腮腺癌术后调强放疗缩小临床靶区的探索性研究  

Clinical exploratory study on reduction of clinical target volume in postoperative intensity‐modulated radiotherapy for parotid gland cancer

作　　者：董俊雅 孙学明 黄蓉 卢晓旭 贺家琪 吴慧 Dong Junya;Sun Xueming;Huang Rong;Lu Xiaoxu;He Jiaqi;Wu Hui(Department of Radiation Oncology,The Affiliated Cancer Hospital of Zhengzhou University Cancer Hospital of Henan Province,Zhengzhou 450008,China)

机构地区：[1]郑州大学附属肿瘤医院河南省肿瘤医院放疗科,郑州450008

出　　处：《中华放射肿瘤学杂志》2022年第12期1109-1114,共6页Chinese Journal of Radiation Oncology

摘　　要：目的探讨腮腺癌术后调强放疗(IMRT)缩小临床靶区对局部控制和患者生存的影响,并分析失败模式,为精准放疗时代腮腺癌术后放疗靶区勾画提供临床依据。方法回顾性分析行术后放疗的126例腮腺癌患者,根据CTV前界勾画不同分为腮腺前缘组(A组)和咬肌前缘组(B组),采用Kaplan-Meier法进行生存分析,log-rank检验行单因素分析,Cox回归模型行多因素分析腮腺癌的预后影响因素。结果A组和B组5年无局部复发生存(LRFS)率、无区域复发生存(RRFS)率、无远处转移生存(DMFS)率及总生存(OS)率分别为96.7%∶91.3%、96.7%∶90.2%、86.9%∶81.3%、86.0%∶81.4%,差异均无统计学意义。全部患者局部复发7例:A组2例,野内、外复发各1例;B组5例,4例野内复发,1例边缘区复发。单因素分析结果显示年龄是LRFS的影响因素,年龄、N分期和病理类型是OS的影响因素。Cox多因素回归分析显示年龄、N分期、病理类型为OS的独立影响因素。结论对于前界无腮腺外侵犯、术后切缘阴性的腮腺癌患者,缩小CTV前界体积未增加局部复发风险。与勾画至咬肌前缘相比,生存获益无明显差异。CTV勾画需根据风险因素区别对待。Objective To evaluate the effect of reducing clinical target volume(CTV)on local control and overall survival in postoperative intensity‐modulated radiotherapy(IMRT),and analyze the patterns of failure,aiming to provide clinical basis for postoperative IMRT delineation of CTV for parotid gland cancer in the era of precision radiotherapy.Methods Clinical data of 126 patients who were pathologically diagnosed with parotid gland cancer and treated with parotidectomy as well as postoperative radiotherapy were retrospectively analyzed.All patients were divided into two groups according to the prozone of CTV.It was delineated to the anterior border of parotid gland in group A,and delineated to the anterior border of masseter in group B.Actuarial estimates of local recurrence‐free survival,regional recurrence‐free survival,distant metastasis‐free survival and overall survival were obtained with the Kaplan‐Meier method.Univariate prognostic analysis was performed by log‐rank test.Multivariate prognostic analysis was conducted by Cox regression model.Results The 5‐year local recurrence‐free survival(LRFS),regional recurrence‐free survival(RRFS),distant metastasis‐free survival(DMFS)and overall survival(OS)in groups A and B were 96.7%vs.91.3%,96.7%vs.90.2%,86.9%vs.81.3%and 86.0%vs.81.4%,respectively.There were no significant differences in these parameters between two groups.Of 126 patients with parotid carcinoma,7 had local recurrence.There were 2 cases in group A which 1 recurred in‐field and 1 recurred out‐field.And there were 5 cases in group B which 4 recurred in‐field and 1 recurred marginally.Univariate analysis showed that age was associated with LRFS.Age,N stage and pathological grading were associated with OS.Cox multivariate analysis revealed that age,N stage and pathological grading were the independent influencing factors of OS.Conclusions Reducing the CTV would not increase the risk of local recurrence in patients with parotid gland carcinoma without tumor extravasation and negative

关 键 词：腮腺肿瘤 术后放射疗法 适形调强放疗 临床靶区 治疗结果 失败模式 

分 类 号：R739.87[医药卫生—肿瘤]