本文關(guān)鍵詞： 鼻咽癌 調(diào)強(qiáng)放療 咽縮肌 喉 劑量分布　出處：《中華腫瘤防治雜志》2017年04期 　論文類型：期刊論文

【摘要】：目的鼻咽癌高危危及器官的勾畫和限量受到廣泛重視,但低危危及器官的勾畫常被放療醫(yī)師忽視。為此本研究探討中下咽縮肌、喉及主支氣管勾畫對(duì)其劑量分布的影響,以及與放療期間咳嗽反應(yīng)間的關(guān)系。方法回顧性分析2014-06-01-2015-08-30海南省人民醫(yī)院放療科收治的68例N2期鼻咽癌的治療計(jì)劃及放療期間的咳嗽反應(yīng),根據(jù)是否勾畫中下咽縮肌、喉及主支氣管分為勾畫組和未勾畫組,兩組均為34例。通過劑量-體積直方圖(dosse volume histograms,DVH)評(píng)估計(jì)劃靶區(qū)(the planning target volume,PTV,包括PTV1、PTV2和PTVnd)和危及器官(organs at risk,OAR,包括咽縮肌、喉、主支氣管及甲狀腺)劑量分布,以及兩組間的咳嗽反應(yīng)差異。結(jié)果兩組靶區(qū)(PTV1、PTV2和PTVnd)劑量分布差異無統(tǒng)計(jì)學(xué)意義。勾畫組與未勾畫組PTV2的適形指數(shù)(conformity index,CI)分別為0.97±0.24和0.93±0.02,P0.001。勾畫組的咽縮肌V_(55)(t=3.881,P=0.004)、V_(50)(t=5.102,P=0.001)和V_(40)(t=34.028,P0.001)均小于未勾畫組,兩組比較差異均有統(tǒng)計(jì)學(xué)意義;V_(30)、V25兩組比較差異無統(tǒng)計(jì)學(xué)意義,P0.05。勾畫組的喉及主支氣管接受55Gy照射的體積V_(55)(t=2.266,P=0.038)、V_(50)(t=6.734,P0.001)、V_(40)(t=17.056,P0.001)和V_(30)(t=47.28,P0.001)小于未勾畫組,兩組比較差異均有統(tǒng)計(jì)學(xué)意義;V20、V15兩組比較差異無統(tǒng)計(jì)學(xué)意義,P0.05。未勾畫組更容易發(fā)生3級(jí)咳嗽反應(yīng)。限定主支氣管劑量可顯著降低甲狀腺V_(40)(t=8.728,P0.001)、V_(50)(t=9.153,P0.001)和V_(60)(t=8.467,P0.001)。結(jié)論勾畫咽縮肌、喉及主支氣管可顯著降低其高劑量段(40~55Gy)的受照體積,提高PTV2的適形度,并減輕咳嗽反應(yīng),同時(shí)可減少甲狀腺照射劑量以及40~60Gy的受照體積。低危OAR的勾畫和劑量限定應(yīng)受到重視。
[Abstract]:Objective the drawing and limitation of high risk organs of nasopharyngeal carcinoma (NPC) have been paid more attention to, but the sketches of low risk organs are often ignored by radiotherapy doctors. Effects of laryngeal and main bronchus drawing on dose distribution. Methods retrospective analysis of 68 patients with N2 stage nasopharyngeal carcinoma treated by Department of radiotherapy, Hainan Provincial people's Hospital, 2014-06-01-2015-08-30. Cough reaction during stroke and radiotherapy. According to whether or not to draw the hypopharyngeal contraction muscle, larynx and main bronchi were divided into sketching group and unsketched group. There were 34 cases in both groups. Dosse volume histograms was obtained by dose-volume histogram. Planning target volume PTVs, including PTV1. The dose distribution of PTV2 and PTVnd and the organ at riskard, including pharyngeal contractile muscle, larynx, main bronchus and thyroid gland. Results PTV1 was found in the target area of the two groups. There was no significant difference in dose distribution between PTV2 and PTVnd.The conformal index of PTV2 was conformity index. The CIs were 0.97 鹵0.24 and 0.93 鹵0.02 P0.001 respectively. There were significant differences between the two groups (P < 0.05) and V _ (40) (P _ (0.001)) were significantly lower than those of the unpainted group (P _ (0.001)). There was no significant difference between the two groups (P 0.05). P0. 038 / V / T / T 6.734 / P 0.001 / V / T / T / T 17.056. P0.001) and VACTH 47.28 (P0.001) were significantly lower than those of unpainted group (P 0.001), and there were significant differences between the two groups. There was no significant difference between V20 and V15 groups. P0.05. the undelineated group was more likely to develop grade 3 cough. Limiting the dose of the main bronchus could significantly reduce the thyroid Vastitis (8.728% P0.001). Conclusion the pharyngeal contractile muscle is delineated. Larynx and main bronchus could significantly reduce the irradiation volume of PTV2, improve the conformability of PTV2, and relieve cough reaction. At the same time, the irradiation dose of thyroid gland and the irradiation volume of 40g / 60Gy were reduced. The outline and dose limit of low-risk OAR should be paid more attention to.
【作者單位】： 海南省人民醫(yī)院放療科;
【分類號(hào)】：R730.55;R739.63
【正文快照】： 中華腫瘤防治雜志,2017,24(4):252-256Chin J Cancer Prev Treat,2017,24(4):252-256鼻咽癌放療期間的急性反應(yīng)如吞咽疼痛、咳嗽與放療引起的急性咽炎、主氣管炎有關(guān),而咽喉及主支氣管的黏膜炎與受照劑量有關(guān)[1-2]。關(guān)于勾畫咽縮肌和主支氣管對(duì)其劑量分布的影響、以及與急性咳，

本文編號(hào)：1459586