本文關(guān)鍵詞：新輔助化療對局部晚期鼻咽癌自適應(yīng)放療的影響　出處：《醫(yī)學(xué)研究雜志》2017年08期 　論文類型：期刊論文

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【摘要】：目的研究局部晚期鼻咽癌新輔助化療前后腫瘤體積變化,對調(diào)強放療鼻咽癌患者腮腺、腦干、脊髓等劑量分布的影響,進而明確新輔助化療在自適應(yīng)放療中的影響。方法選取2014年5~9月期間15例福建省腫瘤醫(yī)院收治的鼻咽癌患者,均接受新輔助化療、同步放化療,放療采用調(diào)強放射治療。治療前和第2周期新輔助化療結(jié)束2周后分別行定位CT掃描,分別進行靶區(qū)勾畫。根據(jù)兩次CT制定plan1和plan2,將plan1映射到化療后CT上獲得新的計劃plan1',分別對比plan1、plan1'、plan2,分析其解剖學(xué)及劑量學(xué)分布改變。結(jié)果 2周期新輔助化療結(jié)束,GTVnx(P=0.000)及GTVnd(P=0.000)平均體積均明顯縮小。將plan1和plan1'對比,頸部轉(zhuǎn)移淋巴結(jié)最大層面最短徑≥3cm(N≥3cm)的患者,其腮腺的Dmean、D50劑量明顯升高(P0.05)。將plan1'和plan2對比,脊髓的Dmax、D1cc劑量降低,腮腺(N≥3cm)組Dmean、D50劑量明顯降低(P0.05)。將6例原發(fā)腫瘤靠近腦干的患者進行劑量分析發(fā)現(xiàn),plan1'和plan2對比,腦干Dmax(P=0.001)及D1cc(P=0.038)均降低。結(jié)論新輔助化療后鼻咽腫瘤體積明顯縮小,減少放射治療過程中的解剖學(xué)和劑量學(xué)分布改變,從而減少放療過程中實際劑量分布與計劃劑量分布的差異,有助于減少自適應(yīng)放療過程中修正治療計劃的次數(shù)。新輔助化療有助于N≥3cm的鼻咽癌患者腮腺的保護,也可降低腫瘤靠近腦干患者的腦干損傷。
[Abstract]:Objective to study the effects of neoadjuvant chemotherapy on the dose distribution of parotid gland, brain stem and spinal cord in patients with nasopharyngeal carcinoma (NPC) treated by intensity modulated radiotherapy (IMRT). Methods from 2014 to September, 15 patients with nasopharyngeal carcinoma treated in Fujian Provincial Cancer Hospital received neoadjuvant chemotherapy and concurrent radiotherapy and chemotherapy. Radiotherapy was performed with intensity modulated radiotherapy. Before and 2 weeks after the end of the second cycle of neoadjuvant chemotherapy, the localization CT scan was performed, and the target area was delineated respectively. Plan1 and plan2 were determined according to twice CT. New plan1s were obtained by mapping plan1 to CT after chemotherapy and compared with plan1 / plan1and plan2 respectively. Results 2 cycles of neoadjuvant chemotherapy were completed. Plan1 and plan1 'were compared with plan1. The Dmean of parotid gland was found in patients with the shortest diameter of the largest layer of cervical metastatic lymph nodes 鈮，

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