局部中晚期鼻咽癌四程诱导化疗后肿瘤靶区勾画的研究  

Target volume delineation in locoregionally advanced nasopharyngeal carcinoma after four circles of induction chemotherapy

作　　者：王蕾[1] 吴峥[2] 程皖琴 周树[1] 钟睿[1] 曾睿芳[4] 苏勇[1] 

机构地区：[1]中山大学肿瘤防治中心放疗科、华南肿瘤学国家重点实验室,广州市510060 [2]湖南省肿瘤医院放疗科 [3]南方医科大学附属医院、顺德第一人民医院肿瘤科 [4]南方医科大学中西医结合肿瘤中心放疗科

出　　处：《中国肿瘤临床》2016年第22期986-991,共6页Chinese Journal of Clinical Oncology

摘　　要：目的:探讨根据诱导化疗后肿瘤变化勾画靶区的方式及其临床疗效。方法:回顾性分析2009年8月至2013年8月中山大学肿瘤防治中心57例局部中鼻咽癌患者,行诱导化疗联合同期放化疗。诱导化疗前后鼻咽原发肿瘤范围(gross tumor volume,GTV)(包括咽后淋巴结)分别为GTVnx-pre和GTVnx-post。临床靶区(clinical tumor volume,CTV)CTVnx1为GTVnx-post外扩10 mm范围,并包括GTVnx-pre的区域。颈部淋巴结的靶区勾画与上述方法相似,分别命名为GTVnd-pre、GTVnd-post和CTVnd1。CTV2为CTVnx1及CTVnd1外扩5 mm^10 mm范围及淋巴引流选择性预防照射范围。观察全组患者不良反应、近期及远期疗效。结果:GTVnx-pre和GTVnx-post平均体积分别为63.7 cm3和21.8 cm3(P<0.01);GTVnd-pre和GTVnd-post平均体积分别为21.7 cm3和7.5 cm3(P<0.01)。中位随访时间60.0个月,全组患者5年总生存率(overall survival,OS)为86.0%(49/57),无远处转移生存率(distant metastasis free survival rate,DMFS)为91.2%(52/57),无局部复发生存率(local recurrence survival rate,LRFS)为93.0%(53/57),无进展生存率(progression free survival,PFS)为93.0%(53/57),复发患者均为GTVnx-post或GTVnd-post内复发。结论:鼻咽癌4个疗程诱导化疗后肿瘤体积明显缩小,按化疗后肿瘤勾画靶区疗效较好,值得进一步验证。Objective： To investigate target volume delineation after four cycles of induction chemotherapy in Iocoregionally advanced nasopharyngeal cancer （NPC）. Methods： From August 2009 to August 2013, 57 patients with stage Ⅲ-Ⅳ NPC were treated with induc- tion-concurrent chemotherapy and intensity-modulated radiotherapy. The primary gross tumor volume （GTV）, including retropharyn- geal lymph node metastasis before and after induction chemotherapy, was defined as GTVnx-pre and GTVnx-post, respectively, and the clinical target volume （CTV） was divided into two parts： CTV1 and CTV2. The CTVnxl was defined as the GTVnx-post plus a 10-mm margin, covering the region of GTVnx-pre. The contouring of neck lymph nodes was similar to the primary gross tumor, with the neck lymph nodes GTV and CTV defined as GTVnd-pre, GTVnd-post, and CTVndl, respectively. CTV2 was defined as CTVnxl and CTVndl plus a 5-mm margin together with the bilateral cervical selective lymph drainage respectively areas. Treatment outcome and toxicity were determined in all patients. Results： The GTVnx-post was significantly smaller than the GTVnx-pre （21.8 cm3 vs. 63.7 cm3, P〈0.01）, whereas the GTVnd-post was significantly smaller than the GTVnd-pre （21.7 cm3 vs. 7.5 cm3, P〈0.01）. With a median follow-up of 60.0 months, the 5-year overall survival （OS）, Iocoregional relapse-free survival （LRFS）, distant metastasis-free survival （DMFS）, and progres- sion-free survival （PFS） rates were 49/57 （86.0%）, 53/57 （93.0%）, 52/57 （91.2%）, and 53/57 （93.0%） respectively. All Iocoregional fail- ures occurred in the GTVnx-post or GTVnd-post field with no relapses in the CTVnxl or CTVndl. Conclusion： Four cycles of IC can signif- icantly reduce tumor volume. The target volume delineation according to the tumor volume after IC has encouraging long-term treat- ment outcome.

关 键 词：鼻咽癌 诱导化疗 调强放射治疗 靶区勾画 临床疗效 

分 类 号：R739.63[医药卫生—肿瘤]