磁共振影像对鼻咽癌放疗前后涎腺功能的评价研究

发布时间：2018-03-28 01:11

本文选题：磁共振涎管成像　切入点：弥散加权磁共振成像　出处：《复旦大学》2010年硕士论文

【摘要】： 磁共振影像对鼻咽癌放疗前后涎腺功能的评价研究【目的】探索磁共振涎管成像(MRS)和弥散加权磁共振成像(DW MRI)两种影像方法评价鼻咽癌放疗前后涎腺(腮腺、下颌下腺)功能的可行性,与患者主观评价的相关性。结合鼻咽癌不同治疗策略(单纯放疗和放化疗序贯治疗)分析化疗对口干严重程度的影响。【方法】2009年8月至2010年3月间,病理证实且无远处转移的初治鼻咽癌患者进入研究。Ⅰ、Ⅱa期患者采用单纯放疗,Ⅲ、Ⅳ期患者采用诱导化疗+放疗+辅助化疗各2疗程。放疗采用IMRT技术,鼻咽部总剂量66 Gy(T1-2)/30次或70.4 Gy(T3-4)/32次,2.2 Gy/次,5次/周。TPF方案：多西他赛60mg/m2 ivgttd1,顺铂25mg/m2 ivgtt d1-3,5-氟脲嘧啶2500 mg/m2 civ120h。每3周重复。放疗前、后患者分别行MRS和DW MRI检测双侧腮腺和颌下腺功能。应用一种MRS评分系统对患者放疗前后及酸刺激前后涎腺导管进行评分,并结合RTOG/EORTC口干标准和EORTC QLQ-C30和QLQ-HN35量表进行分析。【结果】共17例患者进入研究(单纯放疗组5例和序贯放化疗组12例)。所有患者均完成预期的放射治疗及化疗。所有患者双侧腮腺平均受照剂量为39.04Gy(SD,3.75Gy),双侧颌下腺平均受照剂量为57.83Gy(SD,2.95Gy)。治疗后,QLQ-C30量表显示序贯放化疗组除恶心呕吐较单纯放疗组明显加重外,其余各领域生活质量无统计学意义上的下降。QLQ-HN35量表的9项口干相关症状领域/条目前者比后者评分明显升高(即生活质量降低),差异有统计学意义(P均0.05)。得到高质量MRS图像,酸刺激涎腺导管评分升高,放疗后导管评分下降,对酸刺激反应较放疗前差。放疗后酸刺激前后腮腺导管评分差值两组间有统计学差异(P=0.023),且与QLQ-C30量表的总生活质量领域有正相关性(rs=0.485,p=0.049),与QLQ-HN35量表中的口干条目有负相关性(rs=-0.486,p=0.048)。放疗前腮腺表观弥散系数(apparent diffusion coefficient, ADC)平均值为(1.16±0.18)×10-3mm2/s,酸刺激后ADC值升高([1.27±0.18]×10-3mm2/s,P0.001)。放疗后相同时间点ADC值较放疗前升高。放疗后酸刺激后ADC值较静息时升高([1.98±0.27]×10-3mm2/s vs. [1.27±0.18[×10-3mm2/s, P0.001)。放疗前在酸刺激后的最初5分钟,76.5%的腮腺ADC值呈上升趋势,最大值出现时间个体差异较大,约在6min-21min范围内。放疗后腮腺酸刺激后ADC值变化呈无序性。将序贯放化疗组患者腮腺按平均受照剂量(Dmean)为≤39Gy和39Gy分为2组,两组腮腺导管酸刺激前后得分差值差异有统计学意义(P=0.016)。将序贯放化疗组患者腮腺按V35≤52%(中位值)和52%分为2组,两组腮腺导管酸刺激前后得分差值差异有统计学意义(P=0.041)。【结论】MRS和DW MRI可以无创检测涎腺放疗前后功能变化,用来评价鼻咽癌患者放疗后口干严重程度有巨大的潜力。TPF方案序贯放化疗口干早期反应较单纯放疗严重。减少腮腺照射剂量,有利于早期腮腺功能特别是酸刺激后分泌功能的保护。
[Abstract]:Evaluation of salivary gland function of nasopharyngeal carcinoma before and after radiotherapy by magnetic resonance imaging
[Objective] to explore the magnetic resonance sialography (MRS) and diffusion-weighted magnetic resonance imaging (DW MRI) two imaging methods evaluated before and after radiotherapy for nasopharyngeal carcinoma of salivary gland (parotid gland, submandibular gland function) the feasibility of correlation with subjective evaluation of patients with nasopharyngeal carcinoma. Combined with different treatment strategies (radiotherapy and chemotherapy sequential therapy) analysis of the effect of chemotherapy on xerostomia severity.
[Methods] from August 2009 to March 2010, confirmed by pathology and metastasis of nasopharyngeal carcinoma were enrolled into the study. First, patients in stage a were treated with radiotherapy, III, IV were treated with induction chemotherapy + radiotherapy + chemotherapy 2 radiotherapy treatment. Using IMRT technology, the total dose of nasopharynx in 66 Gy (T1-2) /30 or 70.4 Gy (T3-4) /32, 2.2 Gy/, 5 times / week.TPF: Docetaxel 60mg/m2 ivgttd1, cisplatin 25mg/m2 IVGTT d1-3,5- fluorouracil 2500 mg/m2 civ120h. was repeated every 3 weeks. Before radiotherapy, patients underwent MRS and DW MRI detection of bilateral parotid and submandibular gland function. Application of a MRS scoring system to score the patients before and after radiotherapy before and after acid stimulation of salivary duct, and combined with the RTOG/EORTC standard and EORTC QLQ-C30 dry mouth and QLQ-HN35 scale were analyzed.
[results] a total of 17 patients entered the study (radiotherapy group 5 cases and sequential chemotherapy group 12 cases). All patients completed radiotherapy and chemotherapy. All patients expected bilateral parotid mean dose of 39.04Gy (SD, 3.75Gy), bilateral submandibular gland the average dose of 57.83Gy (SD, 2.95Gy). After treatment, the QLQ-C30 scale showed sequential chemoradiotherapy in addition to nausea and vomiting compared with radiotherapy alone group was significantly increased, the quality of life was no significant decline in the scale of 9.QLQ-HN35 dry mouth symptoms related to field / the score was significantly higher than the latter (i.e., reduced quality of life), there was statistical significance the difference (P < 0.05). To obtain high quality MRS images, acid stimulation of salivary gland were increased after radiotherapy, catheter score decreased, the acid stimulation than before radiotherapy. Radiotherapy after acid stimulation before and after parotid duct score differences between the two groups had statistical difference ISO (P=0.023), and there is a positive correlation with the total quality of life scale of QLQ-C30 (rs=0.485, p=0.049), a negative correlation with the QLQ-HN35 scale in dry mouth (rs=-0.486, p=0.048). The entry before radiotherapy of parotid gland and apparent diffusion coefficient (apparent diffusion, coefficient, ADC) average (1.16 + 0.18) * 10-3mm2/s, ADC increased after acid stimulation ([1.27 + 0.18] * 10-3mm2/s, P0.001) after radiotherapy. At the same time ADC value higher than before radiotherapy. Radiotherapy after acid stimulation ADC values were elevated resting ([1.98 + 0.27] + 0.18[* 10-3mm2/s vs. [1.27 * 10-3mm2/ s, P0.001) before radiotherapy after acid stimulation in. The first 5 minutes, 76.5% of the parotid gland ADC value increased, the maximum time of individual differences, approximately in the range of 6min-21min. The parotid gland after radiotherapy after acid stimulation ADC value change with the disorder. The sequential chemotherapy group according to the average dose of parotid gland (Dmean) is less than or equal to 39Gy and 3 9Gy were divided into 2 groups, statistically significant difference of scores of the two groups before and after acid stimulation of parotid duct (P=0.016). The sequential chemoradiotherapy group patients with parotid gland by V35 is less than or equal to 52% (median 52%) and divided into 2 groups, statistically significant difference of scores of the two groups before and after acid stimulation of parotid duct (P= 0.041).
[Conclusion] MRS and DW MRI can be noninvasive detection of salivary gland function changes before and after radiotherapy, to evaluate the severity of xerostomia in patients with nasopharyngeal carcinoma after radiotherapy has the potential to.TPF huge sequential chemotherapy xerostomia early response compared with radiotherapy alone. Seriously reduce the parotid irradiation dose, is conducive to the early parotid gland function especially the protection of secretory function after acid stimulation.

【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R739.63

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