鼻咽癌螺旋断层放疗过程中靶区和危及器官变化及近期临床观察

发布时间：2018-02-21 22:22

本文关键词： 鼻咽癌螺旋断层放疗靶体积危及器官急性反应　出处：《中国人民解放军军医进修学院》2010年硕士论文　论文类型：学位论文

【摘要】： 目的研究鼻咽癌螺旋断层放射治疗(Helical Tomotherapy, HT)过程中靶区和危及器官的变化及近期临床观察。方法回顾性分析2008年3月至2010年1月收治的43例经病理证实的、在我科接受螺旋断层放疗的鼻咽癌患者,所有病例均在治疗第20次时重复行CT扫描及治疗计划设计。比较两次定位CT中原发肿瘤(GTVnx)、转移性淋巴结(GTVnd)、腮腺的体积和面部轮廓横径的变化,并分析其变化规律。根据RTOG/EORTC标准,在治疗结束时及结束后1个月评价急性反应,同时观察近期疗效。结果两次CT扫描间隔23-28天,中位间隔时间25天。比较两次CT扫描图像观察到,GTVnx、GTVnd、腮腺体积及面部轮廓横径均发生了明显的变化,其中GTVnx体积平均缩小了30.1%、中位29.8%,GTVnd体积平均缩小了41.6%、中位45.9%,左侧腮腺体积平均缩小了35.5%、中位33.4%,右侧腮腺体积平均缩小了36.8%、中位33.5%,面部轮廓横径缩小了9.4%(1.6cm)、中位9.1%(1.6cm)。其中GTVnx和GTVnd体积的缩小与其初始体积有显著相关性,且GTVnd体积的缩小与体重下降程度有相关性,但均与不同治疗方式无相关性。急性放射反应以1、2级为主,其中皮肤为95%,唾液腺和粘膜分别为100%和93%。6例原发病灶完全缓解(CR,14.0%),32例部分缓解(PR,74.4%),5例病灶稳定(SD,11.6%)；在有淋巴结转移的39例患者中,16例CR(37.2%),21例PR(48.8%),1例SD(2.3%)；鼻咽原发灶和颈部转移淋巴结消退率分别为88.37%和94.87%。中位随访9个月,无肿瘤局部复发,2例患者出现骨转移,2例患者死亡,均死于局部大出血。结论鼻咽癌患者在螺旋断层放疗过程中,存在着明显的靶区及腮腺体积的缩小和面部轮廓等解剖结构的变化,这将会影响剂量分布,及治疗的精确性,因而对于有明显解剖体积变化的患者,应选择合适的时机重新行CT扫描并及时调整治疗计划。鼻咽癌螺旋断层放疗急性放射反应较轻,远期结果需要进一步观察。
[Abstract]:Objective to study the changes of target area and dangerous organs during helical tomography radiotherapy (HTT) in nasopharyngeal carcinoma (NPC). Methods from March 2008 to January 2010, 43 patients with nasopharyngeal carcinoma (NPC) who had been treated with spiral radiation in our department were retrospectively analyzed. The CT scan and treatment plan design were performed repeatedly in all patients at the 20th time of treatment. The changes of the volume of parotid gland and the transverse diameter of facial contour were compared and analyzed according to RTOG/EORTC standard. Acute response was evaluated at the end of treatment and 1 month after treatment. Results the interval between two CT scans was 23-28 days and the median interval was 25 days. The volume of GTVnx was reduced by 30.1 on average, the volume of GTVnd by 29.8m was reduced by 41.6 on average, the volume of left parotid gland was reduced by 45.9, the volume of left parotid gland was reduced by 35.5. the median was 33.4, the volume of right parotid gland was reduced by 36.8, the median by 33.5. the transverse diameter of facial contour was reduced by 9.41.6cmand the median by 9.1cm. The reduction of GTVnx and GTVnd volumes was significantly correlated with their initial volumes. The reduction of GTVnd volume was correlated with the degree of weight loss, but not with different treatment methods. The skin was 95, the salivary gland and mucous membrane were 100% and 93.6, respectively, and there were 32 cases with partial remission of PRN 74.4% and 5 cases with stable SDN 11.6D, among 39 cases with lymph node metastasis, 16 cases with CR37.221 cases with PRT 48.8% and 1 case with SD2. 3% with primary nasopharynx focus and cervical metastasis. The lymph node regression rates were 88.37% and 94.87, respectively. No tumor recurrence occurred in 2 patients with bone metastasis and 2 patients died of local hemorrhage. Conclusion there are obvious changes in target area, parotid gland volume and facial contour in patients with nasopharyngeal carcinoma, which will affect the dose distribution and the accuracy of treatment. Therefore, for patients with obvious anatomical volume changes, CT scan and timely adjustment of treatment plan should be chosen at the appropriate time. The acute radiation response of nasopharyngeal carcinoma treated by spiral tomography radiotherapy is mild, and the long-term results need to be further observed.
【学位授予单位】：中国人民解放军军医进修学院
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R739.63

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