【摘要】 目的观察调强放射治疗(IMRT)在2008新分期下初治鼻咽癌应用中的近期疗效。方法 2014年2月至2015年11月,经病理确诊的初治鼻咽癌患者60例按2008年广州分期标准,Ⅰ期4例,Ⅱ期12例,Ⅲ期25例,Ⅳa期19例,所有患者全程均接受IMRT治疗,部分患者接受放化综合治疗。根据ICRU52号和60号定义,鼻咽及颈部靶体积定义为鼻咽大体肿瘤体积(GTVnx)、颈部淋巴结大体肿瘤体积(GTVnd)、临床靶体积1(CTV1)、临床靶体积2(CTV2),各靶区处方剂量均以其计划靶体积(PTV)定义给予,即PGTVnx、PGTVnd、PTV1、PTV2,处方剂量分别为68 Gy、64~68 Gy、60 Gy、54 Gy,分次数30~33次,所有患者均统一采用IMRT给予照射。所有患者均采用热塑面膜固定,行CT模拟定位,数据传至Viran eclipse 10.0调强计划系统进行靶区勾画、计划设计及评估。采用Kaplan-Meier法进行生存分析,RTOG/EORTC标准评价急性反应及晚期损伤。结果中位随访时间9个月。全组患者有2例死亡,1年生存率为96.7%。60例患者中,3例发生远处转移,转移部位分别为骨、肝、肺,远处转移率为5%,2例分别于治疗后第12个月和第14个月局部复发,且均为鼻咽野内复发,1年局部控制率为96.7%。大部分患者为1~2级急性反应,有2例患者因发生3度放射性口腔炎,未完成全程放疗,全组未出现4级以上放射性反应者。PGTVnx、PGTVnd、PTV1、PTV2的平均剂量均数分别为72.3 Gy、69.3 Gy、66.5 Gy、58.3 Gy,PGTVnx、PTVnd、PTV1、PTV2的V95平均剂量覆盖分别为99.8%、99.9%、99.7%、99.5%。结论 2008新分期下初治鼻咽癌获得较好的近期局部控制率,各靶区剂量达到很好的剂量分布,同时周围危及器官受照剂量和体积下降,从而较好的保护了周围危及器官,但远期结果仍需进一步观察及病例积累。更多还原

【Abstract】 Objective To observe the short-term therapeutic effect of intensity modulated radiation therapy(IMRT) in the treatment of nasopharyngeal carcinoma(NPC) at 2008 stage. Methods A total of 60 cases of nasopharyngeal carcinoma patients, who was confirmed by pathological examination in our hospital from February 2014 to November 2015, were divided intoⅠstage(n=4), Ⅱstage(n=12), Ⅲ stage(n=25) and Ⅳ stage(n=19) according to 2008 Guangzhou staging standards. Sixty cases received IMRT, and some patients received comprehensive treatment. According to ICRU52 and 60, the patients underwent IMRT with modified dose fractionation patterns at the dose of 68 Gy/30~33fraction for nasopharyngeal gross tumor volume(GTVnx), at the dose of 64~68 Gy/30~33 fraction for neck gross tumor volume(GTVnd), at the dose of 60 Gy/30~33 fraction for clinical target volume 1(CTV1), at the dose of 54 Gy/30~33 fraction for clinical target volume 2(CTV2). All patients were treated with thermoplastic mask fixation, CT simulation, and data was send to Viran eclipse 10 IMRT plan system for target delineation, plan design and evaluation. Survival analysis was performed by Kaplan-Meier method, and RTOG/EORTC criteria were used to evaluate acute and late injury. Results During the median follow-up time of 9 months, the whole group had 2 patients died, with 96.7% of one-year survival rate. In 60 patients, 3 cases had distant metastases, and metastatic sites were bone, liver and lung, with the rate of metastasis of 5%, of which 2 cases of local recurrence(which occurred in the twelfth months after treatment and fourteenth months) were in nasopharyngeal recurrence, and 1-year local control rate was 96.7%. Most of the patients was grade 1~2 acute reaction,and 2 patients, due to the occurrence of 3 radioactive stomatitis, did not complete the entire radiotherapy. There was no case belongs to more than 4 cases of radioactive reaction. The average dose of PGTVnx, PGTVnd, PTV1 and PTV2 were respectively 72.3 Gy, 69.3 Gy, 66.5 Gy, 58.3 Gy; The average dose coverage of V95 for PGTVnx, PGT Vnd,PTV1, PTV2 were respectively 99.8%, 99.9%, 99.7%, 99.5%. Conclusion According to the new staging standards, the better local control rate of nasopharyngeal carcinoma was obtained, the enough and uniformity dose to every target volume was yielded, and the dose and volume for the organs were decreased, which can protect surrounding normal tissue.However, its long-term results is yet to be further observed.更多还原