局部晚期鼻咽癌IMRT下视神经及视交叉耐受剂量探讨  

Dose constraints of optic nerves and chiasm in locally advanced nasopharyngeal carcinoma patients treated with intensity-modulated radiotherapy

作　　者：徐萌[1] 黄路路 胡凯[1] 王仁生[1] 

机构地区：[1]广西医科大学第一附属医院放疗科,南宁530021 [2]广西医科大学护理学院

出　　处：《中华放射肿瘤学杂志》2017年第11期1248-1252,共5页Chinese Journal of Radiation Oncology

摘　　要：目的 探讨局部晚期鼻咽癌患者在IMRT下视神经及视交叉的耐受剂量。方法 回顾分析2009—2013年在我院接受IMRT且视神经或视交叉2%体积受量（D2）〉55 Gy的108例局部晚期鼻咽癌的剂量学特点及放射性视神经病变的发病情况。采用CTCAE3.0标准评价视神经和视交叉的不良反应,用Logistic回归法分析RION的危险因素。结果 108例患者中均未观察到严重的放射性视神经病变（3—5级）,其中7例患者出现轻微视神经病变（1—2级）,未发现患者个人因素或治疗相关因素与RION发生有统计学意义（P〉0.05）。108例患者中位随访时间为46个月（13-91个月）,3年OS、LRFS、DMFS率分别为90.0%、94.5%、86.4%。结论 常规放疗下得出的视神经和视交叉限制剂量〈55 Gy可能不适用于IMRT;IMRT下为提高处方剂量对靶区覆盖率,视神经和视交叉的限制剂量或许可以适当放宽。Objective To investigate the tolerated dose of the optic nerves and chiasm in patients with locally advanced nasopharyngeal carcinoma （NPC） treated with intensity-modulated radiotherapy （IMRT）. Methods A retrospective analysis was performed on dose characteristics and the incidence of radiation optic neuropathy in 108 patients with locally advanced NPC treated with IMRT at D2〉55 Gy in the optic nerves and chiasm in our hospital between May 2009 and December 2013. The Common Terminology Criteria for Adverse Events （CTCAE） Version 3.0 grading criteria were used for evaluating adverse reactions of the optic nerves and optic chiasm. A logistic regression analysis was performed to assess the risk factors for the development of radiation-induced optic neuropathy （RION）. Resutls No patient had severe RION （grade 3-5）,although 7 of the 108 patients had mild optic nerve disorder （grade 1-2）. No patient-or treatment-related factors were found to be associated with the development of RION （P〉0.05）. With a median follow-up of 46 months （range,13-91 months）,the 3-year estimated overall survival,local recurrence-free survival,and distant metastasis-free survival rates were 90.0%,94.5%,and 86.4%,respectively. Conclutions The dose constraint of〈55 Gy derived for optic nerves and chiasm from conventional radiotherapy does not seem to apply to IMRT. For advanced NPC patients treated with IMRT,the dose constraints of optic nerves and chiasm might be relaxed in order to improve target coverage.

关 键 词：放射性视神经病变 鼻咽肿瘤/调强放射疗法 限制剂量 

分 类 号：R730.55[医药卫生—肿瘤] R739.63[医药卫生—临床医学]