偏侧鼻咽癌原发灶CTV的个体化优化方案可行性探讨  

The feasibility of individualized primary CTV for lateralized nasopharyngeal carcinoma

作　　者：张丝雨 黄文轩 王丽君[1] 刘菊英[1] 赵丽君[1] 吴俚蓉[1] 王德军[1] 徐文静 郭业松[1] 严鹏伟[1] 张兰芳[3] 翟振宇[1] 黄生富[1] 何侠[1] Zhang Siyu;Huang Wenxuan;Wang Lijun;Liu Juying;Zhao Lijun;Wu Lirong;Wang Dejun;Xu Wenjing;Guo Yesong;Yan Pengwei;Zhang Lanfang;Zhai Zhenyu;Huang Shengfu;Hexia(Department of Radiation Oncology,Jiangsu Cancer Hospital,Jiangsu Institute of Cancer Research,the Affiliated Cancer Hospital of Nanjing Medical University,Nanjing 210009,China;Department of Oncology,Peoples Hospital of Xinghua,Xinghua 225700,China;Department of CT and MR,Jiangsu Cancer Hospital,Jiangsu Institute of Cancer Research,the Affiliated Cancer Hospital of Nanjing Medical University,Nanjing 210009,China)

机构地区：[1]江苏省肿瘤医院江苏省肿瘤防治研究所南京医科大学附属肿瘤医院放疗科,南京210009 [2]兴化市人民医院肿瘤科,兴化225700 [3]江苏省肿瘤医院江苏省肿瘤防治研究所、南京医科大学附属肿瘤医院CT、MR室,南京210009

出　　处：《中华放射肿瘤学杂志》2023年第8期675-682,共8页Chinese Journal of Radiation Oncology

基　　金：江苏省卫健委面上项目(M2021093)。

摘　　要：目的探讨偏侧鼻咽癌调强放疗原发灶临床靶区(CTV)的个体化优化方案的可行性。方法回顾性分析2016年10月至2018年2月于江苏省肿瘤医院连续收治的偏侧鼻咽癌初诊患者87例。偏侧鼻咽癌定义为肿瘤浸润不超过健侧侧壁。根据鼻咽肿瘤侵犯趋势, 对原发灶CTV进行如下优化:CTV2健侧包及翼腭窝根部, 不包及健侧卵圆孔, 咽旁间隙水平健侧仅充分包及咽后外侧淋巴结, 健侧颈内静脉不常规包及。评估失败模式和5年生存率[局部控制率(LCR)、无进展生存(PFS)、总生存(OS)], 采用Kaplan-Meier法计算;配对t检验和秩和检验法分析优化区域剂量变化及不良反应。结果全组中位随访59.5个月, 5年LCR、PFS、OS分别为98.9%、86.5%、92.1%。CTV优化区域内无1例局部复发。健侧风险结构的优化使腮腺、颞叶、耳蜗、中耳剂量分别降低了13.45%、9.14%、38.83%、29.36%。观察到4例(4.6%)3级晚期听力损伤, 均位于患侧。对比患侧, 优化方案明显减轻了健侧的听力损伤(P<0.001)。其他3级晚期不良反应包括颅神经损伤、颈部皮下纤维化、视力损伤, 各1例。结论偏侧鼻咽癌原发灶CTV采取个体化优化方案是安全的, 剂量学优势明显, 不良反应发生率低, 值得临床推广。Objective To investigate the feasibility of individualized primary clinical target volume(CTV)delineation in intensity-modulated radiotherapy for nasopharyngeal carcinoma(NPC).Methods Clinical data of 87 consecutive patients newly diagnosed with lateralized NPC in Jiangsu Cancer Hospital between October 2016 and February 2018 were retrospectively analyzed.Lateralized NPC is defined as tumor invasion not exceeding the contralateral wall.According to the tumor spread,the primary CTV was optimized as follows:CTV2 only covered the medial part of the contralateral pterygopalatine fossa,whereas the contralateral foramen oval was not included;on the level of parapharyngeal space,the contralateral side of CTV only covered the posterior lateral lymph nodes,whereas the contralateral internal jugular vein was not regularly covered.Failure patterns and 5-year survival[local control rate(LCR),progression-free survival(PFS)and overall survival(OS)]were evaluated by Kaplan-Meier method.Paired t-test and rank-sum test were used to analyze the dose variation in the optimized region and adverse reactions.Results The median follow-up time was 59.5 months.The 5-year LCR,PFS,and OS were 98.9%,86.5%and 92.1%,respectively.There was no local recurrence in the optimized area of CTV.Dosimetric comparison results showed that the doses of parotid gland,temporal lobe,cochlea and middle ear on the contralateral side were reduced by 13.45%,9.14%,38.83%,and 29.36%,respectively.Four cases(4.6%)developed grade 3 hearing loss,all on the ipsilateral side.The optimized scheme significantly alleviated the hearing loss on the contralateral side compared to that on the ipsilateral side(P<0.001).Other grade 3 late adverse reactions included cranial nerve injury,subcutaneous fibrosis in the neck and visual impairment,with 1 case each.Conclusion Individualized primary CTV for lateralized NPC is feasible and safe,with obvious dosimetric advantages and reduced adverse reaction rate,which is worthy of clinical promotion.

关 键 词：鼻咽肿瘤 临床靶区 靶区优化 个体化靶区 靶区缩小 

分 类 号：R739.63[医药卫生—肿瘤]