鼻咽癌调强放疗口腔黏膜保护的初步研究  

Protection of oral mucosa for patients with nasopharyngeal carcinoma treated with intensity-modulated radiotherapy

作　　者：郑斯明[1] 程皖琴 苏勇[2] 胡江[2] 吴峥[3] 黄邵敏[2] 

机构地区：[1]广东省中山市人民医院放疗科,广东中山528400 [2]华南肿瘤学国家重点实验室.中山大学肿瘤防治中心放疗科,广东广州510060 [3]中南大学湘雅医学院附属肿瘤医院放疗科,湖南长沙410013

出　　处：《中华肿瘤防治杂志》2015年第7期532-536,共5页Chinese Journal of Cancer Prevention and Treatment

基　　金：国家自然科学基金(81272575);广东省自然科学基金(2010B080701016)

摘　　要：目的探讨鼻咽癌（nasopharyngeal carcinoma,NPC）适形调强放射治疗中口腔的勾画范围及照射剂量体积与黏膜反应的关系。方法收集2010-03-02-2012-11-03连续在中山大学肿瘤防治中心接受（intensity modulated radiation therapy,IMRT）的101例鼻咽癌患者的口腔为危及器官,包括口腔解剖结构披覆黏膜和舌下腺的勾画范围,口腔受照平均剂量限定于〈40Gy。分别于放疗前及放疗中每周观察患者口腔黏膜反应程度,并结合口腔剂量体积直方图（dose-volume histograms,DVH）分析其关系。结果 101例患者随访至2013-12-31,中位随访期为26个月,本组患者中2例因远处转移死亡;2例放疗6个月后局部复发,1例出现肺转移,至随访日期结束仍生存。91.1%（92/101）患者在IMRT期间仅发生Ⅰ~Ⅱ级黏膜反应,Ⅲ级者仅8.9%（9/101）,无1例出现Ⅳ级黏膜反应;口腔剂量为28.6~65.8Gy,平均剂量（38.1±4.66）Gy;口腔黏膜反应与口腔平均剂量（r=0.216,P=0.030）、V40（r=0.249,P=0.012）、V45（r=0.317,P=0.001）、V50（r=0.313,P=0.001）和V54（r=0.270,P=0.006）明显相关。结论结合解剖结构的口腔的勾画范围较为合理,受照剂量体积的限定优化条件也较为可行,建议口腔平均剂量〈40Gy或V40≤33%,口腔得到较好保护。OBJECTIVE To investigate the delineation of oral cavity and relationship between irradiation dose and oral mucosa reaction in nasopharyngeal carcinoma with intensity modulated radiation therapy（IMRT）. METHODS 101 patients＇ oral cavities were taken into the study from Mar 2010 to Nov 2012 in Sun Yet-sen Cancer Center. The delineation of oral cavity included its anatomy structure covering mucosa and sublingual gland, limiting the mean dose less than 40 Gy. Patients＇ oral mucosa reactions were observed before and during radiotherapy weekly, their dose volume histo- grams （DVH） of oral cavity were taken into consideration. RESULTS 101 patients were followed up to Dec. 31,2013, the median follow-up was 26 months,2 patients died of distant metastasis;2 cases were local recurrence half a year after radiotherapy, 1 case was pulmonary metastasis, all still alive during the follow-up date. 91.1 %（92/101） patients during IMRT had I to Ⅱ mucosa reaction,grade Ⅲ was only 8.9%（9/101） ,none of them had grade IV mucositis;The average dose of oral cavity was 38.1 ±4.66 （28.6±65.8 Gy） Gy. The oral irradiated reactions during radiotherapy and their mean dose,V40 ,V45,V50 ,V54were significantly correlated （r =0. 216,P=0. 030 r=0. 249,P=0. 012;r=0. 317,P=0. 001;r=0. 313,P=0. 001;r=0. 270,P=0. 006）. CONCLUSIONS Based on the anatomic structure of oral cavity,the delinea- tion is reasonable, the defined dose volume is feasible. The mean dose less than 40 Gy or V40≤33% of oral cavity has good protective results.

关 键 词：鼻咽癌 口腔黏膜反应 调强放射治疗 剂量 体积 勾画 

分 类 号：R739.63[医药卫生—肿瘤]