鼻咽癌患者调强放疗后海马区保护效果及认知能力影响  

Effect of hippocampal avoidance using intensity modulated radiation therapy on cognitive performance in nasopharyngeal carcinoma patients

作　　者：沈莲 魏鑫 姜鹏[2] 崔欢亮 张玉良 陆海军[2] SHEN Lian;WEI Xin;JIANG Peng;CUI Huan-liang;ZHANG Yu-liang;LU Hai-jun(Department of Medical Oncology,The Second People's Hospital of Rizhao,Rizhao 276800,P.R.China;De partment of Radiation Oncology,The Affiliated Hospital of Qingdao University,Qingdao 266003,P.R.China)

机构地区：[1]日照市第二人民医院肿瘤科,山东日照276800 [2]青岛大学附属医院肿瘤放疗科,山东青岛266003

出　　处：《中华肿瘤防治杂志》2020年第22期1832-1837,共6页Chinese Journal of Cancer Prevention and Treatment

基　　金：国家卫生计生委医院管理研究所项目(WJWYGS-201818)。

摘　　要：目的分析海马区的剂量学变化及观察放疗后患者认知功能变化,探讨鼻咽癌(nasopharyngeal carcinoma,NPC)在动态调强放射治疗(intensity-modulated radiation therapy,IMRT)中海马区保护的必要性。方法选取2017-01-01-2019-7-01青岛大学附属医院确诊为鼻咽癌患者52例。按随机数字表法分为2组,进行IMRT动态调强计划设计。对照组按医生靶区处方剂量和危及器官限量做动态调强计划,研究组在对照组的基础上添加海马区为危及器官并给予剂量保护后做出相应的调强计划。统计分析2组间海马区、靶区和危及器官受照射剂量,并对2组患者治疗前和治疗后3、6及12个月采用蒙特利尔认知评估(MoCA)。结果对照组和研究组海马区受照射剂量Dmax分别为(41.04±5.13)和(23.28±7.34)Gy,t=7.220,P<0.001;Dmean分别为(27.02±4.73)和(14.58±3.72)Gy,t=8.102,P<0.001。对照组和研究组的海马区受照射量D40分别为(27.22±5.03)和(14.30±3.06)Gy,Z=-4.512,P<0.001;D50分别为(26.08±4.62)和(13.80±3.11)Gy,Z=-4.497,P<0.001。对照组和研究组患者的PTV-Lr、PTV-Hr靶区覆盖率均>95%,2组高危靶区受照射剂量和低危靶区受照射剂量Dmin、Dmax、Dmean值比较,差异均无统计学意义,均P>0.05。2组低危靶区适形指数CI值和危及器官受照剂量比较,差异均无统计学意义,均P>0.05。2组放疗前、放疗后3和6个月总项目及子项目评分差异均无统计学意义(均P>0.05)。放疗后1年,2组MoCA均降低,对照组MoCA总分为(26.20±0.83),低于研究组的(27.01±0.91),t=-3.001,P=0.011。对照组视空间和结构功能、即时记忆与延时回忆子项目评分均低于研究组,3.12±0.51 vs 3.67±0.57,Z=-2.739,P=0.009;2.46±0.53 vs 2.78±0.36,Z=-2.152,P=0.033。结论在调强放疗中,海马区保护技术在不增加靶区其他正常组织照射剂量的同时,能有效降低脑海马区放射剂量。视空间和结构功能、即时记忆及延时回忆等认知功能减退与鼻咽癌海马区受放OBJECTIVE By analyzing the dosimetric changes in the hippocampal area and evaluating the changes in the cognitive function of patients after radiotherapy,this study discusses the necessity of hippocampal protection in the dynamic intensity-modulated radiotherapy(IMRT)of nasopharyngeal carcinoma(NPC).METHODS Fifty-two patients with NPC were randomly selected from January 1,2017 to January 1,2019 in the Affiliated Hospital of Qingdao University.They were divided into two groups based on the random number table method,they were then subjected to the dynamic IMRT with different designs.The control group followed a dynamic intensity regulation plan according to the doctor’s prescription dose on the target area and the limit doses for organs at risk,while the study group further added the hippocampus as an organ at risk and limited its received radiation dosage accordingly while designing the dynamic intensity regulation plan.Exposure doses to hippocampus,target and organs at risk were compared between the two groups with statistical analysis.Besides,using Montreal cognitive assessment(MoCA)scale we evaluated all the patients’cognitive performance before and 3,6 months and 12 months after the treatment.RESULTS The Dmaxof the control group and the study group were 41.04±5.13 and 23.28±7.34,respectively,t=7.220,P<0.001;and the Dmean were 27.02±4.73 and 14.58±3.72,respectively,t=8.102,P<0.001.The D40 in the hippocampus of the study group and the control group were27.22±5.03 and 14.30±3.06,respectively,Z=-4.512,P<0.001;and the D50 were 26.08±4.62 and 13.80±3.11,respectively,Z=-4.497,P<0.001.The PTV-Lr and PTV-Hr target coverage rates of the patients in the control group and the study group were both>95%.There was no difference in the Dmin,Dmax,Dmean values of the high-risk target area and the low-risk target area between the two groups,all P>0.05.There was no significant difference between the two groups of low-risk target zone conformity index(CI)values and the exposure dose of organs at risk,both P>0.05.There

关 键 词：鼻咽癌 海马区 海马保护 调强放射疗法 认知能力 

分 类 号：R739.6[医药卫生—肿瘤]