鼻咽癌调强放疗中再计划的初步研究

发布时间：2018-06-11 22:16

本文选题：鼻咽癌 + 螺旋断层放疗　；参考：《中国人民解放军军医进修学院》2011年博士论文

【摘要】：目的观察鼻咽癌患者在调强放射治疗过程中腮腺解剖学及剂量学的变化,并寻找影响该变化的因素。方法采用螺旋断层放疗系统及其计划系统和自适应系统,计算鼻咽癌患者腮腺每周体积、外界间距变化,及单分次V1和D50的变化,采用重复数据模型计算体积及剂量学参数在分次间的差异,以及影响该参数变化的因素。结果35例患者左右侧腮腺体积在放疗结束时分别平均缩小29.47%和24.47%,每周间体积差异明显(p0.05),第16次放疗时腮腺体积变化率最高；腮腺外界间距平均缩小7.5±3.85%,左右侧腮腺靶区内外体积比值分别平均增加102.3±80.05%和86.43±122.1%；左右侧腮腺单分次V1分别平均升高32.2%和28.6%,单分次D50分别平均升高33.9%和24.93%,第2～3周间剂量学参数差异显著(p0.05)。放疗过程中,腮腺体积变化因其初始体积(p=0.000)及治疗方法(p=0.04)的不同而不同,而治疗方式(p=0.007)、年龄(p=0.025)及初始计划中Dmean(p=0.004)和V30(p=0.000)均影响其D50的变化趋势。结论放疗过程中腮腺解剖学及剂量学参数存在着明显的变化,该变化趋势受疗前腮腺体积、初始计划剂量、治疗方式及年龄的影响,在放疗第四周时实施再次计划可能有临床应用价值。目的探寻鼻咽癌调强放疗过程中影响腮腺体积变化的因素。方法回顾性分析104例鼻咽癌临床资料及计划参数,采用螺旋断层放疗计划系统及其自适应系统,勾画腮腺轮廓,获得患者放疗中期时腮腺的体积变化参数,采用Spearman相关和Logistic多因素回归模型分析腮腺体积变化与多个研究因素间的关系。结果至第20次放疗时,左右侧腮腺体积分别平均减少6.69cm3(25.51%)和6.43cm3(24.95%)。腮腺初始体积、体重、治疗方式及肿瘤和转移性淋巴结总体积与腮腺体积缩小的绝对值相关,肿瘤分期、治疗方式、淋巴结转移情况及肿瘤和转移性淋巴结总体积与腮腺体积缩小的相对值相关。Logistic多因素模型分析发现,治疗方式是影响腮腺体积缩小绝对值(p=0.009)和相对值(p=0.007)的独立影响因子,而腮腺初始体积是其体积缩小绝对值的独立影响因子(p=0.000) 结论对于接受放疗同步联合化疗或靶向治疗和拥有大体积腮腺的鼻咽癌患者,因腮腺变化较大,应密切观察,及时重新定位修正计划。目的寻找影响鼻咽癌患者放疗后晚期口干症的因素。方法对本研究第二部分中的104例鼻咽癌患者采用门诊接诊和电话随访的方式,依据RTOG/EORTC标准评价晚期口干症状,以Spearman秩相关法分析与口干症状严重程度相关的各种因素。结果患者在放疗结束后6至12月时,0级、1级及2级口干症的分布分别为17例(16.3%)、78例(75%)和9例(8.6%)。本研究未发现,口干症严重程度与放疗期间再计划存在相关关系(p0.05)；放疗同步联合化疗与单独放疗或放疗同步靶向治疗相比,会加重口干症状(p=0.006)；另外,腮腺初始体积大者口干症状更严重(p=0.024)。结论评价放疗期间再计划改善口干症状的效果,可能需要大量病例和较长时间的观察,对于同步放化疗和腮腺初始体积大的患者,则应进行干预以减轻口干症状。
[Abstract]:Objective To investigate the changes of parotid anatomy and dosimetry in patients with nasopharyngeal carcinoma ( NPC ) during radiotherapy and to find out the factors affecting the changes .

Methods Spiral CT radiotherapy system and its planning system and adaptive system were used to calculate the weekly volume of parotid gland , the change of external space and the change of single - divided V1 and D50 in nasopharyngeal carcinoma patients . The difference between volume and dosimetry parameters was calculated by repeated data model , and the factors affecting the parameter change were calculated .

Results The volume of parotid gland was reduced by 29.47 % and 24.47 % at the end of radiotherapy , and the volume difference was significant ( p < 0.05 ) .
The mean reduction of the external space of parotid gland was 7.5 卤 3.85 % , and the volume ratio of intra - and external volume of parotid gland was 102.3 卤 80.05 % and 86.43 卤 122.1 % , respectively .
In the course of radiotherapy , the volume change of parotid gland was significantly different ( p = 0.007 ) , age ( p = 0.025 ) and Dmean ( p = 0.004 ) and V30 ( p = 0.000 ) in the initial plan .

Conclusion There are significant changes in parotid anatomy and dosimetry parameters during radiotherapy . This change trend is influenced by the volume of parotid gland , initial planned dose , treatment modality and age , and it may have clinical application value at the fourth week of radiotherapy .

Objective To explore the factors influencing the volume change of parotid gland during radiotherapy of nasopharyngeal carcinoma ( NPC ) .

Methods The clinical data and planning parameters of 104 patients with nasopharyngeal carcinoma were retrospectively analyzed . Spiral CT radiotherapy planning system and its adaptive system were used to delineate the profile of parotid gland , and the parameters of volume change of parotid gland were obtained in the middle of radiotherapy . The relationship between the volume change of parotid gland and the multiple factors was analyzed by means of Pearson correlation and Logistic regression model .

Results The volume of parotid gland decreased by 6.69 cm3 ( 25.51 % ) and 6.43 cm3 ( 24.95 % ) on the left and right parotid gland , and the total volume of parotid gland was correlated with the absolute value of the volume of parotid gland .

Conclusion For patients with nasopharyngeal carcinoma receiving radiotherapy simultaneous chemotherapy or targeted therapy and large - volume parotid gland , due to the large change of parotid gland , the correction plan should be re - located in time .

Objective To find out the factors influencing the late oral dryness of patients with nasopharyngeal carcinoma ( NPC ) .

Methods 104 NPC patients in the second part of the study were followed up by outpatient visit and telephone follow - up . Based on the RTOG / EORTC standard , the symptoms of late mouth stem were evaluated , and the factors related to severity of dry mouth symptom were analyzed by means of Pearson ' s rank correlation method .

Results There were 17 cases ( 16.3 % ) , 78 cases ( 75 % ) and 9 cases ( 8.6 % ) of Grade 0 , Grade 1 and 2 dry mouth disease at 6 to 12 months after radiotherapy .
Compared with radiotherapy alone or radiotherapy alone , radiotherapy combined with chemotherapy could aggravate the symptom of dry mouth ( p = 0.006 ) .
In addition , the initial volume of parotid gland was more severe than that of dry mouth ( p = 0 . 024 ) .

Conclusion It may be necessary to evaluate the effect of re - planning to improve dry mouth symptoms during radiotherapy , which may require a large number of cases and longer observation . For patients with large initial volume of concurrent chemoradiotherapy and parotid gland , intervention should be made to relieve dry mouth symptoms .
【学位授予单位】：中国人民解放军军医进修学院
【学位级别】：博士
【学位授予年份】：2011
【分类号】：R739.63

【参考文献】