鼻咽癌调强放疗临床靶区中ⅡB区的优化对腮腺剂量的影响研究  

The Effect of Optimizing Clinical Target Volume in ⅡB Region on Parotid Gland Dose in Nasopharyngeal Carcinoma Treated with Intensity Modulated Radiotherapy

作　　者：王丽君[1] 黄生富[1] 蒋明华[1] 何侠[1] 张兰芳[1] 张宜勤[1] 

机构地区：[1]江苏省肿瘤医院,江苏南京210009

出　　处：《肿瘤学杂志》2014年第10期812-818,共7页Journal of Chinese Oncology

基　　金：2013江苏省卫生厅科研项目(Q201302)

摘　　要：[目的]评估优化鼻咽癌调强放疗临床靶区中ⅡB区后对腮腺剂量的影响,为鼻咽癌调强放疗靶区的优化提供依据。[方法]81例鼻咽癌调强放疗患者,以Kaplan-Meier法进行生存分析。对治疗计划保存完整的76例病例测算腮腺的放疗剂量参数,评估优化ⅡB区后对腮腺剂量的影响,并比较不同临床期别、T分期和N分期间腮腺放疗剂量参数。[结果]缩减临床靶区中C1横突或C2椎体以上水平ⅡB区可显著降低同侧腮腺的平均剂量及体积百分剂量V26(P<0.05);将该区处方剂量降为50Gy亦可显著降低同侧腮腺的平均剂量及V26(P<0.05)。Ⅳ期和T4期患者的腮腺平均剂量与V26显著高于相应的其它各期别,而N0期患者的腮腺平均剂量与V26则显著低于淋巴结阳性者。[结论]对早期患者尤其是N0患者可以更合理地设计靶区,优化临床靶区中C1横突或C2椎体以上水平ⅡB区,更好地保护腮腺。[Purpose ] To assess the effect of IMRT clinical target volume（CTV） optimization in ⅡB region for nasopharyngeal carcinoma（NPC） on parotid gland dose, and to provide the basis for optimization of IMRT target area in NPC. [Methods] For 81 cases of NPC treated with IMRT,a survival analysis was performed with Kaplan-Meier method. Radiation dose parameters of parotid glands were estimated in 76 cases, of which treatment plan was preserved integrity. The impact on parotid gland dose after optimization in ⅡB area was evaluated. Meanwhile,radiotherapy dose parameters of parotid gland were compared among different clinical stages,T and N stages. [Resuits] Reduction of U B region above C1 transverse process or C2 vertebral level in CTV significantly reduced the ipsilateral parotid mean dose and volume percent dose V26 （P〈0.05）. Dose reduced to 50Gy in the corresponding CTV could also significantly reduce the mean dose and V1 of ipsilateral parotid gland （P〈0.05）. The parotid gland mean dose and V26 of patients with stage Ⅳ and stage T4 were significantly higher than other clinical stages and T stages,and the mean dose and V26 of No patients were significantly lower than the lymph node positive patients. [Conclusion] Target region should be designed more reasonably for patients with early stage especially stage No. Optimization of Ⅱ B region above C1 transverse process or C2 vertebral level in CTV can protect the parotid gland better.

关 键 词：鼻咽肿瘤 调强放疗 腮腺 放疗靶区 

分 类 号：R739.63[医药卫生—肿瘤]