鼻咽癌调强适形放射治疗后颞叶放射性损伤的相关因素分析

发布时间：2018-06-22 10:20

  本文选题：鼻咽肿瘤/放射疗法 + 调强适形放射治疗　； 参考：《中华肿瘤防治杂志》2014年23期

【摘要】：目的探讨初治鼻咽癌患者接受调强适形放射治疗(intensity modulated radiation therapy,IMRT)引起颞叶放射性损伤(temporal lobe necrosis,TLN)的发生情况并分析其相关危险因素。方法回顾性分析2006-01-01-2008-06-30中山大学肿瘤防治中心288例接受IMRT根治性放疗的初治鼻咽癌患者发生TLN的情况,并分析了患者性别、年龄、T分期、诱导化疗、同时期化疗、辅助化疗、联合化疗、鼻咽照射总剂量、鼻咽照射分次剂量、后装治疗、糖尿病或高血压病、肝病、吸烟、颞叶最大剂量和平均剂量与TLN发生的关系,进一步采用Logistic回归进行多因素分析TLN的独立危险因素,并用Kaplan-Meier法分析了具有不同独立危险因素的患者累积无颞叶损伤生存情况。结果 288例患者中有33例(11.5%)出现TLN;576侧颞叶中有41例(7.1%)出现TLN。TLN潜伏时间为17~70个月,中位时间36个月。ROC曲线分析显示,本组患者颞叶最大剂量分界点为65.85Gy,颞叶平均剂量分界点为15.42Gy;Logistic回归分析证实T分期、颞叶最大剂量和平均剂量是鼻咽癌放疗后TLN独立危险因素。T4、颞叶最大剂量≥65.85Gy及平均剂量≥15.42Gy的患者3年及5年累积无颞叶损伤生存率均显著低于低风险的患者,P均0.001。结论 T4、颞叶最大剂量≥65.85Gy和平均剂量≥15.42Gy是鼻咽癌IMRT后发生TLN的危险因素。
[Abstract]:Objective to investigate the incidence of radiation injury of temporal lobe (temporal lobe necrosis) induced by intensity modulated radiotherapy (IMRT) in patients with nasopharyngeal carcinoma (NPC) and to analyze its risk factors. Methods the incidence of TLN in 288 patients with nasopharyngeal carcinoma (NPC) undergoing IMRT radical radiotherapy was retrospectively analyzed in the Cancer Prevention and treatment Center of Sun Yat-sen University from January to June 2006.The patients' sex, age, T stage, induced chemotherapy, chemotherapy at the same time and adjuvant chemotherapy were analyzed. Combined chemotherapy, total dose of nasopharyngeal irradiation, fractional dose of nasopharyngeal irradiation, afterloading therapy, diabetes or hypertension, liver disease, smoking, maximum dose and average dose of temporal lobe were associated with the occurrence of TLN. Logistic regression was used to analyze the independent risk factors of TLN, and Kaplan-Meier method was used to analyze the survival of patients with different independent risk factors. Results among 288 patients, 33 cases (11.5%) had TLN.TLN latency of 17 ~ 70 months (41 / 576), and the median time was 36 months. ROC curve analysis showed that TLN.TLN occurred in 41 (7.1%) of the 576 sides of temporal lobe. The maximum dose boundary point of temporal lobe was 65. 85 Gy, and the mean dose boundary point of temporal lobe was 15. 42 Gym logistic regression analysis to confirm T stage. The maximum dose and average dose of temporal lobe were independent risk factors of TLN after radiotherapy. The survival rates of patients with temporal lobe maximum dose 鈮，

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