容积旋转调强放疗治疗鼻咽癌的效果及急性口腔黏膜反应分析  

Analysis of VMAT Efficay and Acute Oral Mucosa Response in the Treatment of Nasopharyngeal Carcinoma

作　　者：宋鹏 杨远富 廖长富 Song Peng;Yang Yuanfu;Liao Changfu(Oncology Department of Guanghan People's Hospital,Guanghan,Sichuan 618300,China.)

机构地区：[1]广汉市人民医院肿瘤科,四川广汉618300

出　　处：《四川医学》2024年第4期399-404,共6页Sichuan Medical Journal

摘　　要：目的分析容积旋转调强放疗(VMAT)治疗鼻咽癌的效果及对急性口腔黏膜反应的影响。方法采取前瞻性研究,选择2021年10月至2022年10月我院收治的80例鼻咽癌患者作为研究对象,按随机数字表法分为两组,各40例。对照组采取静态调强适形放疗(s-IMRT)治疗,观察组采取VMAT治疗。治疗后,比较两组患者临床疗效、治疗效率(加速器跳数、治疗时间)、计划靶区剂量参数[肿瘤靶区(PGTV)、计划靶区(PTV):均匀性指数(HI)、适形性指数(CI)、最小剂量(D_(min))、最大剂量(D_(max))、平均剂量(D_(mean))]、危及器官剂量参数(腮腺D_(mean)、颞颌关节V_(40))、皮肤、口腔黏膜反应分级;采用双变量相关tau-b(K)分析,急性口腔黏膜反应分级与腮腺D_(mean)、颞颌关节V_(40)剂量的关系。结果治疗后,观察组总有效率(92.50%)高于对照组(75.00%)(P<0.05);观察组加速器跳数、治疗时间[(658.04±103.36)MU、(3.14±0.46)min]低于对照组[(1844.25±462.47)MU、(7.84±1.09)min](P<0.05);观察组PGTV的CI(0.45±0.09)高于对照组(0.37±0.08),PTV的CI(0.40±0.16)高于对照组(0.29±0.08),D_(mean)[(64.38±4.43)Gy]低于对照组[(66.49±5.87)Gy](P<0.05);观察组腮腺D_(mean)、颞颌关节V_(40)[(34.14±5.29)Gy、(4.29±0.67)Gy]低于对照组[(37.05±6.33)Gy、(5.11±1.32)Gy](P<0.05);观察组急性口腔黏膜反应发生率(37.50%)低于对照组(72.50%)(P<0.05);采用双变量相关tau-b(K)分析,急性口腔黏膜反应分级与腮腺D_(mean)、颞颌关节V_(40)剂量呈正相关(r>0,P<0.05)。结论VMAT治疗鼻咽癌能够有效调节靶区剂量,控制危及器官剂量,降低急性口腔黏膜反应发生率,提升治疗效率。Objective To analyze the efficacy of volume rotation intensity modulated radiotherapy(VMAT)in the treatment of nasopharyngeal carcinoma and its impact on acute oral mucosal response.Methods A prospective study was conducted,selecting 80 nasopharyngeal carcinoma patients admitted to our hospital from October 2021 to October 2022 as the study subjects.They were divided into two groups by random number tablemethod,with 40 patients ineach group.The control groupreceived static stress adaptive radiotherapy(s-IMRT)treatment,while the observation group received VMAT treatment.After treatment,the clinical efficacy,treatment efficiency(accelerator jumps,treatment time),planned target area dose parameters[tumor target area(PCTV),planned target area(PTV):uniformity index(HI),fitness index(CI),minimum dose(D_(min)),maximum dose(D_(max)),average dose(D_(mean))],endangered organ dose parameters(parotid gland D mean,temporomandibular joint V_(40)),skin and oral mucosal response grading between the two groups of patients were compared;Using bivariate correlation tau-b(K)analysis,the relationship between the grading of acute oral mucosal response and the dose of parotid gland D_(mean) and temporomandibular joint V_(40) was studied.Results After treatment,the total effective rate in the observation group(92.50%)was higher than that in the control group(75.00%)(P<0.05);The number of accelerator jumps and treatment time in the observation group[(658.04±103.36)MU,(3.14±0.46)min]were lower than those in the control group[(1844.25±462.47)MU,(7.84±1.09)minutes](P<0.05);The CI of PGTV in the observation group(0.45±0.09)was higher than that of the control group(0.37±0.08),the CI of PTV(0.40±0.16)was higher than that of the control group(0.29±0.08),and the D mean[(64.38±4.43)Gy]was lower than that of the control group[(66.49±5.87)Gy](P<0.05);The observation group showed lower levels of parotid gland D mean and temporomandibular joint V_(40)[(34.14±5.29)Gy,(4.29±0.67)Gy]compared to the control group[(37.05±6.33)Gy,(5.11±1.32)G

关 键 词：鼻咽癌 容积旋转调强放疗 静态调强适形放疗 疗效 急性口腔黏膜反应 

分 类 号：R766.3[医药卫生—耳鼻咽喉科]