鼻咽癌调强放射治疗后腮腺解剖位置与照射剂量的变化  

Explore the Influences of Intensity-modulated Radiotherapy in Nasopharyngeal Carcinoma Patients on the Parotid Gland Changesand Function

作　　者：郭艳红[1] 郝迎春[1] 张莲香[2] 李晓燕[1] 王文娟[1] 马志芳[1] 闵佳[1] 

机构地区：[1]宁夏医科大学总医院肿瘤医院放疗科,银川750004 [2]宁夏医科大学基础医学院人体解剖与组织胚胎学系,银川750004

出　　处：《宁夏医科大学学报》2016年第12期-,共6页Journal of Ningxia Medical University

摘　　要：目的观察鼻咽癌调强放射治疗后腮腺体积、位置变化的规律及与放射剂量之间的阈值关系,为放疗靶区校正提供解剖学资料,为优化调强放射治疗计划提供理论依据。方法选取2013年4月到2015年3月经病理确诊,接受调强放射治疗的鼻咽癌患者60例。分别在调强放射治疗前、治疗25次及治疗后1个月行腮腺定位CT;利用腮腺剂量-体积直方图(DVH)进行相关受量分析。结果治疗25次、1个月后双侧腮腺平均体积分别为(12.787±0.520)cm3、(10.968±0.291)cm3,腮腺平均体积均小于调强放射治疗前(21.854±0.705)cm3(P<0.01);调强放射治疗后1个月双侧腮腺平均体积小于治疗25次(P<0.01)。调强放射治疗过程中双侧腮腺逐渐向体中线侧移位,其中外侧界向体中线侧移位大,内侧界向体中线侧移位变化不大。治疗25次腮腺A2横断面外侧界值低于治疗前,腮腺A1和A2横断面内、外侧界差值高于治疗前(P均<0.01)。腮腺体积变化与腮腺平均照射剂量呈负相关(r=-0.941,P=0.000)。结论二次靶区校正及二次治疗计划的个体化实施,一方面提高肿瘤精确照射;另一方面减少腮腺受照射体积及降低受照射剂量。有助于腮腺功能的恢复,是减轻腮腺功能损伤的有效途径。Objective To provide anatomic data for the correction of the second target area and the application of the second radiotherapy based upon anatomic observations on the variation of parotid gland location and volume after intensity modulated radiotherapy in nasopharyngeal carcinoma patients and to supply theoretical evidences to help optimize radiotherapy and increase recovery rate of nasopharyngeal carcinoma patients,the study also analyzed parotid gland morphologic changes as a result of radiotherapy and examined the injury of parotid gland function and dose-volume relation.Methods Clinical information of 60 nasopharyngeal carcinoma patients were selected. They were confirmed to have nasopharyngeal carcinoma by imaging examination and pathological diagnoses,and received intensity modulated radiotherapy. All patients were performed CT examination before radiotherapy,after 25 times radiotherapy,and three months after radiotherapy. The dose-volume histogram (DVH)was used to analyze the dose of parotid gland.Results Parotid gland volume change: Parotid average volume was(12.787±0.520)cm3,(10.968 ±0.291)cm3,respectively,after treatment of 25 times radiotherapy, one month. Parotid gland average volume were less than the former intensity modulated radiation therapy(IMRT) (21.854 ±0.705)cm3. The volume changes were statistically significant(P<0.01). Parotid gland volume during the period from 25 times radiotherapy to one month radiotherapy was decreased. The volume changes were statistically significant(P<0.01). Parotid gland location change: external boundary shifted inboard and internal boundary almost unchanged after 25 times radiotherapy. The distance between the external boundary and reference point before radiotherapy and after 25 times radiotherapy was different relative to cross section A2 . The difference was statistically significant(P<0.01). In contrast,the displacements of the external and internal boundaries were different relative to cross section A1 and relative to cross section A2 either before radioth

关 键 词：鼻咽癌 调强放射治疗 腮腺功能 剂量 体积 

分 类 号：R739.63[医药卫生—肿瘤] R730.55[医药卫生—临床医学]