局部晚期鼻咽癌自适应放疗中靶区体积变化的影响因素  

Factors affecting target volume in adaptive radiotherapy for locally advanced nasopharyngeal carcinoma

作　　者：董书慧 姚文燕[1,2] 何梦雪 钟梓悦 周宇鹏 许森奎[1,2] 夏伟雄[1] DONG Shuhui;YAO Wenyan;HE Mengxue;ZHONG Ziyue;ZHOU Yupeng;XU Senkui;XIA Weixiong(Department of Nasopharyngeal Carcinoma,Sun Yat-sen University Cancer Center,Guangzhou 510060,China;Department of Radiotherapy,Sun Yat-sen University Cancer Center,Guangzhou 510060,China)

机构地区：[1]中山大学肿瘤防治中心鼻咽科,广东广州510060 [2]中山大学肿瘤防治中心放疗科,广东广州510060

出　　处：《中国医学物理学杂志》2024年第7期798-802,共5页Chinese Journal of Medical Physics

基　　金：广东省自然科学基金(2022A1515010673);广东省基础与应用基础研究基金(2021B151520013)。

摘　　要：目的:探究放疗前患者的体质量、性别、年龄、肿瘤分期、EBVDNA、血红蛋白、血浆白蛋白、诱导化疗方案与自适应放疗中患者靶区及淋巴结体积变化的关系,为自适应放疗的时机和人群选择提供参考依据。方法:回顾性分析2022年1月~2022年11月在中山大学肿瘤防治中心接受首程放疗的34名鼻咽癌患者资料,均在放疗20次后重新行CT扫描,制定二次放疗计划,收集患者体质量、性别、年龄、肿瘤分期、血红蛋白、血浆白蛋白、诱导化疗方案、EBVDNA等资料。结果:治疗前血浆白蛋白≥40 g/L的患者较血浆白蛋白<40 g/L的患者原发灶肿瘤体积缩小更加明显(t=3.971,P=0.001)。治疗前EBVDNA≤4000 copies/mL的患者较EBVDNA>4000copies/mL的患者原发灶肿瘤体积缩小更加明显(t=4.080,P=0.001)。Pearson分析显示,GTVnx体积差与GTVnx放疗前体积(r=0.444,P=0.009)、放疗前后左、右腮腺体积差(左腮腺r=0.435,P=0.010;右腮腺r=0.737,P<0.001)、血红蛋白(r=0.722,P<0.001)呈显著正相关。结论:血浆白蛋白在正常范围内的鼻咽癌患者,放疗期间肿瘤体积缩小更加明显。治疗前EBVDNA≤4000copies/mL的患者放疗期间肿瘤体积缩小更加明显。放疗前原发灶的治疗体积、放疗前后腮腺体积变化、放疗前EBVDNA水平、血红蛋白水平及血浆白蛋白水平可以帮助预测放疗期间肿瘤体积缩小程度,为鼻咽癌自适应放疗时机的选择提供参考。Objective To investigate the relationships of pre-radiotherapy body weight,gender,age,EBVDNA,hemoglobin,plasma albumin,and induction chemotherapy regimen with the changes of target area and lymph node volume in adaptive radiotherapy,so as to provide a reference for the timing and population selection of adaptive radiotherapy.Methods A retrospective analysis was conducted on 34 patients who received the first course of radiotherapy at Sun Yat-sen University Cancer Center from January 2022 to November 2022.All patients underwent CT scans again after 20 sessions of radiotherapy for developing the secondary radiotherapy plans.The body weight,gender,age,tumor stage,hemoglobin,plasma albumin,induction chemotherapy regimen,and EBVDNA were collected.Results The tumor volume reduction in the primary focus was more evident in patients with pre-treatment plasma albumin≥40 g/L than in those with pre-treatment plasma albumin<40 g/L(t=3.971,P=0.001),and in patients with pretreatment EBVDNA≤4000 copies/mL than in those with pretreatment EBVDNA>4000 copies/mL(t=4.080,P=0.001).Pearson analysis showed that GTVnx volume difference was positively correlated with pre-radiotherapy GTVnx volume(r=0.444,P=0.009),right parotid gland volume difference(r=0.737,P<0.001),left parotid gland volume difference(r=0.435,P=0.010),and hemoglobin(r=0.722,P<0.001).Conclusion The reduction in tumor volume during radiotherapy is more pronounced in nasopharyngeal cancer patients with normal plasma albumin level and those with pretreatment EBVDNA≤4000 copies/mL.The pre-radiotherapy treatment volume of primary focus,parotid gland volume change before and after radiotherapy,and pre-radiotherapy EBVDNA,hemoglobin and plasma albumin levels can be used to predict the degree of tumor volume shrinkage during radiotherapy,providing a reference for the selection of the timing of adaptive radiotherapy for nasopharyngeal carcinoma.

关 键 词：局部晚期鼻咽癌 自适应放疗 靶区体积 影响因素 

分 类 号：R73[医药卫生—肿瘤] R811.1[医药卫生—临床医学]