量变化的有效手段,从而达到提高靶区剂量、降低正常组织器官剂量,改善患者远期生存质量的目的。但目前尚无自适应放疗对颞叶剂量影响的大宗病例研究结果。本研究拟回顾性比较一组颅底受累的初治鼻咽癌患者于调强放射治疗后改和不改计划的长期疗效和放射性颞叶损伤的发生率,并对部分患者的颞叶进行剂量学分析,以评价自适应调强放疗对颞叶损伤的影响。研究目的：回顾性收集和分析接受调强放射治疗的鼻咽癌患者资料,观察和初步总结单程与自适应调强放疗计划对放射性颞叶损伤的发生率及其临床剂量学特征。材料与方法：收集2002年1月至2010年1月在四川省肿瘤医院接受IMRT放射治疗且无远处转移的初治T3、T4期鼻咽癌患者,筛选出满足条件患者共221例。分为2组：单程IMRT+化疗161例：多程IMRT+化疗60例；通过门诊复查、电话及信函方式随访,并获取患者定期复查资料,包括MRI/CT检查、胸片和ECT等,以评价并计算鼻咽局部控制率、放射性颞叶损伤、以及患者远期疗效。采用Kaplan-Meier法计算局部控制率(LC)、无远转生存率(D-MFS)、无病生存率(DFS)和总生存率(OS)。通过查询病历资料,找出这些患者的计划号。通过计划号在计划系统CORVUS6.2(NOMOS MIMIC)上调出9年来患者所做的放疗计划,并记录下颞叶的受照射剂量情况。根据治疗方式、年龄、分割剂量、化疗方案对所有患者进行亚分组。分析各组放射性颞叶损伤发生比率,并比较发生与无发生放射性颞叶坏死患者之间的颞叶实际接受剂量(D5,D1,Dlcc)的差异。研究结果： 1、全部患者的中位随访时间为54.7个月(6-96个月),5年随访的初步结果,自适应放疗和单程调强放疗治疗局部晚期鼻咽癌局控率(LC)、无远处转移率(D-MFS)、无病生存率(DFS)及总生存率(OS)分别为：97.5%、91.1%、73.5%、75.8%和96.6%、90.2%、71.2%、71.4%。 2、自适应调强放疗,可以使T3/T4期鼻咽癌患者颞叶得到较好的保护,放射性颞叶损伤率降低。单程调强放疗放射性颞叶损伤率为14.7%；自适应调强放疗放射性颞叶损伤率为5%。 3、发生放射性颞叶损伤患者其左、右侧颞叶的D05分别为76.67±5.61Gy/33F和74.52±5.82Gy/33F,均显著高于无放射性颞叶坏死者(64.52±4.82Gy/33F和64.71±4.74/33F(P0.05)。自适应放疗颞叶D05(61.67±3.47/33F)明显低于单程调强放疗(65.67±4.56/33F)(P0.01)。 4、分割剂量≤2Gy时放射性颞叶损伤发病率为6.4%(21/190)明显低于分割剂量2Gy/F颞叶损伤发生率(12.6%)(P0.01)；年龄50岁时患者颞叶损伤率为14.1%,显著高于≤50岁患者颞叶损伤率(7.6%)(P0.01)。TP和PF化疗方案对放射性颞叶损伤发生率无明显(P0.05) 结论： 1、5年随访的初步结果提示,自适应放疗治疗局部晚期鼻咽癌与单程调强放疗相比,没有明显改善局控率(LC)及无远处转移率(D-MFS)；但可提高无病生存率(DFS)及总生存率(OS) 2、与单程调强放疗相比,自适应放疗可以显著降低局部晚期鼻咽癌患者颞叶损伤发生率,年龄和分割剂量是重要的影响因素。 3、剂量学分析提示,自适应放疗患者的颞叶受照剂量(D01、D05、D1cc)显著低于单程调强放疗；颞叶损伤患者左、右侧颞叶的受量显著高于无放射性颞叶损伤者。 4、本研究推荐：颞叶放疗限制剂量D0565Gy/33F,D1cc75Gy/33F。
[Abstract]:Research background:
Nasopharyngeal carcinoma is a common head and neck cancer, especially in China South and Southeast Asian countries with high incidence, radiotherapy is the main treatment. The local control rate and radiation dose was positively related to the target volume of nasopharyngeal carcinoma. In recent years, due to the gradual development of IMRT and other radiotherapy, the curative effect of continuous improvement, the survival time is getting longer and quality of life are increasingly high requirements. Radiation brain injury is one of the most important complications affecting the quality of life of patients with nasopharyngeal carcinoma.
Recent studies have pointed out the apparent anatomical position changes will head and neck cancer, multi course radiotherapy plan may lead to the target and normal tissue and organ doses to change. Adaptive radiotherapy refers to the CT/MRI images of patients in the treatment process to plan design, effective means to solve the target and normal tissue the organ dose changes due to the change, so as to improve the target dose, reducing the dose of normal tissues and organs, improve the quality of life of patients with long-term purpose. But there is no impact on temporal lobe adaptive radiotherapy dose of major cases. The results of this study retrospectively compared a group of skull base involvement of NPC patients with IMRT after radiotherapy and long term treatment does not change the plan and radioactive temporal lobe injury incidence, and some patients with temporal lobe dosimetry analysis to evaluate the self adaptation The effect of intensity modulated radiation therapy on temporal lobe injury.
The purpose of the study is:
We retrospectively collected and analyzed the data of nasopharyngeal carcinoma patients undergoing intensity modulated radiation therapy. We observed and summarized the incidence and clinical dosimetry characteristics of single and adaptive intensity modulated radiation therapy for radiation temporal lobe injury.
Materials and methods:
From January 2002 to January 2010 in the tumor hospital of Sichuan province received IMRT radiotherapy and metastasis of untreated T3, stage T4 nasopharyngeal carcinoma were selected to meet the conditions of patients with a total of 221 cases. Divided into 2 groups: single IMRT+ chemotherapy in 161 cases: 60 cases with IMRT+ chemotherapy; outpatient review, follow-up telephone and letters. And get patients regularly reviewed data, including MRI/CT examination, chest X-ray and ECT, to evaluate and calculate the control rate of nasopharynx, radiation-induced temporal lobe injury, and patients with long-term effect. The local control rate calculation using Kaplan-Meier method (LC), distant MFS (D-MFS), disease free survival rate (DFS) and total the survival rate (OS).
By querying the medical records of these patients to find out plan. The plan in the planning system of CORVUS6.2 (NOMOS MIMIC) increased in 9 years to do with radiotherapy, and record the temporal lobe radiation dose. According to treatment, age, dose of chemotherapy for segmentation, sub group of all patients. Analysis of each radioactive temporal lobe injury incidence rate, and compare the occurrence and non occurrence of radioactive temporal lobe necrosis in patients with temporal lobe dose (D5, actually received D1, Dlcc) of the difference.
The results of the study:
1, the median follow-up time for all patients was 54.7 months (6-96 months), the preliminary results of 5 years of follow-up, adaptive radiotherapy and one way intensity-modulated radiotherapy for locally advanced nasopharyngeal carcinoma (LC), the local control rate without distant metastasis rate (D-MFS), disease free survival rate (DFS) and overall survival (OS) were 97.5%, 91.1%, 73.5%, 75.8% and 96.6%, 90.2%, 71.2%, 71.4%.
2, adaptive intensity modulated radiation therapy can protect the temporal lobe of patients with stage T3/T4 nasopharyngeal carcinoma, and reduce the incidence of radiation temporal lobe injury. The rate of radiation temporal lobe injury in single intensity modulated radiation therapy is 14.7%, and the rate of radiation temporal lobe injury in adaptive intensity modulated radiation therapy is 5%.
3, radioactive temporal lobe injury in patients with left and right temporal lobe D05 were 76.67 + 5.61Gy/33F and 74.52 + 5.82Gy/33F were significantly higher than that of non radioactive temporal lobe necrosis (64.52 + 4.82Gy/33F and 64.71 + 4.74/33F (P0.05). Adaptive radiotherapy of temporal lobe D05 (61.67 + 3.47/33F) significantly lower than single IMRT (65.67 + 4.56/33F) (P0.01).
4, when the split dose is less than or equal to 2Gy radioactive temporal lobe injury incidence rate was 6.4% (21/190) was significantly lower than the segmentation dose of 2Gy/F temporal lobe injury incidence (12.6%) (P0.01); age of 50 patients with temporal lobe injury rate was 14.1%, significantly higher than that of less than 50 years old patients with temporal lobe injury rate (7.6%) (P0.01).TP and PF chemotherapy on radiation-induced temporal lobe injury incidence was no significant (P0.05)
Conclusion:
The initial results of 1,5 follow-up showed that the adaptive radiotherapy for locally advanced nasopharyngeal carcinoma did not significantly improve the local control rate (LC) and the distant metastasis rate (D-MFS) compared with the single pass intensity modulated radiotherapy, but it increased the disease-free survival rate (DFS) and the overall survival rate (OS).
2, compared with one-way intensity modulated radiation therapy, adaptive radiotherapy can significantly reduce the incidence of temporal lobe injury in locally advanced nasopharyngeal carcinoma patients. Age and split dose are important factors.
3, dosimetric analysis showed that the radiation dose (D01, D05, D1cc) of the patients in the adaptive radiotherapy group was significantly lower than that of the single pass intensity modulated radiotherapy. The amount of left and right temporal lobe in the patients with temporal lobe injury was significantly higher than that in the patients without radiation temporal lobe injury.
4, this study recommended: temporal lobe radiotherapy limited dose D0565Gy/33F, D1cc75Gy/33F.

【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R739.63

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