IMRT计划优化参数中听觉器官分区限制剂量研究  

The research of IMRT plan optimization on dose limitation of sub regional auditory organ

作　　者：郭明[1] 王胜资[1] 吴朝霞[2] 马长明 王雷[1] 倪晓晨[1] 诸枫 

机构地区：[1]复旦大学附属眼耳鼻喉科医院放疗科,上海200031 [2]清华大学工程物理系,北京100084 [3]美国Fox Chase癌症中心肿瘤放疗科

出　　处：《中华放射肿瘤学杂志》2015年第4期438-442,共5页Chinese Journal of Radiation Oncology

基　　金：上海市浦东新区社会发展局卫生科技项目（PW2009d-7）;上海科学技术委员会医学引导类项目（09411962000）

摘　　要：目的：探讨鼻咽癌 IMRT 中通过听觉器官分区限制剂量方式优化计划对降低听觉器官剂量的影响。方法共选取223例鼻咽癌患者分为 A、B 两组。 A 组114例，通过提高听觉器官 Dmean限制的调强优化权重等级方法设计 IMRT 计划。 B 组109例，以 PTV 外放5 mm 为分割线将听觉器官分成高剂量和低剂量区，限制听觉器官高剂量区剂量不高于靶区处方剂量，听觉器官低剂量区剂量不高于靶区处方剂量一半作为调强优化参数设计放疗计划。成组 t 检验组间差异。结果 T1、T2、T3、T4期中 B 组耳鼓室腔（中耳） Dmean 均值较 A 组分别减少17.7％、22.4％、15.7％、14.2％（P＝0.000、0.000、0.000、0.000）；耳蜗 Dmean均值分别减少11.0％、20.1％、10.0％、9.0％（P＝0.004、0.000、0.007、0.036）；前庭 Dmean均值分别减少22.6％、31.8％、20.6％、21.4％（P＝0.000、0.000、0.000、0.000）。 B组骨性段咽鼓管 Dmean 均值较 A 组无改善（减少3.4％、6.8％、3.6％、0.1％；P＝0.291、0.006、0.155、0.963）。结论听觉器官分区限制剂量方法能有效降低听觉器官剂量，减小听觉器官放射损伤，更好地保护听觉功能。Objective To investigate the effects of reducing the auditory organ dose by limitation of sub regional auditory organ in IMRT plan. Methods Total 223 cases of nasopharyngeal carcinoma patients were divided into group A and group B. In group A, the IMRT plans of 114 patients were designed by limiting overall auditory organ dose. In group B, the IMRT plans of 109 patients were designed by limiting sub regional auditory organ dose. According to the Clinical prescription, the IMRT plans were designed. Paried t？test was difference between groups. Results By comparing the two groups of auditory organ dose, in all stages, the tympanic cavity Dmean average in group B decreased by T1 vs. 17. 7%,T2 vs. 22. 4%,T3 vs. 15. 7% and T4 vs. 14. 2% （ P= 0. 000,0. 000,0. 000,0. 000）;cochlea Dmean average decreased by T1 vs. 11. 0%, T2 vs. 20. 1%, T3 vs. 10. 0% and T4 vs. 9. 0%（P= 0. 004,0. 000,0. 007,0. 036）;vestibule Dmean average decreased by T1 vs. 22. 6%, T2 vs. 31. 8%, T3 vs. 20. 6% and T4 vs. 21. 4%, significantly less than in group A （P= 0. 000,0. 000,0. 000,0. 000）. The bony portion of eustachian tube Dmean average in group B decreased were not significantly less than in group A （decreased by 3. 4%,6. 8%,3. 6%,0. 1%;P= 0. 291, 0. 006,0. 155,0. 963）. Conclusions In IMRT plan, optimization on dose limitation of sub regional auditory organs were used to reduce the auditory organ dose and decrease the radiation damage to auditory organ.

关 键 词：听觉器官 限制剂量 鼻咽肿瘤/调强放射疗法 

分 类 号：R739.63[医药卫生—肿瘤]