鼻咽癌调强放疗对患者颌下腺保护的临床研究  

Clinical Study on Submandibular Gland Sparing in Intensity Modulated Radiotherapy for Nasopharyngeal Carcinoma

作　　者：周益琴[1] 王丽君[1] 黄生富[1] 蒋明华[1] 张兰芳[1] 何侠[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12期1012-1017,共6页Journal of Chinese Oncology

基　　金：江苏省卫生厅科研项目(Q201302)

摘　　要：[目的]探讨鼻咽癌调强放疗保护颌下腺的可行性,为鼻咽癌调强放疗靶区的优化提供依据。[方法]95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87例病例测算Ⅰb区和颌下腺的放疗剂量参数,评估Ⅰb区不设靶区但颌下腺设保护区以及Ⅰb区不设靶区同时颌下腺也不设保护区两种情况对颌下腺剂量的影响,并比较不同临床期别、T分期和N分期间颌下腺平均剂量的差异。[结果]对无Ⅰb区照射指征的患者,Ⅰb区不设靶区的同时设立颌下腺保护区并未降低患者的近期疗效,但可显著减少同侧颌下腺的最大放射剂量、最小放射剂量以及平均放射剂量。Ⅰ期以及N0的患者颌下腺平均剂量明显较低(P<0.05)。Ⅰb区无靶区且同时设立颌下腺保护区的患者,其颌下腺平均剂量明显低于N0患者(P<0.05)。[结论]对无Ⅰb区照射指征的患者,Ⅰb区不设靶区并设立颌下腺保护区是安全的。调强放疗可以更好地保护鼻咽癌患者的颌下腺,进一步减少放疗后口干的发生。[Purpose] To explore the feasibility of sparing submandibular glands （SMGs） by in- tensity modulated radiotherapy（IMRT） in the treatment for nasopharyngeal carcinoma （NPC）,and to provide the basis for optimization of IMRT target area in NPC. [Methods] For 95 cases of NPC treated with IMRT,a survival analysis was performed with Kaplan-Meier method. Radia- tion dose parameters of Ⅰ b area and submandibular glands were estimated in 87 cases,of which treatment plan was preserved integrity. Effect on SMGs dose was evaluated when non-tar- get in Ⅰ b area with or without SMGs sparing. Meanwhile,mean dose of SMGs was compared among different clinical stages,T and N stages. [Results] For patients without Ⅰ b area irradia- tion indications,short-term response was not reduced,but the ipsilateral minimum,maximum and mean radiation dose of SMG were significantly decreased when Ⅰ b area did not set the target and SMG sparing set up. Mean dose of SMGs was significantly lower in patients with stage Ⅰ and N0（P〈0.05）. The mean dose of the SMGs of patients without target in Ⅰb area and at the same time sparing SMGs was significantly lower than that of patients with No stage （P〈 0.05）. [Conclusion] Not setting target in Ⅰ b area,meanwhile submandibular glands sparing set up is safe for patients without Ⅰ b area irradiation indications. The submandibular glands func- tion could be protected better and the xerostomia risk after radiotherapy could be reduced.

关 键 词：鼻咽肿瘤 调强放疗 颌下腺 放疗靶区 

分 类 号：R739.63[医药卫生—肿瘤]