摘要
目的探讨颅底、后颅窝和茎突后区广泛c彤侵犯局部晚期鼻咽癌互补分野同期加量照射（SF—SBI）分割剂量的合理设置、设野的优化和应用时机。方法选取2004年1月至2008年6月中山大学肿瘤防治中心收治的局部晚期NPC患者6例，分别采用分割剂量为2．3～2．7Gy／次的不同SF-SBI方案，用剂量体积直方图比较加量照射肿瘤靶区（BTV）、原发肿瘤计划靶体积（PTVnx）和危及器官（OARs）的剂量学特点差异，评价其临床疗效及并发症。结果全组BTV的平均剂量（Dmean）为73．8～76．2Gv，95％处方剂量所包含的靶体积百分数（V99%）为95．8％～99．9％。PTVnx的Dmean为70．3～75。9Gy，V99%为96．0％～99．9％。靶区中不存在大于80Gy的体积。明V1和PTV2的V9分别为98．8％～99．9％和98．9％～99．9％。腩干的50、60Gy所包含的体积百分数（v。v。，和33％体积所受照射的最大剂量（D33）分别为13．2％-46．3％、2．6％～12．8％和23．8～53．9Gy。同侧颞叶的Dmean、D33和v。分别为23．8～32．2Gy、26．4～39．2Gy和19．5％～25．7％。患者A、B、c同侧颞叶的百分体积分别为9．5％、32．2％和28．7％。同侧颞颌关节的Dmean和D。分别为69．1-76．2Gy和62．2-69．8Gy。随访时间3．5～7年。除患者A为部分缓解（PR）外，其余患者均在放疗中或放疗后获得完全缓解（CR），所有患者均未出现肿瘤局部进展或复发。无1例患者出现脑干放射损伤。采用较大分割剂量（2．4～2．7Gy／次）的患者分别m现了放射性脑病、后组脑神经损伤和严重的张口困难。结论从放疗开始即对BTV和大部分GTV采用2．3Gy／次分割剂量进行照射改进的SF．SBI适形放射治疗计划，以及根据肿瘤实际退缩情况个体化缩小后程放疗射野的优化理论，为局部晚期NPC实施个体化放疗提供了新的技术参考：
Objective To explore reasonable fractioned doses, optimized field and application time of split-filling and simultaneous boost irradiation（SF-SBI）in patients with locally advanced nasopharyngeal carcinoma（NPC）involving extensive,C-shaped invasion of the skull base,posterior c, ranial fossa and post-styloid parapharyngeal space. Methods Six patients with locally advanced NPC treated at the Cancer Center of Sun Yat-sen University between January 2004 and June 2008 were enrolled in this study. Different SF-SBI schemes were used for the patients,and dose volume histograms（DVHs）were used to analyze dosimetrie characteristics of boost tumor volume（BTV ）,primary tumor planning target volume（ PTVnx）and organs at risk （OARs）.Clinical efficacy and complications were e- valuated for each patient. Results The mean dose （Dmean）of BTV was 73.8-76.2 Gy and the target volume percentage contained by the 95% prescribed dose curve （V9y/~）of BTV was 95.8%-99.9%.The Dmean and Vg~/o of PTVnx was 70.3-75.9Gy and 96.0%-99.9%, re-spectively.No volume received more than 80Gy for PTVnx and BTV.The Vg~,lrof PTV1 and PTV2 was 98.8%-99.9% and 98.9%- 99.9%,respectively.The volume percentage at 50 and 60Gy（Vs, V60）were 13.2%-46.3% and 2.6%~12.8%,respectively;the maximum close for 33% volume （I）33）of＂ the brain stem was 23.8-53.9Gy.The Dmean, D33and V60 of the ipsilateral temporal lobe were 23.8-32.2Gy, 26.4-39.2Gy and 19.5%-25.7%,respectively.The temporal lobe percentage volume of patients A,B and C was 9.5%, 32.2% and 28.7%, respectively. The Dmean and Dso of the ipsilatera] temporo-mandibular joint were 69.1~76.2Gy and 62.2-69.8Gy,respectively. Follow-up tittle was 3.5 to 7 years. Except patient A,who showed partial remission（PR）,the remaining patients showed complete re- mission（CR ）during or after radiotherapy.None of the patients showed local tumor progression or tumor recurrence,and none showed signs of brain stem injury.Patients treated with a large fractioned dose（2.4-2.7Gy）suffere
出处
《中国癌症防治杂志》
CAS
2012年第3期218-224,共7页
CHINESE JOURNAL OF ONCOLOGY PREVENTION AND TREATMENT
基金
广东省科技计划项目(2008B030301109)
中山大学医科青年教师科研启动基金(2007026)
关键词
鼻咽肿瘤/放射疗法
同期加量照射
剂量学
Nasopharyngeal neoplasms/radiotherapy
Simultaneous boost irradialion
Dosimetry
