基于MRI动态图像观察吞咽时器官动度对头颈部肿瘤调强放疗靶区影响  

Observation of the effect of organ displacement on target area of intensity-modulated radiotherapy during swallowing for head and neck cancer based on dynamic MRI images

作　　者：孙萌 刘璇 曹莹 左丽静 王凯 曲媛 易俊林 肖建平 高黎 徐国镇 黄晓东 罗京伟 Sun Meng;Liu Xuan;Cao Ying;Zuo Lijing;Wang Kai;Qu Yuan;Yi Junlin;Xiao Jianping;Gao Li;Xu Guozhen;Huang Xiaodong;Luo Jingwei(Department of Radiation Oncology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)

机构地区：[1]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院放疗科,100021

出　　处：《中华放射肿瘤学杂志》2020年第11期937-940,共4页Chinese Journal of Radiation Oncology

摘　　要：目的利用MRI技术连续采集头颈部肿瘤患者吞咽时图像,观察并测量软腭、舌、喉的运动规律及最大活动度。方法随机选取2018年7月-10月在中国医学科学院肿瘤医院接受调强放疗的原发头颈部恶性肿瘤20例患者,其中男17例、女3例,中位年龄58.5岁(28~78岁)。20例患者中鼻咽癌7例,口腔癌3例,口咽癌5例,下咽癌3例,鼻腔鼻旁窦2例。根据AJCC第八版分期Ⅰ-Ⅱ期患者2例,Ⅲ期8例,Ⅳ期10例。结果吞咽时软腭向上移动移动距离为(1.06±0.31)cm且服从正态分布,向后移动距离为(0.83±0.24)cm且近似正态分布。舌体向后移动距离为(0.77±0.22)cm,且服从正态分布。含压舌板行图像采集患者舌上移位移为0,无压舌板患者舌体中位上移距离为1.23 cm(0.59~1.41 cm)。喉向上移动距离为(1.14±0.22)cm且服从正态分布,向前移动的中位距离为0.4 cm(0.27~0.90 cm)。结论吞咽运动有可能发生于头颈部肿瘤患者放疗过程中,并引起大体肿瘤体积(GTV)及周围正常组织移动;因此在制定放疗计划时应注意GTV至PGTV的个体化外放距离,以保证肿瘤处方剂量。Objective Continuous acquisition of swallowing images of head and neck cancer patients by using MRI technique was performed to observe and measure the movement regularity and maximum displacement of the soft palate,tongue and larynx.Methods From July 2018 to October 2018,20 patients with primary head and neck cancer were chosen randomly,17 male and 3 female.The median age was 58.5 years(28 to 78 years).Among the 20 patients,7 patients were diagnosed with nasopharyngeal carcinoma,3 patients with oral cancer,5 patients with oropharyngeal cancer,3 patients with hypopharyngeal cancer,and 2 patients with nasal and paranasal sinuses cancer.Two patients were classified as stageⅠ-Ⅱ,8 patients as stageⅢand 10 patients as stageⅣaccording to the eighth edition of AJCC.Results The displacement of the upward movement of the soft palate during swallowing was(1.06±0.31)cm and followed the pattern normal distribution.The displacement of backward movement of the soft palate was(0.83±0.24)cm,which also almost normally distributed.The displacement of backward tongue movement was(0.77±0.22)cm and followed the normal distribution pattern.The displacement of upward tongue movement was 0 in patients with tongue depressor for image acquisition.The mediandisplacement of upward tongue movement in patients without tongue depressor was 1.23 cm(0.59 to 1.41 cm).The displacement of upward laryngeal movement was(1.14±0.22)cm and followed the normal distribution pattern,and the median displacement of forward laryngeal movement was 0.4 cm(0.27 to 0.90 cm).Conclusions Swallowing movement may occur in head and neck cancer patients during radiotherapy.It can also cause the movement of gross tumor volume(GTV)and surrounding normal tissues.Therefore,extensive attention should be paid to the individual distance between GTV and planning gross tumor volume(PGTV)when making radiotherapy plans,aiming to ensure the prescription dose of cancer.

关 键 词：动态磁共振图像 吞咽 器官动度 头颈部肿瘤/放射疗法 

分 类 号：R739.91[医药卫生—肿瘤] R445.2[医药卫生—临床医学]