鼻咽癌适形调强放射治疗中颞叶勾画方式的推荐  

Suggestion of A Contouring Method of Temporal Lobe in Intensity-Modulated Radiotherapy(IMRT) for Nasopharyngeal Carcinoma

作　　者：余孝丽[1] 张广顺[1] 陈默[1] 郭颖[2] 孙颖[1] 

机构地区：[1]中山大学肿瘤防治中心//华南肿瘤学国家重点实验室放射治疗科,广东广州510060 [2]中山大学肿瘤防治中心//华南肿瘤学国家重点实验室医学统计与流行病学科,广东广州510060

出　　处：《中山大学学报（医学科学版）》2013年第4期627-632,共6页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：国家自然科学基金(81071836);广东省科技计划项目(2009B030801016);中山大学5010项目(050243)

摘　　要：【目的】推荐一种适用于接受适形调强放疗(IMRT)的鼻咽癌患者颞叶的勾画方式和图谱,以利于多中心的剂量学比较。【方法】通过系统阅读关于颞叶放疗损伤的文献,收集了不同单位颞叶的勾画方法。将2004年11月至2006年11月共21例接受IMRT治疗并且通过核磁共振(MRI)诊断为具有单侧放射性颞叶坏死(TLN)的鼻咽癌患者纳入研究。比较了颞叶不同勾画方式得出的剂量体积参数,颞叶体积,最大剂量(D max),D1(1%颞叶体积所接受的剂量),D2,D1PRV(1%颞叶PRV所接受的剂量)。【结果】颞叶不同的勾画方法具有不同的剂量体积参数值(P<0.05);鼻咽癌IMRT治疗中放射性TLN发生最常见部位为颞下回和/或颞中回前内侧,常累及海马或海马旁回。本文推荐颞叶勾画应该包括海马及海马旁回,不包括脑岛及基底节。另外,本文还提供了一套基于CT-MRI融合图像的颞叶勾画范围的图谱。【结论】推荐的基于解剖学和放疗损伤部位的颞叶勾画方式,能减少不同中心关于颞叶勾画的差异,从而有利于不同中心关于剂量和副作用的相关性研究。[ Objective ] To suggest a contouring method of temporal lobe for nasopharyngeal carcinoma （NPC） patients receiving intensity-modulated radiotherapy （IMRT）, to facilitate multicenter comparison of dosimetric parameters. [Methods] Various contouring methods were identified via systematic literature review on temporal lobe radiation-induced injury. We recruited 21 NPC patients diagnosed as unilateral TLN by MRI who underwent IMRT between November 2004 and November 2006. Dosimetric parameters including the volume, Dmax （the maximum dose）, DI （the dose received by 1% volume of temporal lobe ）, D2, Dzmv （the dose received by 1% volume of temporal lobe PRV） were compared. [ Results ] Various contouring methods for the temporal lobe lead to different volumes and dosimetric parameters （P 〈 0.05）. The most common location of radiation-induced TLN was the anteromedial part of inferior and middle temporal gyrus, hippocampus or parahippocampal gyms usually being involved. Temporal lobe contouring should include the hippocampus and parahippocampal gyrus but not the basal ganglia or insula; Furthermore, a CT-MRI fusion atlas on temporal lobe contouring were developed. [Conclusion] Our suggested atlas, based on anatomic definitions and radiation-induced injury location, will minimize inter-institutional variation in temporal lobe delineation; facilitating dosimetric parameter/side effect correlation studies.

关 键 词：图谱 鼻咽癌 IMRT 颞叶 勾画方法 

分 类 号：R73[医药卫生—肿瘤]