摘要
背景与目的:头颈部淋巴水肿(head and neck lymphedema,HNL)是鼻咽癌(nasopharyngeal carcinoma,NPC)调强放射治疗(intensity-modulated radiotherapy,IMRT)后一种常见的不良反应,但相关的研究和报道则较少。该研究旨在探索一种预防或减轻NPC患者放疗后HNL的计划设计方法,研究其剂量学可行性。方法:对20例NPC患者分别设计两组计划,计划A按常规方法设计简单调强放射治疗(simplified intensitymodulated radiotherapy,sIMRT)计划,计划B在计划A的基础上使用头颈前部淋巴引流保护区设计的sIMRT计划,比较两组计划在靶区剂量分布、危及器官(organ at risk,OAR)受量和机器跳数方面的差异。结果:两组计划靶区剂量分布均满足临床要求,计划靶区1(planning target volume 1,PTV1)的各项指标在两组间的差异均无统计学意义,计划A中PTV2的D98%、V100%(%)、V95%(%)和均匀性指数(homogeneity index,HI)均优于计划B(t=4.134、3.455、2.423和-2.410,P<0.05)。计划A中左、右腮腺Dmean和左侧腮腺V30均低于计划B(t=-2.454、-2.113和-4.651,P<0.05);但计划A的口腔Dmean和V50高于计划B(t=4.639和2.237,P<0.05);计划A的喉Dmean和V50也高于计划B(t=10.934和4.624,P<0.05)。机器跳数方面,计划B比计划A略有增加,但差异无统计学意义。结论:NPC患者给予头颈前部淋巴引流保护区的计划设计在剂量学上是可行的,在满足临床靶区覆盖的前提下,于头颈前部留出了低剂量(<20 Gy)照射的区域以利于淋巴回流,更好地保护了口腔、喉等可导致淋巴水肿的正常组织。
Background and purpose： Head and neck lymphedema（HNL） is a common side effect of intensitymodulated（IMRT） radiotherapy for nasopharyngeal carcinoma（NPC）, but few studies have been reported. The purpose of this study was to explore a method to prevent or mitigate HNL after radiotherapy for NPC patients and to study its dosimetric feasibility. Methods： Two groups of plans were designed for 20 NPC patients. Plan A included simplified intensity-modulated radiotherapy（sIMRT） plans by conventional method, and plan B included sIMRT plans using the anterior head and neck lymphatic drainage protection area. Dose distributions of the target, dose-volume parameters of organs at risk（OAR） and the total monitor units（MU） were compared between the two groups. Results： The target dose distributions of the two groups all met the clinical requirements. The indicators of planning target volume 1（PTV1） had no significant difference between the two groups. In plan A, D98%, V100%（%）, V95%（%） and homogeneity index（HI） of PTV2 were superior to those in plan B（t=4.134, 3.455, 2.423 and-2.410, P〈0.05）. Dmean of left and right parotid gland and V30 of left parotid gland in plan A were lower than those in plan B（t =-2.454,-2.113 and-4.651, P〈0.05）. For oral cavity, Dmean and V50 were higher in plan A（t=4.639 and 2.237, P〈0.05）. Similarly, Dmean and V50 of larynx were also higher in plan A（t=10.934 and 4.624, P〈0.05）. Compared with plan A, the total MU of plan B increased slightly, but the differences were not statistically significant. Conclusion： The plan design of the anterior head and neck lymphatic drainage protection is feasible in dosimetry for NPC patients. Without sacrificing the target coverage, a low-dose（〈20 Gy） lymphatic drainage area can be reserved to the front of head and neck while oral cavity and larynx are better protected.
作者
黄娟
陈晓慧
翟瑞萍
孔芳芳
应红梅
HUANG Juan;CHEN Xiaohui;ZHAI Ruiping;KONG Fangfang;Y(Department of Radiation Oncology,Fudan University Shanghai Cancer Cente;Department of Oncology,Shanghai Medical College,Fudan University,Shanghai 200032,China)
出处
《中国癌症杂志》
CAS
CSCD
北大核心
2018年第9期692-697,共6页
China Oncology
关键词
鼻咽癌
头颈部淋巴水肿
简单调强放射治疗
危及器官
Nasopharyngeal carcinoma
Head and neck lymphedema
Simplified intensity-modulated radiotherapy
Organ at risk
