调强(IMRT)放疗复发性鼻咽癌初期报道  

Preliminary results of locally recurrent nasopharyngeal carcinoma treated with intensity modulated radiation therapy

作　　者：盛晓芳[1] 鲁飞[2] 孙磊[3] 董海波[1] 袁士毅[1] 戴嘉中[1] 潘力[1] 

机构地区：[1]复旦大学附属华山医院 [2]复旦大学附属华山医院耳鼻喉科上海200040 [3]复旦大学附属华山医院上海200040

出　　处：《中国癌症杂志》2001年第3期213-216,共4页China Oncology

摘　　要：目的 :观察调强放疗复发性鼻咽癌剂量分布及可行性。方法 :1999年 6月— 2 0 0 0年 8月 ,10例病理确诊局部复发的鼻咽癌接受了调强放疗。复发距初次治疗中位时间 :2 5 (14— 5 0 )个月。首程放疗均采用单纯外放射 ,中位剂量 :5 2天共 6 9Gy 35次。调强放疗通过NOMOS公司PEACOCK系统完成。再程放疗处方剂量 :4周共 5 7Gy 19次。结果 :除部分患者有体重下降和轻度口腔粘膜反应外 ,所有患者均能耐受这一治疗。即期疗效 :完全缓解 6例 ,部分缓解 4例。 2例局部再次复发 ,1例肺转移 ,2例病人死亡。全组中位生存时间 14个月。全组中位计划靶体积 (PTV) :95 .8(6 0— 134 )cm3。PTV剂量分布 :平均 :2 5— 2 8天 5 9.6 5± 2 .47Gy 19次 ;均匀指数 (最大剂量 处方剂量 ) :1.18± 0 .0 6 ,95 %PTV的接受剂量为 5 3.2± 1.36Gy以上 ,低于 95 %处方剂量的体积 (5 .4± 1.2 ) %。危险组织器官 (OAR)平均剂量均值 :脊髓 (9.46± 5 .2 3)Gy ;脑干 (2 0 .2 4± 3.5 5 )Gy ;腮腺 (18.5 3± 5 .30 )Gy(左 ) ,(19.6 8± 6 .2 1)Gy(右 ) ;晶体 (2 .11± 0 .6 5 )Gy(左 ) ,(2 .94± 0 .5 7)Gy(右 ) ;视交叉 (12 .34± 2 .47)Gy ;视神经 :(13.14± 3.6 5 )Gy(左 ) ,(17.6 5± 3.2 1)Gy(右 )。结论 :该治疗能被患者耐受 ,即期?Purpose:To evaluate the physical dose distributions and tolerance in locally recurrent nasopharyngeal carcinoma treated with intensity modulated radiation therapy (IMRT).Methods:From June 1999 to August 2000, 10 patients with locally recurrent nasopharyngeal carcinoma proven by histology, without neck lymphoid node recurrence and distant metastasis, were treated by IMRT. The interval from the time of initial radiotherapy to recurrence ranged from 14—50(median 25) months. The initial radiotherapy in all patients were treated with external radiotherapy alone to a median dose of 69Gy/35fractions/52days. IMRT method was performed by means of the MIMiC collimator and inverse treatment planning system (NOMOS company, USA). The prescribed dose of re radiotherapy to target volume was 57Gy/19fractions/4weeks.Results:All patients, except for some patients with mild weight loss and reaction in the oral cavity during radiotherapy, tolerated this IMRT well. IMRT achieved the better immediate responses in 10 patients with complete response in 6 cases and partial response in 4 cases. Recurrence was found in two patients, lung distant metastasis in one patient. The median survival in the 10 patients was 14 months. The median planning target volume (PTV) was 95.8(60—134) cm 3. The dose distributions in the PTV were as follows: median average dose 59.65±2.47Gy, median homogeneity index (HI): 1.18(±0.06); median dose to 95% PTV ≥ 53.2 (±1.36)Gy. The median dose to the organs at risk (OAR) were as follows: spinal cord 9.46±5.23Gy; brain stem 20.24±3.55Gy; left parotid gland 18.53±5.30Gy, right parotid gland 19.68±6.21Gy; left lens 2.11±0.65Gy, right lens 2.94±0.57Gy;Chiasm12.34Gy; left optical nerve13.14 Gy, right optical nerve17.65 Gy.Conclusions:Better dose distributions treated with IMRT was achieved in the patients with locally recurrent nasopharyngeal carcinoma and the patients tolerated this radiotherapy well. [

关 键 词：放疗 复发性鼻咽癌 IMRT 

分 类 号：R739.63[医药卫生—肿瘤] R730.55[医药卫生—临床医学]