鼻咽癌调强放疗初步研究

发布时间：2018-08-24 19:43

【摘要】：目的：回顾性分析339例鼻咽癌调强放疗计划的剂量分布，重点分析局部治疗失败患者调强放疗计划的剂量学特点，，以评价治疗计划的合理性。 方法：2006年6月至2010年12月，339例病理证实的鼻咽癌（NPC）患者接受全程调强放疗（IMRT）。利用剂量体积直方图(dose volumehistogram，DVH)分析靶区及部分危及器官剂量学特点。将局部治疗失败患者疗前和复发时局部病灶范围于三维治疗计划系统进行对比，根据等剂量曲线进行剂量学评价，分为野内复发、野边缘复发及野外复发。并分析相关预后因素。 结果：中位随访时间为22.5个月（5~62个月），共12例局部治疗失败，12例均为野内复发，全组1、2、3年局部控制率、区域控制率分别为98.1%、96.5%、95.7%；99.3%、98.5%、97.8%。不同T分期PGTVnx平均Dmin、Dmean和D95分别为T1：66.03Gy、74.16Gy、71.19Gy；T2：66.23Gy、73.26Gy、70.53Gy；T3：65.98Gy、73.62Gy、70.66Gy；T4：65.11Gy、72.36Gy、70.18Gy。多因素分析显示PGTVnx-66.5Gy(p=0.026, HR=2.12)和年龄(p=0.013, HR=2.29)是局部控制率的独立影响因子。放化综合治疗的副反应可较好耐受。 结论：目前的鼻咽癌调强放疗计划取得了较好的局部控制率，同时有效保护了正常组织。原发肿瘤局部加量照射有望进一步提高局部控制率。 目的：报道首程无远处转移鼻咽癌调强放疗的初步临床疗效。 方法：回顾性分析2006年6月至2010年12月采用调强放疗的首程无远处转移鼻咽癌患者临床资料。采用Kaplan-Meier法进行生存分析，Cox回归模型进行多因素分析评价预后因子，RTOG／EORTC标准评价急性放疗反应和晚期损伤。 结果：339例初治鼻咽癌患者，男性244例，女性95例，男：女比例为2.57:1，中位年龄44岁。根据2010AJCC/UICC分期，76.1%（258例）为Ⅲ/Ⅳ期患者。中位随访时间为22.5个月,随访率为97.3%。全组1、2、3年总生存率分别为99.0%、94.9%、90.7%；疾病特异生存率分别为99.1%、97.0%、94.2%；无疾病生存率分别为96.4%、92.9%、86.4%；无远处转移生存率分别为97.1%、93.6%、88.1%。Cox多因素分析显示年龄(p=0.026、HR=2.959)和PGTVnx-66.5Gy (p=0.032、HR=1.306)是无疾病生存的独立预后因子，PGTVnx-66.5Gy (p=0.016、HR=3.065)是无远处转移生存的独立预后因子。年龄和临床分期是总生存率的独立预后因子(p=0.036,HR=2.985；p=0.004, HR=3.718)；临床分期是疾病特异生存的独立预后因子(p=0.002, HR=4.096)。常见急性放疗不良反应为1、2级皮肤损伤(98.8%)及2、3级口腔黏膜损伤(95.0%)。随访超过2年的患者中12名仍存在1、2级腮腺损伤，未观察到3、4级晚期损伤。 结论：本中心IMRT治疗首程无转移鼻咽癌可获得理想的局部区域控制率及总生存率，对正常组织器官有较好的保护作用。急性不良反应可较好耐受，远处转移是本中心治疗失败的主要模式。
[Abstract]:Objective: to analyze the dose distribution of 339 patients with nasopharyngeal carcinoma (NPC) treated by intensity modulated radiotherapy (IMRT), and to analyze the dosimetric characteristics of IMRT in patients with failed local treatment, and to evaluate the rationality of the treatment plan. Methods: from June 2006 to December 2010, 339 patients with pathologically proved nasopharyngeal carcinoma (NPC) received (IMRT). With full intensity modulated radiotherapy (IMRT). Dose volume histogram (dose volumehistogram,DVH) was used to analyze the dosimetric characteristics of target and partial organ hazards. The range of local focus before and after local treatment failure was compared with that of 3D treatment planning system. Dosimetric evaluation was carried out according to the isodose curve, which was divided into field recurrence, field marginal recurrence and field recurrence. The prognostic factors were analyzed. Results: the median follow-up time was 22.5 months (5 ~ 62 months). Twelve cases of local treatment failure and 12 cases of local recurrence were found. The local control rate was 98.1 96.5% and the regional control rate was 98.1 96.5% (99.5%) and 97.8% respectively. The average Dmin,Dmean and D95 of PGTVnx in different T stages were T 1: 66.03 Gy (74.16 Gy) and T 2: 66.23 Gy (73.26 Gy) 70.53 Gy (T3: 65.98 Gy / 73.66 Gy) T4: 65.11 72.36 Gy (70.18 Gy). Multivariate analysis showed that PGTVnx-66.5Gy (p0. 026, HR=2.12) and age (p0. 013, HR=2.29) were independent factors of local control rate. The side effects of combined radiotherapy and chemotherapy can be well tolerated. Conclusion: the current intensity-modulated radiotherapy program for nasopharyngeal carcinoma has achieved a good local control rate and effectively protected normal tissue. Local dose irradiation of primary tumor is expected to further improve the local control rate. Objective: to report the preliminary clinical effect of intensity modulated radiotherapy (IMRT) for nasopharyngeal carcinoma without distant metastasis. Methods: the clinical data of patients with primary metastatic nasopharyngeal carcinoma without distant metastasis were retrospectively analyzed from June 2006 to December 2010. Kaplan-Meier survival analysis Cox regression model was used to evaluate prognostic factors RTOG / ORTC criteria for acute radiation response and late injury. Results of 339 patients with nasopharyngeal carcinoma, 244 were males and 95 were females. The ratio of males to females was 2.57: 1. The median age was 44 years old. According to 2010AJCC/UICC staging, 76.1% (258 cases) were stage 鈪

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