RTOG推荐靶区与中国推荐靶区对T1-2期鼻咽癌IMRT计划内耳及耳蜗NTCP差异性研究  

Differences in Inner Ear and Cochlear Normal Tissue Complication Probability between Target Volumes Recommended by Radiation Therapy Oncology Group and Those by China in Intensity-Modulated Radiotherapy for T1-2 Nasopharyngeal Carcinoma

作　　者：钱建军[1] 卢丽娜 田野[1] 宦坚 

机构地区：[1]苏州大学附属第二医院放疗科苏州大学放射肿瘤治疗学研究所苏州市肿瘤放射治疗学重点实验室,215004 [2]苏州科技城医院放疗科,苏州215153

出　　处：《中华耳科学杂志》2017年第6期685-691,共7页Chinese Journal of Otology

基　　金：苏州市科技发展计划-产业技术创新专项(民生)科技-医疗卫生应用基础研究项目编号:(SYSD2016060);国家自然基金面上项目(81372411)~~

摘　　要：目的探T1-2期鼻咽癌IMRT中中国推荐靶区和RTOG推荐靶区IMRT计划间内耳及耳蜗NTCP的差异,为鼻咽癌IMRT中保护内耳及耳蜗提供剂量体积效应依据。方法选择T1-2期鼻咽癌患者20例,分别在其CT定位图像上勾画内耳及耳蜗,针对每位患者按照RTOG0225推荐靶区定义方法(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)分别勾画靶区和设计计划,计算两种靶区定义方法之间内耳及耳蜗的受照射剂量及NTCP差异性。结果 RTOG推荐靶区定义方法和中国推荐靶区定义方法的左侧内耳受照射剂量Dmean分别为(4489±440)、(4039±482)c Gy;右侧内耳受照射剂量Dmean分别为(4339±749)、(3926±739)c Gy;左侧耳蜗受照射剂量Dmean分别为(5109±396)、(4584±474)c Gy;右侧耳蜗受照射剂量Dmean分别为(4855±774)、(4381±783)c Gy。两种推荐靶区定义方法间左右侧内耳及耳蜗的P值均为0.000。RTOG推荐靶区定义方法和中国推荐靶区定义方法的左侧内耳受照射剂量Dmax分别为(6369±355)、(5901±426)c Gy;右侧内耳受照射剂量Dmax分别为(6247±463)、(5699±529)c Gy;左侧耳蜗受照射剂量Dmax分别为(5794±354)、(5230±387)c Gy;右侧耳蜗受照射剂量Dmax分别为(5616±562)、(5061±649)c Gy。两种靶区定义方法间左右侧内耳及耳蜗的P值均为0.000。RTOG靶区定义方法和中国靶区定义方法的左侧内耳NTCP[中位数(四分位间距)%]分别为12(5.25~23.5)、3.5(2~9.5);右侧内耳NTCP分别为8(2.25~19.75)、2.5(1~8);左侧耳蜗NTCP分别为23.5(16.25~35.75)、9(5.25~16.75);右侧耳蜗NTCP分别为14(6.25~33.75)、6(1.25~12.5)。两种靶区定义方法间左右侧内耳及耳蜗的P值分别为0.000、0.000、0.000、0.001。结论 T1-2期鼻咽癌IMRT中内耳的NTCP与其受照剂量及受照体积密切相关,耳蜗的NTCP与其受照量有关,与受照体积无明显相关性;在两种靶区定义方法中,中国推荐靶区定义方法的内�Objective To evaluate the differences in inner ear and cochlear normal tissue complication probability(NTCP) between target volumes recommended by China and those by Radiation Therapy Oncology Group(RTOG) for intensity-modulated radiotherapy for T1-2 nasopharyngeal carcinoma, to provide the dose-volume effect basis for protection of the inner ear and cochlea. Methods A total of 20 patients with T1-2 nasopharyngeal carcinoma were identified,whose inner ears and cochleae were delineated on their CT images. Two sets of target volume delineation and treatment plan design were completed according to recommendations by the RTOG0225(RTOG methods) and to those by the Chinese Working Committee for Clinical Staging of Nasopharyngeal Carcinoma in 2010(Chinese methods). Radiation dosage and NTCP were calculated for the inner ear and cochlea for both methods and the differences between the two methods were compared. Results With the RTOG methods, the average radiation dosage(Dmean in c Gy) was 4489±440 for the left inner ear, 4339±749 for right inner ear, 5109±396 for the left cochlea and 4855±774 for the right cochlea; while with the Chinese methods, the radiation dosages were 4039±482, 3926±739, 4584±474 and 4381±783, respectively,(P =0.000). With the RTOG methods, the maximum radiation dosage(Dmax in c Gy) was 6369 ± 355 for the left inner ear,6247±463 for the right inner ear, 5794±354 for the left cochlea and 5616±562 for the right cochlea; whereas with the Chinese methods Dmax was 5901±426, 5699±529, 5230±387 and 5061±649, respectively,(P = 0.000). With the RTOG methods, NTCP was 12(5.25-23.5) for the left inner ear, 8(2.25-19.75) for the right inner ear, 23.5(16.25-35.75) for the left cochlea and 14(6.25-33.75) for the right cochlea; whereas with the Chinese methods, NTCPs were 3.5(2-9.5), 2.5(1-8), 9(5.25-16.75) and 6(1.25-12.5), respectively,(P = 0.000-0.001). Conclusions For T1-2 nasopharyngeal carcinoma, the inner ear NTCP is closely associated with the target volume dose and irradiated volume, but t

关 键 词：鼻咽肿瘤/调强放射疗法 耳蜗 内耳 正常组织并发症概率 

分 类 号：R764[医药卫生—耳鼻咽喉科]