基于外科切除范围个体化勾画腮腺肿瘤术后放射治疗靶区研究  

Application of surgical principles in postoperative intensity-modulated radiotherapy for parotid cancer

作　　者：吕少文 吴峥 谢德欢 程皖琴 王蕾 钟睿 胡江 王明理 黄劭敏[1] 苏勇[1] LYU Shao-wen;WU Zheng;XIE De-huan;CHENG Wan-qin;WANG Lei;ZHONG Rui;HU Jiang;WANG Ming-li;HUANG Shao-min;SU Yong(Department of Radiotherapy,Sun Yat-sen University Cancer Center,Guangzhou 510000,P.R.China)

机构地区：[1]中山大学附属肿瘤医院放疗科,广东广州510000

出　　处：《中华肿瘤防治杂志》2020年第10期785-791,共7页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的目前腮腺肿瘤术后调强放射治疗(intensity modulated radiation therapy,IMRT)临床靶区(clinical target volume,CTV)勾画方法国内外尚未达成共识。本研究旨在探讨借助外科切除原则设定及勾画CTV的方法。方法选取2010-06-01-2018-06-01中山大学肿瘤防治中心放疗科连续收治的29例腮腺癌术后放疗患者临床资料进行分析。靶区勾画时结合手术记录,根据手术前后临床及影像资料对比,分析测算手术切面及周围各保留组织术前旁开原肿瘤大体外缘的距离,判断各保留组织术前受侵累及的风险,<5mm定义为高危临床靶区(CTV-HD),5~10mm的组织定义为中危靶区(CTV1),>10~20mm的组织定义为低危靶区(CTV2),必要时CTV2还包括需要预防照射的区域淋巴结引流区。CTV-HD、CTV1和CTV2的处方剂量分别为64.0~66.0、59.5~61.0和45.0~54.0Gy。统计靶区及毗邻危及器官剂量分布,并用Kaplan-Meier法进行生存分析,单因素分析采用Log-rank检验,多因素分析采用Cox风险回归模型。结果茎突、下颌支、二腹肌后腹、颈动脉鞘、茎乳孔对应组织范围被勾画为CTV-HD的比例分别高达31.03%、27.59%、55.17%、37.93%和37.10%。截至2019-03-31,29例患者中位随访时间35(5~98)个月,未发现局部区域复发。所有患者3和5年预期生存率(overall survival,OS)分别为95.7%和81.2%,无复发生存率(recurrence-free survival,RFS)分别为100.0%和100.0%,无远处转移生存率(distant metastasis-free survival,DMFS)分别为87.9%和81.7%。单因素分析结果示,N分期与腮腺肿瘤患者生存预后有关联,P=0.02。Cox风险回归模型未见有统计学意义的独立预后因素。结论根据个体肿瘤手术切面及周围各保留组织术前与原肿瘤外缘距离判定其术前受侵风险,勾画为不同CTV,给予不同剂量照射,为腮腺肿瘤术后靶区勾画提供了新思路,疗效显示安全可行,值得进一步研究。OBJECTIVE Delineation of postoperative intensity-modulated radiotherapy(PO-IMRT)clinical target volumes(CTV)for parotid cancer hasn’t reached a consensus internationally.The purpose of this article was to report our experience according to surgical principles.METHODS All 29 parotid cancer patients from June 1,2010 to June 1,2018 were enrolled continuously.Tissues around the margin of resection that were less than 5 mm from the invasive tumor edge before surgery were defined as high-risk clinical target volumes(CTV-HD),those less than 10 mm were defined as medium-risk CTV(CTV1),and those 10-20 mm were defined as low-risk CTV(CTV2),with 64.0-66.0 Gy,59.5-61.0 Gy and 45.0-54.0 Gy,respectively.Target volume distributions of reserved tissues were analysed and actuarial estimates of overall survival(OS),recurrence-free survival(RFS)and distant metastasis-free survival(DMFS)were obtained with the Kaplan-Meier method.Log-rank test was performed to make univariate analysis.COX risk regression model was used for multivariate prognostic analysis.RESULTS The percentages of defined CTV-HD in the styloid process,mandibular ramus,posterior venter of the digastric muscle,carotid sheath and stylomastoid foramen reached 31.03%,27.59%,55.17%,37.93%and 37.10%,respectively.The median follow-up was 35 months(range,5-98 months).The 3-year and 5-year Kaplan-Meier estimates of OS,RFS and DMFS were 95.7%and 81.2%,100.0%and 100.0%,87.9%and81.7%,respectively.Univariate analysis showed that N stage was associated with survival(P=0.02).Cox multivariate analysis showed no independent prognostic factors.CONCLUSION It is supposed to be a new method to delineate CTVs according to distances between various reserved tissues and the primary tumor edge before operation.

关 键 词：腮腺癌 术后放疗 调强放射治疗 临床靶区 手术治疗 

分 类 号：R739.8[医药卫生—肿瘤]