摘要
目的研究同步加量调强放射治疗(SMART)对鼻咽癌的疗效以及对正常组织的保护和毒性反应。方法对38例鼻咽癌初治患者大体肿瘤和肿大淋巴结给予SMART,2.5Gy/次,共28次,总量70Gy。亚临床灶和预防照射区接受常规照射,2.0Gy/次,共28次,总量56Gy。均照射1次/d,5次/周,总治疗时间为38d。腮腺功能测定采用99mTc核素显像法,采用摄取指数(UI)和分泌指数(EI)验证SMART对腮腺功能的保护作用。结果治疗计划结果显示临床靶体积(CTV)的D95为53.8Gy,平均剂量57.0Gy,95%等剂量线(54Gy)可以覆盖98%的CTV。大体肿瘤体积(GTV)的D95为64.5Gy,平均剂量67.2Gy,90%等剂量线(63Gy)覆盖98%～99%的GTV。健侧腮腺的平均剂量为23Gy,实际腮腺功能测定显示健侧腮腺功能变化在治疗前后无明显改变;患侧腮腺的UI、EI疗后比疗前分别下降43.6%和26.3%(P<0.05)。全组患者黏膜和咽部反应较重,但未发生严重的4级不良反应。治疗结束3个月后,完全缓解率为89.5%(34/38),有效率为100%(38/38),1年生存率为100%。结论SMART技术无论在早期或晚期鼻咽癌病例均可获得理想的剂量分布,正常组织得到很好的保护,毒副反应可以耐受,临床疗效令人满意。
Objective To evaluate the feasibility, toxicity and clinical efficacy of simultaneous modulated accelerated radiation therapy(SMART)for nasopharyngeal carcinoma. Methods Thirty eight patients with nasopharyngeal carcinoma were treated by SMART with 2.5?Gy/fraction at gross tumor volume(GTV)to a total dose of 70?Gy and 2.0?Gy/fraction at the clinical treatment volume(CTV)to a total dose of 56?Gy in 38 days. Quantitative 99m Tc pertechnetate salivary scintigraphy was used to assess the uptake and excretion index (EI、UI) of parotid gland in order to validate the value of IMRT in parotid gland sparing. Results The mean doses delivered to the GTV and CTV were 67.2?Gy and 57.0?Gy, respectively. An average of 1% of GTV and 2% of CTV received less than 90% or 95% of the prescribed dose. The mean dose to the contralateral parotid were 23?Gy and no significant decline in EI and UI as compared with significant decline in the ipsilateral parotid by 43.6% and 26.3%(P<0.05). Acute toxicity was well tolerated except the high incidence of severe mucositis. No grade IV side effects occurred. Thirty four patients had complete response(89.5%) while 4 patients had partial response after completion of treatment, giving a 1 year survival rate of 100%. Conclusions Simultaneous modulated accelerated radiation therapy yields better dose distribution and acceptable toxicity than the traditional radiotherapy in both early and advanced stage nasopharyngeal carcinoma. The preliminary clinical result is encouraging.
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
2004年第3期154-157,共4页
Chinese Journal of Radiation Oncology
