T1-2期鼻咽癌RTOG推荐靶区与中国推荐靶区IMRT计划之间后组颅神经NTCP差异性分析  

Difference in normal tissue complication probability of lower cranial nerves between target volumes recommended by Radiation Therapy Oncology Group and China in intensity-modulated radiotherapy for T1-2 nasopharyngeal carcinoma

作　　者：钱建军[1] 孙彦泽[1] 周钢[1] 田野[1] 陆雪官[1] 

机构地区：[1]苏州大学附属第二医院放疗科,215004

出　　处：《中华放射肿瘤学杂志》2016年第6期546-551,共6页Chinese Journal of Radiation Oncology

基　　金：基金项目：江苏省临床医学科技专项（BL2014040）;苏州市临床重点病种诊疗技术专项（LCZX201405）

摘　　要：目的 通过研究T1-2期鼻咽癌IMRT中基于RTOG推荐靶区和中国靶区IMRT计划之间后组颅神经NTCP的差异，为鼻咽癌IMRT中后组颅神经保护提供剂量体积效应依据。 方法 选取2013—2015年间T1、T2期鼻咽癌病例共20例，分别在其CT定位影像上勾画后组颅神经。根据RTOG0225推荐方法（RTOG靶区方法）和2010年中国鼻咽癌临床分期工作委员会推荐的靶区定义方法（中国靶区方法）勾画靶区和设计治疗计划，计算两种靶区定义方法之间后组颅神经受量及NTCP差异性。 结果 RTOG靶区和中国靶区方法的左、右侧后组颅神经受量Dmax分别为（7450±273）、（7294±309） cGy和（7361±160）、（7190±395） cGy （左、右侧P＝0.018、0.042）；Dmean分别为（6735±285） 、（6660±333） cGy和（6446±429） 、（6299±467） cGy （左、右侧P＝0.000、0.000）；NTCP分别为（60±10）%、（57±13）%和（51±15）%、（45±17）%（左、右侧P＝0.000、0.000）。 结论 鼻咽癌IMRT中将后组颅神经作为常规OAR来精确勾画并进行剂量评估和NTCP预测是可行的；后组颅神经的NTCP与其靶区接受剂量和受照体积密切相关；中国靶区方法的后组颅神经受量和NTCP都明显小于RTOG靶区方法。Objective To investigate the difference in normal tissue complication probability （NTCP） of lower cranial nerves （LCNs） between target volumes recommended by Radiation Therapy Oncology Group （RTOG） and China in intensity-modulated radiotherapy （IMRT） for T1-2 nasopharyngeal carcinoma （NPC）, and to provide the evidence of dose-volume effect for the protection of LCNs in IMRT for NPC. Methods A total of 20 patients with T1-2 NPC who were treated from 2013 to 2015 were enrolled, and LCNs were delineated on CT images. Target volume delineation and treatment plan designing were performed according to the method recommended by RTOG0225（RTOG target volume delineation method） or the Chinese Working Committee for Clinical Staging of NPC in 2010（Chinese target volume delineation method）, and the differences in the dose to LCNs and NTCP were calculated. Results In the RTOG and Chinese Methods for target volume delineation, Dmax to the left and right LCNs was 7450±273 cGy/7294±309 cGy and 7361±160 cGy/7190±395 cGy, respectively （P=0.018 and 0.042）, Dmean was 6735±285 cGy/6660±333 cGy and 6446±429 cGy/6299±467 cGy, respectively （both P=0.000）, and the NTCP was 60%±10%/57%±13% and 51%±15%/45%±17%, respectively （both P=0.000）. Conclusions It is feasible to precisely delineate target volume with the LCNs as a routine OAR and predict NTCP in IMRT for T1-2 NPC. The NTCP of the LCNs is closely associated with target volume dose and irradiated volume. The dose to the LCNs and NTCP determined by the Chinese target volume delineation method are significantly lower than those determined by the RTOG method.

关 键 词：鼻咽肿瘤/调强放射疗法 后组颅神经 正常组织并发症概率 

分 类 号：R739.63[医药卫生—肿瘤]