| 张玉雷,廖雄飞,黎杰,白立新,徐鹏,李厨荣,陈亚正,王培.早期鼻咽癌螺旋断层放疗颈部皮肤受量的剂量学研究[J].中华放射医学与防护杂志,2017,37(12):906-910 |
| 早期鼻咽癌螺旋断层放疗颈部皮肤受量的剂量学研究 |
| A dosimetric study of neck skin dose for early-stage nasopharyngeal carcinoma treated by Tomotherapy |
| 投稿时间：2017-05-31 |
| DOI：10.3760/cma.j.issn.0254-5098.2017.12.005 |
| 中文关键词: 鼻咽癌 螺旋断层放疗 皮肤剂量 |
| 英文关键词:Nasopharyngeal carcinoma Helical tomotherapy Skin dose |
| 基金项目:四川省科技支撑计划项目（2015SZ0053） |
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| 中文摘要: |
| 目的 探索早期鼻咽癌螺旋断层放射治疗（Tomotherapy）计划设计过程中降低颈部皮肤受照剂量的方法。方法 采用简单随机抽样法选取17例已接受螺旋断层放射治疗的早期鼻咽癌病例，将各病例颈部外轮廓内缩3 mm生成新的组织器官即颈部皮肤组织，同时清除各靶区与颈部皮肤组织的交叉部分；针对上述处理过的病例进行两组计划设计，常规（TP）组按照常规计划方法进行螺旋断层放疗计划设计；新计划（NP）组是将颈部皮肤组织作为危及器官进行剂量限制计划设计；比较两组计划中各靶区以及危及器官的剂量参数、机器跳数以及治疗时间等参数。结果 两组计划均能满足临床处方要求，两组计划各靶区的D98、D95以及D2差异均无统计学意义（P>0.05）；NP组的脑干Dmax、脊髓D1 cm3、右侧腮腺Dmean高于TP组接受的剂量（t=2.47、2.34、2.77，P<0.05），左颞颌关节Dmax较TP组低（t=2.30，P<0.05），皮肤V30、V40、V50、V60比TP组明显降低（t=8.37、6.02、5.82、4.89，P<0.05）。NP组单次总机器跳数比TP组平均减少6.3%，单次实际执行时间比TP组平均减少8.1%。结论 早期鼻咽癌螺旋断层放射治疗应该勾画颈部皮肤，并在计划设计过程中将其作为危及器官进行剂量限制，该方法能够有效降低颈部皮肤受照剂量，减轻放射治疗过程中皮肤反应，提高患者生活质量。 |
| 英文摘要: |
| Objective The purpose of this study is to investigate the method to reduce the radiation dose to the neck skin in the Tomotherapy treatment plans for early-stage nasopharyngeal carcinoma. Methods The 17 patients with early-stage nasopharyngeal carcinoma that have been treated by the Tomotherapy were selected randomly for this skin sparing study. The neck skin sparing region was generated as an internal margin of 3 mm from the out body contour, excluding the intercrossed area with the targets. Candidate patients were planned using TP and NP method respectively:the TP group was planned with the traditional method. The new neck skin region was considered as an organ at risk (OAR) for planning dose constrain in NP group. The dosimetric metrics of targets and OARs, monitor units (MU) and delivery time were compared as the end points of these two groups. Results The two treatment plan groups satisfied the clinical requirement. There were no significant differences for D98, D95 and D2 of the targets (P>0.05). The Dmax of brainstem, D1cc of spinal cord, Dmean of right parotid were higher in NP group than in the TP group (t=2.47, 2.34, 2.77, P<0.05). The Dmax of left mandible joint was lower than TP group(t=2.30, P<0.05). The V30, V40, V50 and V60 of the skin were considerably lower than TP group(t=8.37, 6.02, 5.82, 4.89, P<0.05). The mean MU and mean delivery time per fraction of NP group were 6.3% and 8.1% less than that of TP group respectively. Conclusions The neck skin region should be delineated as an OAR to be spared in the Tomotherapy treatment planning for early-stage nasopharyngeal carcinoma. This method can reduce the skin radiation dose effectively, alleviate the skin reaction, and improve the life quality of patients in radiotherapy. |
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