局部晚期鼻咽癌诱导化疗后靶区勾画探讨  

作　　者：龙金华[1] 董事 金风[1] 吴伟莉[1] 甘家应[1] 陈海霞[1] 李媛媛[1] 龚修云[1] 

机构地区：[1]贵阳医学院附属医院贵州省肿瘤医院肿瘤科,贵阳550004 [2]温州市人民医院肿瘤科,温州市325000

出　　处：《中华放射肿瘤学杂志》2012年第5期417-420,共4页Chinese Journal of Radiation Oncology

基　　金：贵州省科技攻关联合基金项目（黔科合2010-3164.）

摘　　要：目的探讨局部晚期鼻咽癌诱导化疗后调强靶区的勾画。方法2010-2011年收治的11例初治局部晚期鼻咽癌患者采用TPF方案诱导化疗联合同期调强放化疗。诱导化疗前后行cT模拟定位扫描、靶区勾画及计划制定，诱导化疗前靶区由原发灶临床靶体积覆盖。对两次放疗计划靶体积差值及剂量学差异行配对t检验。结果诱导化疗前、后鼻咽部原发灶大体肿瘤体积平均值分别为44．72、28．87cm。（t=3．89，P=0．003），颈淋巴结大体肿瘤体积的分别为32．76、19．82em^3（t=2．47，P=0．033）；诱导化疗后脑干、脊髓、左右眼球所受最大剂量区体积减小（t=2．93～4．59，P均＜0．05）。结论局部晚期鼻咽癌3周期TPF方案诱导化疗后肿瘤体积明显缩小，再次勾画靶区使脑干、脊髓、左右眼球所受剂量减小。Objective To investigate the delineation of gross tumor volume (GTV) in locally advanced nasopharyngeal carcinoma (LANC) according to imageological changes before and after induction chemotherapy (IC) in order to decrease high dose area and protect normal tissue better.Methods Between Mar 2010 to Jan 2011,11 patients with LANC were enrolled and treated with TPF regimen followed by intensity-modulated radiotherapy (IMRT) with concurrent chemotherapy,target volumes were delineated based on fused CT imaging before and after IC following project determination.Tumor target volumes after and before IC were respectively delineated according to imaging tumor residues and were overlaid by CTVnx in order to ensure radical doses for the imaging tumor volume before IC,the resulting differences of tumor target volumes of IC before and after were measured and analyzed by paired t-test.Results Before and after IC,the average volumes of GTVnx were respectively 44.72 cm3 and 28.87 ( t =3.89,P =0.003 ),the average volumes of GTVnd were respectively 32.76 cm3 and 19.82 cm3 ( t =2.47,P =0.033 ),the volumes of maximum dose area in brainstem and spinal cord as well as eyeball decreased ( t =2.93-4.59,all P ＜0.05).Conclusions LANC treated by 3 cycle TPF regimen followed by IMRT with concurrent chemotherapy showes significant shrinkage of tumor volume.The volume of high dose region which caused by normally recovered tissues were decreased by re-delineation of target volume in brainstem and spinal cord as well as eyeball of CT images after IC.

关 键 词：鼻咽肿瘤/化学疗法 化学疗法 诱导 靶区勾画 

分 类 号：R739.63[医药卫生—肿瘤]