鼻咽癌调强放疗继发甲状腺功能减退风险与甲状腺剂量-体积阈值研究  

Risk of hypothyroidism secondary to intensity-modulated radiotherapy and thyroid dose-volume threshold for nasopharyngeal carcinoma

作　　者：谭洪文[1] 谢清兰 马骏[3] TAN Hong-wen;XIE Qing-lan;MA Jun(Department of Radiation Oncology,Jian Central Peoples Hospital,Ji'an 343000China;School of Medical Technology and Nursings Ji'au Vocational and Technical College,Ji'an 343000,China;Sun Yat-sen University Caticer Center,State Key Laboratory of Multidisciplinary Diagnosis arid Treatment of Naso pharyngeal Carcinoma,Guangzhou 510060,China)

机构地区：[1]吉安市中心人民医院肿瘤放疗科,江西吉安343000 [2]吉安职业技术学院医学技术与护理学院,江西吉安343000 [3]中山大学肿瘤防治中心·鼻咽癌多学科诊断与治疗国家重点实验室,广东广州510060

出　　处：《中华肿瘤防治杂志》2021年第24期1888-1893,共6页Chinese Journal of Cancer Prevention and Treatment

基　　金：江西省科技厅社发领域一般项目(20161BBG70036);中组部第十四批“西部之光”访问学者(3316)。

摘　　要：目的探讨调强放疗(IMRT)治疗鼻咽癌放射相关甲状腺剂量-体积阈值与继发性甲状腺功能减退(HT)风险,指导治疗计划设计,降低HT患病率。方法选取2012-01-01-2016-12-31中山大学肿瘤医院采用IMRT治疗的345例鼻咽癌患者进行回顾性分析,定期监测IMRT前后患者血清甲状腺功能变化,采用Cox回归分析影响HT发生的因素。按照甲状腺剂量-体积直方图(DVHs)曲线的3个剂量(25 Gy、35 Gy和45Gy)和对应的照射体积(V)的6个百分点45%、55%、60%、75%、90%和95%划分组合为3组:A组(DVHs符合V_(25Gy)≤60%、V_(35Gy)≤55%、V_(45Gy),≤45%),B组(DVHs符合V_(25ay)>95%、V_(35Gy)≥>90%、V_(45Gy)>75%)和C组(非A且非B组,即DVHs符合60%<V_(25Gy)≤95%、55%<V_(35Gy)≤90%、45%<V_(45Gy)≤75%)。采用χ^(2)检验分析A、B、C3组间HT患病率差异,两两多重比较采用Bonferroni法(检验水准校正值为0.05/3=0.0167)。结果合并早期HT 152例(44.06%),其中症状HT 38例(11.01%)。A、B和C3组间HT患病率比较差异有统计学意义,χ^(2)=13.669,P=0.001。两两比较结果显示,A组与B组患病率差异有统计学意义,χ^(2)=12.907,P=0.004;B组与C组(非A且非B组)患病率差异无统计学意义,χ^(2)=40.238,P=0.022;A组与C组患病率差异有统计学意义,χ^(2)=94.372,P<0.001。结论在不影响靶区覆盖的前提下,推荐V_(25Gy)≤60%、V_(35Gy)≤55%、V_(45Gy)≤45%作为DVHs“严格线”,V_(25Gy)>95%、V_(35Gy)>90%、V_(45Gy)>75%作为DVHs"抑制线"。Objective To explore the radiation-related thyroid dose-volume threshold of intensity-modulated radiotherapy(IMRT)for nasopharyngeal carcinoma and the risk of secondary hypothyroidism(HT),to guide the design of treatment plans,and to reduce the incidence of HT.Methods A retrospective analysis of 345 patients with nasopharyngeal carcinoma who were admitted to the Sun Yat-sen University Cancer Hospital from 2012-01-01 to 2016-12-31 who were all treated with IMRT was performed.The changes in serum thyroid function of the patients before and after IMRT were monitored regularly,and using Cox regression analyzed of factors affecting the occurrence of HT.Three doses(25 Gy,35 Gy and 45 Gy)according to the thyroid dose-volume histogram(DVHs)curve and 6 percentage points of the corresponding exposure volume(V)45%,55%,60%,75%,90%and 95%were divided into 3 groups:group A(DVHs conformed to V_(25Gy)≤60%,V_(35Gy)≤55%,V_(45Gy)≤45%),group B(DVHs conformed to V_(25Gy)>95%,V_(35Gy)〉90%,V_(45Gy)>75%)and group C(non-A and non-B group,DVHs conformed to 60%<V_(25Gy)≤95%,55%<V_(35Gy)≤90%,45%<V_(4Gy)≤75%).The test was used to analyze the difference in the prevalence of HT among the three groups A,B,and C,and the Bonferroni method was used for multiple comparisons(test level correction value was 0.05/3=0.0167).Results There were 152 cases(44.06%)with early HT,including 38 cases(11.01%)with symptomatic HT.There was a statistically significant difference in the prevalence of HT among groups A,B and C,χ^(2)=13.669,P=0.001.Pairwise comparison results showed that the prevalence difference between group A and group B was statistically significant(χ^(2)=12.907,P=0.004).The prevalence difference between group B and group C(not A and B)was not statistically significant(χ^(2)=40.238,P=0.022).The prevalence difference between group A and group C was statistically significant(χ^(2)=94.372,P<0.001).Conclusion Without affecting the coverage of the target area,V_(25Gy)≤60%,V_(35 Gy)≤55%,V_(45Gy)≤45%are recommended as the"strict l

关 键 词：甲状腺功能减退﹔调强放疗﹔鼻咽癌 患病率 甲状腺剂量-体积阈值 

分 类 号：R739.6[医药卫生—肿瘤] R581.2[医药卫生—临床医学]