| 曹燕青,韩非,肖巍魏,沈关驻,吴奕珊,李安川,李阳,赵充.早期鼻咽癌临床靶区的探讨[J].中华放射医学与防护杂志,2014,34(5):345-350 |
| 早期鼻咽癌临床靶区的探讨 |
| Delineation of the clinical target volume in early-stage nasopharyngeal carcinoma |
| 投稿时间：2014-01-09 |
| DOI：10.3760/cma.j.issn.0254-5098.2014.05.007 |
| 中文关键词: 早期鼻咽癌 调强放射治疗 临床靶区 |
| 英文关键词:Early stage nasopharyngeal carcinoma Intensity-modulated radiation therapy Clinical target volume |
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| 中文摘要: |
| 目的 分析早期鼻咽癌调强放疗的疗效及复发模式，探讨临床靶区确定和勾画的合理性。方法 124例初治Ⅰ~Ⅱb期鼻咽癌接受单纯根治性调强放疗。临床靶区（CTV）根据早期鼻咽癌生物学行为特性和规律，并结合鼻咽和颈部大体肿瘤靶区（GTVnx和GTVnd）所在的解剖位置以及邻近结构的特征划分为高危和低危的临床靶区（CTV1和CTV2）。GTVnx、GTVnd、CTV1和CTV2的处方剂量分别为30次68、60~66、60和50~54Gy。分析放疗后复发病灶与靶区的关系及复发模式，统计局部和区域无复发生存率并观察急性和晚期不良反应发生率。结果 中位随访期111.4个月。局部复发2例，复发病灶均位于GTVnx内，皆为野内复发；区域复发3例，复发病灶均位于CTV2内，其中2例为野边缘复发，1例为野外复发。5年局部和区域控制率分别为98.4%和98.3%，总生存率为94.3%。未观察到4级急性和晚期不良反应，3级急性和晚期不良反应的发生率分别为9.7%和4.8%。结论 良好的局部和区域控制率、较低的野边缘和野外复发以及较轻急性和晚期不良反应提示该早期鼻咽癌的临床靶区确定和勾画较为合理，但其准确性仍需进一步临床研究。 |
| 英文摘要: |
| Objective To analyze the clinical outcome and recurrence patterns of IMRT in early-stage NPC, and to explore the rationality of the delineation of clinical target volume (CTV).Methods Totally 124 patients with untreated stage Ⅰ-Ⅱb NPC received IMRT.CTV was divided into CTV1 and CTV2 according to the biological behavior and characteristics of early-stage NPC, the anatomic location and adjacent of gross tumor volume of nasopharynx and neck lymph node (GTVnx and GTVnd).The prescribed dose of GTVnx, GTVnd, CTV1 and CTV2 was 68 Gy/30 f, 60-66 Gy/30 f, 60 Gy/30 f and 50-54 Gy/30 f, respectively.To analyze the relationship between recurrence and target volume, and the recurrence patterns, the local and regional recurrence-free survival rates were determined by the method of Kaplan and Meier.The incidence of acute and late toxicity was recorded.Results With a median follow-up of 111.4 months, 2 patients developed local recurrence within GTVnx.Both were in-field recurrence.3 patients had regional recurrence within CTV2, with 2 marginal recurrences, 1 outside recurrence.The 5-year local and regional recurrence-free survival rates were 98.4% and 98.3%, respectively.The overall survival rate was 94.3%.No grade 4 acute or late radiotherapy-related toxicities were observed.The incidence of grade 3 acute or late toxicities was 9.7% and 4.8%.Conclusions The delineation of CTV in early stage NPC is reasonable with high local and regional control rate, lower marginal and outside recurrence rate, and mild acute or late toxicities.The accuracy of clinical target volume need further study. |
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