【摘要】 [目的]探讨Rapid Arc治疗鼻咽癌(NPC)的剂量分布、近期临床疗效和毒副反应。[方法]100例初治鼻咽癌患者接受Rapid Arc治疗(排除远处转移患者)。2008中国分期,Ⅰ期1例,Ⅱ期14例,Ⅲ期57例,Ⅳa期28例。处方剂量为GTVnx 70Gy,CTV1 60Gy,CTV2 56Gy,颈部淋巴结GTVnd 60~68Gy,分32次。52例患者接受了同期顺铂单药化疗。[结果]PGTV、PTV1、PTV2靶区基本满足95%体积以上PTV大于100%的处方剂量的临床要求,对脊髓、脑干、腮腺、口咽、视神经等危及器官有较好的保护作用。同期放化疗组唾液腺和口咽急性损伤比单纯放疗组严重(P<0.05)。中位随访时间19个月(9~31个月),放疗结束原发病灶完全消退率为99%。1、2年无远处转移生存率为93.2%、82.4%,1、2年总生存率为97.6%、95.8%。[结论]Radid Arc治疗鼻咽癌能使高剂量区集中在靶区,同时可保护正常器官,治疗鼻咽癌局部控制率高。更多还原

【Abstract】 [Purpose] To investigate the dose distribution,short-term response and acute toxicities of the Rapid Arc technology for patients with nasopharyngeal cancer. [Methods] There were 100 cases untreated nasopharyngeal cancer patients undergoing Rapid Arc therapy(patients with distant metastases were excluded). According to 2008 Chinese Classification,the stage distribution was stage Ⅰ,1 case; stage Ⅱ,14 cases; stage Ⅲ,57 cases and stages Ⅳa 28 cases. The prescribed dose was 70 Gy to GTVnx,60~68 Gy to GTVnd,60 Gy to CTV1,and 56 Gy to CTV2 in 32 fractions.There were 52 patients received concurrent chemotherapy with cisplatin. [Results] Concerning the dose distribution,the PGTV,PTV1,PTV2 coverage met the aim of 95% of PTV volumn >100% of the prescribed dose(V100%>95%). The organs at risk(OAR) including spinal cord,the brainstem,parotid glands,oral cavity,optic nerves were well protected. Acute toxicity of salivary gland and dysphagia in concurrent radiochemotherapy group was move serious than that in radiotherapy alone group(P<0.05). With a median follow-up of 19 months(range 9~31),99 patients(99%) presented complete remission in primary site. The 1-year,2-year distant metastasis-free survival was 93.2%and 82.4% respectively. The 1-year,2-year overall survival was 97.6% and 95.8% respectively.[Conclusion] Volumetric modulated Arc therapy for nasopharyngeal cancer is able to deliver high dose to tumor target with good health tissue sparing,and achieves high local-region control.更多还原