| 周祥,张书旭,王锐濠,林生趣,蒋绍惠,雷怀宇,张国前,周露,邓瑾.不同淋巴结转移状况的鼻咽癌调强放疗中腮腺和肿瘤靶区体积退缩与受照剂量的相关性[J].中华放射医学与防护杂志,2016,36(2):111-115 |
| 不同淋巴结转移状况的鼻咽癌调强放疗中腮腺和肿瘤靶区体积退缩与受照剂量的相关性 |
| Correlation between the reduction of parotid gland and gross tumor volume and their exposure dose in patients with different metastasis status of lymph node receiving intensity-modulated radiotherapy for nasopharyngeal carcinoma |
| 投稿时间：2015-09-22 |
| DOI：10.3760/cma.j.issn.0254-5098.2016.02.006 |
| 中文关键词: 鼻咽癌 体积变化 调强放疗 淋巴直径 |
| 英文关键词:Nasopharyngeal carcinoma Volume change IMRT Lymph node diameter |
| 基金项目:广东省教育厅特色创新项目(2014KTSCX104);广东省科技计划项目(2013B021800274);广东省教育厅科技创新项目(2013KJCX0152) |
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| 中文摘要: |
| 目的 探讨鼻咽癌调强放疗中,不同淋巴结转移状况的腮腺和肿瘤靶区体积退缩与受照剂量的相关性,以便确定再次计划最佳时间。方法 选择30例接受调强放疗的鼻咽癌患者,根据颈部淋巴结直径大小将患者分为3组,分别是淋巴结阴性组(A组),淋巴结≤3 cm阳性组(B组),淋巴结>3 cm阳性组(C组)。初始定位CT命名为CT0,每位患者在同一体位下每周重新扫描一次CT,即患者第5、10、15、20、25和32次治疗前行日常验证扫描图像获得CT1、CT2、CT3、CT4、CT5、CT6。结果 CT0显示3组腮腺初始体积大小差异无统计学意义(P>0.05)。与A组相比,B组在CT4以后腮腺体积开始缩小,差异有统计学意义(t=2.12~2.46,P<0.05);C组CT2以后体积差异具有统计学意义(t=2.19~3.25,P<0.05)。各组内分次体积与初始体积CT0相比,A组、B组在CT3以后体积开始缩小,差异有统计学意义(t=2.16~4.11,P<0.05);C组在CT2以后就有差异(t=2.37~5.20,P<0.05);C组CT4与CT2比较,差异也具有统计学意义(t=2.16、3.34,P<0.05)。结论 出于保护腮腺的考虑,淋巴结较大的患者有必要提前修改计划,建议在第10次放疗重新计划,可能在第20次放疗需要再次计划;淋巴结阴性或者很小的患者建议在第15次修改计划。 |
| 英文摘要: |
| Objective The aim of this study was to explore the correlation between the reduction of parotid gland and gross tumor volume and their exposure dose in patients with different metastasis status of lymph node receiving intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma, and to determine the best time for replanning. Methods Thirty patients with NPC treated with IMRT were divided into three groups according to lymph node diameter: lymph-node negative (group A), lymph-node positive and diameter≤3 cm (group B), and diameter >3 cm (group C). The initial computed tomography (CT) scan was CT0. Each patient was rescanned weekly in the same position at the 5th, 10th, 15th, 20th, 25th and 32nd fraction (CT1, CT2, CT3, CT4, CT5 and CT6, respectively). Results CT0 showed no difference in initial parotid volumes among the three groups (P>0.05). Between-group analysis showed a significant difference in parotid volume changes after CT4 between group A and B (t=2.12-2.46, P<0.05) and between group A and C after CT3 (t=2.19-3.25, P<0.05). According to within-group analysis, significant parotid volume changes occurred in groups A and B after CT3 (t=2.16-4.11, P<0.05) and in group C after CT2 (t=2.37-5.20, P<0.05), compared with CT0. There were significant changes when CT4 compared with CT2 (t=2.16, 3.34, P<0.05) in groups C. ConclusionsPatients with larger lymph nodes need earlier replanning of IMRT, at the 10th and possibly again at the 20th fraction, while patients with negative or smaller lymph nodes do not require replanning until the 15th fraction. |
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