鼻咽癌N_(0)-N_(1)期患者Ⅱa区临床靶区优化策略及对远期口干的影响  

The safety and protective effect on resting dry mouth of optimized dose optimization in clinical target volumeⅡa in patients with N_(0)-N_(1) nasopharyngeal carcinoma

作　　者：黄文轩 黄生富[1] 张丝雨 张兰芳 王丽君[1] 刘菊英[1] 葛宜枝 何侠[1] Huang Wenxuan;Huang Shengfu;Zhang Siyu;Zhang Lanfang;Wang Lijun;Liu Juying;Ge Yizhi;He Xia(Department of Radiation Oncology,Affiliated Cancer Hospital of Nanjing Medical University&Jiangsu Cancer Hospital&Jiangsu Institute of Cancer Research,Nanjing 210009,China)

机构地区：[1]南京医科大学附属肿瘤医院/江苏省肿瘤医院/江苏省肿瘤防治研究所放疗科,南京210009

出　　处：《中华放射肿瘤学杂志》2024年第5期397-404,共8页Chinese Journal of Radiation Oncology

基　　金：江苏省博士后科研基金(200730000107);江苏省肿瘤医院博士后科研基金(SZL202013);江苏省肿瘤医院科研基金项目(ZM202022)。

摘　　要：目的分析N_(0)-N_(1)期鼻咽癌患者颈部Ⅱa区可疑淋巴结临床靶区(CTV)减量照射的安全性和对下颌下腺及远期静息口干保护的临床意义,探讨多模态影像对可疑阳性淋巴结的诊断价值。方法回顾性分析2015年7月至2017年4月江苏省肿瘤医院同一治疗组连续收治的T_(0-4)N_(0-1)M_(0)期初诊鼻咽癌患者,收集临床、放射治疗计划、多模态影像等相关资料。所有患者均采用颈部Ⅱa区个体化调强放疗(IMRT)、CTV处方剂量50.4 Gy(命名为CTV50)的优化方案。患者治疗中接受磁共振成像(MRI)、磁共振弥散加权成像(MRI-DWI)、正电子发射计算机体层成像(PET-CT)及重复增强定位CT等检查,监测和评估可疑淋巴结影像学特征和治疗反应。用配对t检验比较下颌下腺在降量照射后与标准治疗计划(CTV50∶CTV60)的剂量学差异。患者远期口干程度采用美国肿瘤放射治疗协作组(RTOG)晚期放射损伤标准、江苏省肿瘤医院多维度放射性口干评估量表和简化版口腔干燥量表(SXI)进行评估,用秩和检验分析口干程度差异。结果共106例患者纳入研究,共149侧颈淋巴结阴性,其中73侧Ⅱa区可辨认淋巴结数≤3枚,76侧>3枚。106例患者中N_(1)期行对侧单颈Ⅱa区优化63例,行双颈Ⅱa区优化43例(N_(0)期及仅有咽后淋巴结转移的N_(1)期患者)。共发现109枚最大横断面上短径>5 mm的可疑淋巴结,其中105枚淋巴结门结构清晰,93例长短径之比≥1.5,76例PET-CT最大标准摄取值(SUV_(max))≥2.5。CTV优化区域内未发现淋巴结复发。优化后肿瘤靶区的大体肿瘤体积(GTV)平均剂量的差异无统计学意义(P>0.05),下颌下腺的D_(mean)、V_(39 Gy)显著低于未优化的常规计划(P<0.01)。下颌下腺单侧和双侧优化患者的远期口干和静息口干差异均无统计学意义(P>0.05)。结论N_(0)-N_(1)期鼻咽癌患者颈部Ⅱa区进行CTV50减量照射的优化方案是安全有效的,下颌下腺剂量学优势明Objective To analyze the safety of reduced clinical target volume(CTV)irradiation of suspicious positive lymph nodes in IIa region in patients with N_(0)-N_(1) nasopharyngeal carcinoma(NPC)and the protective effect of submandibular gland and long-term resting dry mouth,and to explore the diagnostic value of multimodal imaging for suspicious cervical lymph nodes.Methods Clinical data of T_(0-4)N_(0-1)M_(0) stage NPC patients admitted to Jiangsu Cancer Hospital from July 2015 to April 2017 were retrospectively analyzed.Clinical,radiation therapy planning,multimodal imaging and other relevant data were collected.All patients were treated with an optimized regimen of IMRT with a prophylactic radiation dose of 50.4 Gy(named as CTV50)for IIa region.Imaging characteristics and treatment response of suspicious lymph nodes were monitored by MRI,MRI-DWI,PET-CT and repeated enhanced positioning CT,etc.The dosimetry of the submandibular gland between optimized and standard dose plans(CTV50 vs.CTV60)was compared by paired t-test.The long-term dry mouth degree of the patients was evaluated using advanced radiation injury from Radiation Therapy Oncology Group(RTOG),Jiangsu Cancer Hospital Multi-dimensional Dry Mouth Evaluation Scale and summated xerostomia inventory(SXI).The difference of dry mouth degree was analyzed by rank-sum test.Results A total of 106 patients were included in this study,including 149 cervical lymph node negative sides,73 sides of which had≤3 recognizable lymph nodes,and 76 of which were>3 inⅡa region.Among patients with N_(1) stage,63 patients underwent contralateral single neck area optimization,and 43 patients(N_(0) stage and N_(1) stage patients with retropharyngeal lymph node metastasis)underwent double-neck area optimization.A total of 109 suspicious lymph nodes with a short diameter of>5 mm were found on the largest cross section,of which 105 had clear portal structure.The ratio of long to short diameter was≥1.5 in 93 cases,and the maximum standardized uptake value(SUV_(max))in PET-CT was≥2

关 键 词：鼻咽肿瘤 靶区优化 下颌下腺 静息口干 可疑颈部淋巴结 

分 类 号：R739.63[医药卫生—肿瘤]