鼻咽癌适形调强放疗相关体积变化对靶区剂量影响分析

发布时间：2018-04-16 17:15

本文选题：鼻咽癌 + 调强放射治疗(IMRT)　；参考：《中华肿瘤防治杂志》2014年17期

【摘要】：目的:在图像引导的调强放射治疗(intensity modulated radiotherapy,IMRT)局部晚期鼻咽癌的过程中,评价外轮廓、腮腺及体质量的变化对靶区剂量影响的临床价值。方法:收集2011-06-01-2012-03-31贵州省肿瘤医院收治完成全程治疗的局部晚期鼻咽癌患者,可评价15例,放疗采用图像引导的调强放射治疗技术,于放疗第1周每天及以后每周三维锥形束CT(cone beam CT,CBCT)检查,通过图像观察腮腺及外轮廓位移。分别在放疗至33.6Gy/15次及62.72Gy/28次时重新定位扫描,通过骨配准把最新扫描的CT图像导入放疗前的图像中,可以明显观察GTVnx、腮腺及外轮廓的变化,并根据变化进行改野后,重新计算后续放疗的剂量。观察改野后腮腺及GTVnx所接受剂量的变化。结果:靶区体积、鼻咽部外轮廓体积随放疗变化差异无统计学意义,P值分别为0.817和0.280;放疗至15及28次时,左右腮腺体积与放疗前相比较差异均有统计学意义,P0.05;以28次缩小最为显著。随着放疗的进行,腮腺的外侧缘比内侧缘缩小明显,腮腺受照射的平均剂量增加,并且外轮廓横径均发生内移,外轮廓缩小的差异有统计学意义,P=0.007;重新勾画靶区后,GTVnx所接受的剂量较原始计划差异无统计学意义,P=0.051;放疗期间的外轮廓和腮腺的位置、体积及患者体质量的变化,对靶区所受到的剂量影响差异无统计学意义,P0.05。结论:在放疗过程中,可能需考虑由于外轮廓、腮腺及体质量的变化而修改靶区。
[Abstract]:Objective: in IMRT image guide (intensity modulated radiotherapy, IMRT) of locally advanced nasopharyngeal carcinoma, evaluate the clinical value of the outer contour, changes of parotid gland and body weight of target dose. Methods: 2011-06-01-2012-03-31 collection of Guizhou Province Tumor Hospital from complete treatment of locally advanced nasopharyngeal carcinoma patients, evaluation 15 patients with image guided radiotherapy IMRT technique, in every first weeks and every Wednesday after radiotherapy cone beam CT (cone beam CT, CBCT) by image examination, observation of parotid gland and the outer contour of displacement. In radiotherapy to 33.6Gy/15 & 62.72Gy/28 when re positioning the image registration by bone scan, CT the latest scan image into radiotherapy before, we could observe GTVnx changes of parotid gland and outer contour, and modified yehou changes according to the re calculation of subsequent radiotherapy dose To observe the changes of parotid gland and modified. Yehou GTVnx received dose. Results: the target volume of nasopharyngeal contour volume with radiotherapy there was no statistically significant difference, P values were 0.817 and 0.280; radiotherapy to 15 and 28 when the left parotid volume before radiotherapy and phase differences were statistically significant, P0.05 in order to reduce 28 times; the most significant. With radiotherapy, the lateral margin of parotid gland was significantly reduced than the medial margin, average dose of irradiated parotid gland increased, and the outer contour diameter occurred in, statistically significant, difference profile of reduced P=0.007; new target delineation, without statistical significance. GTVnx dose compared with the original plan outline and the difference of P=0.051; the position of the parotid gland during radiotherapy, changes in the volume and quality of patients, no significant dose of impact on the target area difference P0.05. conclusion: in the process of radiotherapy, may be required The target area is modified by considering the changes in the external contour, the parotid and body mass.

【作者单位】：贵州省肿瘤医院;贵阳医学院附属医院头颈肿瘤科;
【基金】：贵州省科技厅基金项目(E2011-16) 贵州省科技厅攻关项目(D2008-05)
【分类号】：R739.63

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