填充模体对放射性皮炎及转移灶消退的影响  

The influence of bolus on the radiation-induced skin disorders and the local regional control rate

作　　者：陈善义[1] 李先明[1] 吴冬[1] 闫茂生[1] 任浙平[1] 胡岳然[1] 吴超权[1] 

机构地区：[1]暨南大学医学院第二附属医院肿瘤放射治疗科,深圳518020

出　　处：《中华放射医学与防护杂志》2005年第1期65-67,共3页Chinese Journal of Radiological Medicine and Protection

摘　　要：目的　前瞻性地研究鼻咽癌放射治疗时组织填充模体对颈部皮肤放射性损伤以及颈淋巴结转移灶消退情况的影响。方法　从 2 0 0 0年 6月至 2 0 0 1年 12月 ,90例初治鼻咽癌患者按T、N、M分层配对分为不加模体组 (1组 ) ,加 0 5cm厚模体组 (2组 ) ,加 1 0cm厚模体组 (3组 )。采用低熔点铅挡块等中心照射技术 ,对原发灶及颈转移灶行根治性放射治疗。常规分割照射全颈 5 0Gy后 ,2、3组除去模体 ,再缩野至原发灶加量至 70Gy。计算出 3组患者皮肤表面及转移灶表面平均百分深度剂量 (PDD) ,比较 3组患者皮肤早期和晚期放射反应及颈淋巴结转移灶消退情况。结果　 2、3组皮肤表面百分深度剂量高于 1组 10 0 %以上 ,1、2、3组分别为 (42 5 4± 2 38) % ,(86 0 3± 1 2 3) % ,(97 77± 0 2 4 ) % ,而 3组转移灶表面平均百分深度剂量只相差 6 %以下 ,1、2、3组分别为 (94 5 8±5 19) % ,(99 80± 0 38) % ,(98 91± 1 37) %。 1组患者皮肤早期和晚期放射反应均轻于 2、3组 (P =0 0 0 0 ) ,而 3组的颈淋巴结转移灶消退率及控制率差异无统计学意义 (P >0 0 5 )。结论鼻咽癌颈部放射治疗一般不应加组织填充模体 ,除非转移灶已侵犯皮肤。Objective To study the severity of radiation-induced skin disorders and local regional control rate in nasopharyngeal carcinoma(NPC) with the using of bolus on the neck. Methods From June, 2000 to December, 2001, 90 patients with pathologically confirmed NPC(stage Ⅱ-Ⅳa ) and without using any kind of anti-tumor treatment previously were randomly assigned into 3 groups:1.no bolus,2.bolus with 0.5 cm thick, 3. bolus with 1.0 cm thick. Radiotherapy was applied by using cerrobend block via-faciocervical portal at isocentre in whole cervical region with 50 Gy/25 fractions in 5 weeks,then removed the bolus and reduced field boost to 20 Gy for 2 weeks. For all patients, the percentage depth dose (PDD) at the surface of neck skin and the metastatic mass surface was caculated.The short- and long-term (2 years) clinical outcome,acute and late radiation sequelae were observed. Results Compared with group 1, there was significant additional dose increase at the surface of the skin in groups 2 and 3.The PDD increased over 100% in both groups [In 1,2 and 3 groups, it was (42.54±2.38)%,(86.03±1.23)% and (97.77±0.24)%, respectively],whereas the elevation of PDD at the metastatic mass surface was less than 6% [In 1,2 and 3 groups it was (94.58±5.19)%,(99.80±0.38)% and (98.91±1.37)%, respectively].The acute and late radiation sequelae for group 1 were better than groups 2 and 3 (P=0.000), while for the short- and long-term control rate of the cervical lymph node metastasis there was no significant difference among them (P>0.05). Conclusion Unless the skin is invaded, it is not necessary to put bolus on the cervical skin in NPC radiotherapy. \;

关 键 词：颈淋巴结转移灶 皮肤 患者 消退 鼻咽癌 放射治疗 放射反应 充模 填充 组分 

分 类 号：R739.63[医药卫生—肿瘤]