本文選題：鼻咽癌　切入點：調(diào)強放療　出處：《廣西醫(yī)科大學(xué)》2012年碩士論文

【摘要】：研究背景： 鼻咽癌是較為常見的頭頸部腫瘤,尤其在中國南方及東南亞各國發(fā)病率較高,放療是其主要治療手段。鼻咽癌的局部控制率與靶體積的照射劑量呈正相關(guān)。近年來由于IMRT等放療技術(shù)的逐漸開展,療效不斷改進(jìn),患者生存時間也越來越長,對生存質(zhì)量的要求也越來越高。而放射性腦損傷是影響鼻咽癌患者生存質(zhì)量的重要并發(fā)癥之一。 近來有研究指出頭頸部腫瘤放療中會出現(xiàn)明顯的解剖位置變化,因此多程放療計劃可能會導(dǎo)致靶區(qū)和正常組織器官所受劑量發(fā)生改變。自適應(yīng)放療是指在治療過程中對患者的CT/MRI影像進(jìn)行重新計劃設(shè)計,解決靶區(qū)及正常組織器官改變引起的劑量變化的有效手段,從而達(dá)到提高靶區(qū)劑量、降低正常組織器官劑量,改善患者遠(yuǎn)期生存質(zhì)量的目的。但目前尚無自適應(yīng)放療對顳葉劑量影響的大宗病例研究結(jié)果。本研究擬回顧性比較一組顱底受累的初治鼻咽癌患者于調(diào)強放射治療后改和不改計劃的長期療效和放射性顳葉損傷的發(fā)生率,并對部分患者的顳葉進(jìn)行劑量學(xué)分析,以評價自適應(yīng)調(diào)強放療對顳葉損傷的影響。 研究目的： 回顧性收集和分析接受調(diào)強放射治療的鼻咽癌患者資料,觀察和初步總結(jié)單程與自適應(yīng)調(diào)強放療計劃對放射性顳葉損傷的發(fā)生率及其臨床劑量學(xué)特征。 材料與方法： 收集2002年1月至2010年1月在四川省腫瘤醫(yī)院接受IMRT放射治療且無遠(yuǎn)處轉(zhuǎn)移的初治T3、T4期鼻咽癌患者,篩選出滿足條件患者共221例。分為2組：單程IMRT+化療161例：多程IMRT+化療60例；通過門診復(fù)查、電話及信函方式隨訪,并獲取患者定期復(fù)查資料,包括MRI/CT檢查、胸片和ECT等,以評價并計算鼻咽局部控制率、放射性顳葉損傷、以及患者遠(yuǎn)期療效。采用Kaplan-Meier法計算局部控制率(LC)、無遠(yuǎn)轉(zhuǎn)生存率(D-MFS)、無病生存率(DFS)和總生存率(OS)。 通過查詢病歷資料,找出這些患者的計劃號。通過計劃號在計劃系統(tǒng)CORVUS6.2(NOMOS MIMIC)上調(diào)出9年來患者所做的放療計劃,并記錄下顳葉的受照射劑量情況。根據(jù)治療方式、年齡、分割劑量、化療方案對所有患者進(jìn)行亞分組。分析各組放射性顳葉損傷發(fā)生比率,并比較發(fā)生與無發(fā)生放射性顳葉壞死患者之間的顳葉實際接受劑量(D5,D1,Dlcc)的差異。 研究結(jié)果： 1、全部患者的中位隨訪時間為54.7個月(6-96個月),5年隨訪的初步結(jié)果,自適應(yīng)放療和單程調(diào)強放療治療局部晚期鼻咽癌局控率(LC)、無遠(yuǎn)處轉(zhuǎn)移率(D-MFS)、無病生存率(DFS)及總生存率(OS)分別為：97.5%、91.1%、73.5%、75.8%和96.6%、90.2%、71.2%、71.4%。 2、自適應(yīng)調(diào)強放療,可以使T3/T4期鼻咽癌患者顳葉得到較好的保護,放射性顳葉損傷率降低。單程調(diào)強放療放射性顳葉損傷率為14.7%；自適應(yīng)調(diào)強放療放射性顳葉損傷率為5%。 3、發(fā)生放射性顳葉損傷患者其左、右側(cè)顳葉的D05分別為76.67±5.61Gy/33F和74.52±5.82Gy/33F,均顯著高于無放射性顳葉壞死者(64.52±4.82Gy/33F和64.71±4.74/33F(P0.05)。自適應(yīng)放療顳葉D05(61.67±3.47/33F)明顯低于單程調(diào)強放療(65.67±4.56/33F)(P0.01)。 4、分割劑量≤2Gy時放射性顳葉損傷發(fā)病率為6.4%(21/190)明顯低于分割劑量2Gy/F顳葉損傷發(fā)生率(12.6%)(P0.01)；年齡50歲時患者顳葉損傷率為14.1%,顯著高于≤50歲患者顳葉損傷率(7.6%)(P0.01)。TP和PF化療方案對放射性顳葉損傷發(fā)生率無明顯(P0.05) 結(jié)論： 1、5年隨訪的初步結(jié)果提示,自適應(yīng)放療治療局部晚期鼻咽癌與單程調(diào)強放療相比,沒有明顯改善局控率(LC)及無遠(yuǎn)處轉(zhuǎn)移率(D-MFS)；但可提高無病生存率(DFS)及總生存率(OS) 2、與單程調(diào)強放療相比,自適應(yīng)放療可以顯著降低局部晚期鼻咽癌患者顳葉損傷發(fā)生率,年齡和分割劑量是重要的影響因素。 3、劑量學(xué)分析提示,自適應(yīng)放療患者的顳葉受照劑量(D01、D05、D1cc)顯著低于單程調(diào)強放療；顳葉損傷患者左、右側(cè)顳葉的受量顯著高于無放射性顳葉損傷者。 4、本研究推薦：顳葉放療限制劑量D0565Gy/33F,D1cc75Gy/33F。
[Abstract]:Research background:
Nasopharyngeal carcinoma is a common head and neck cancer, especially in China South and Southeast Asian countries with high incidence, radiotherapy is the main treatment. The local control rate and radiation dose was positively related to the target volume of nasopharyngeal carcinoma. In recent years, due to the gradual development of IMRT and other radiotherapy, the curative effect of continuous improvement, the survival time is getting longer and quality of life are increasingly high requirements. Radiation brain injury is one of the most important complications affecting the quality of life of patients with nasopharyngeal carcinoma.
Recent studies have pointed out the apparent anatomical position changes will head and neck cancer, multi course radiotherapy plan may lead to the target and normal tissue and organ doses to change. Adaptive radiotherapy refers to the CT/MRI images of patients in the treatment process to plan design, effective means to solve the target and normal tissue the organ dose changes due to the change, so as to improve the target dose, reducing the dose of normal tissues and organs, improve the quality of life of patients with long-term purpose. But there is no impact on temporal lobe adaptive radiotherapy dose of major cases. The results of this study retrospectively compared a group of skull base involvement of NPC patients with IMRT after radiotherapy and long term treatment does not change the plan and radioactive temporal lobe injury incidence, and some patients with temporal lobe dosimetry analysis to evaluate the self adaptation The effect of intensity modulated radiation therapy on temporal lobe injury.
The purpose of the study is:
We retrospectively collected and analyzed the data of nasopharyngeal carcinoma patients undergoing intensity modulated radiation therapy. We observed and summarized the incidence and clinical dosimetry characteristics of single and adaptive intensity modulated radiation therapy for radiation temporal lobe injury.
Materials and methods:
From January 2002 to January 2010 in the tumor hospital of Sichuan province received IMRT radiotherapy and metastasis of untreated T3, stage T4 nasopharyngeal carcinoma were selected to meet the conditions of patients with a total of 221 cases. Divided into 2 groups: single IMRT+ chemotherapy in 161 cases: 60 cases with IMRT+ chemotherapy; outpatient review, follow-up telephone and letters. And get patients regularly reviewed data, including MRI/CT examination, chest X-ray and ECT, to evaluate and calculate the control rate of nasopharynx, radiation-induced temporal lobe injury, and patients with long-term effect. The local control rate calculation using Kaplan-Meier method (LC), distant MFS (D-MFS), disease free survival rate (DFS) and total the survival rate (OS).
By querying the medical records of these patients to find out plan. The plan in the planning system of CORVUS6.2 (NOMOS MIMIC) increased in 9 years to do with radiotherapy, and record the temporal lobe radiation dose. According to treatment, age, dose of chemotherapy for segmentation, sub group of all patients. Analysis of each radioactive temporal lobe injury incidence rate, and compare the occurrence and non occurrence of radioactive temporal lobe necrosis in patients with temporal lobe dose (D5, actually received D1, Dlcc) of the difference.
The results of the study:
1, the median follow-up time for all patients was 54.7 months (6-96 months), the preliminary results of 5 years of follow-up, adaptive radiotherapy and one way intensity-modulated radiotherapy for locally advanced nasopharyngeal carcinoma (LC), the local control rate without distant metastasis rate (D-MFS), disease free survival rate (DFS) and overall survival (OS) were 97.5%, 91.1%, 73.5%, 75.8% and 96.6%, 90.2%, 71.2%, 71.4%.
2, adaptive intensity modulated radiation therapy can protect the temporal lobe of patients with stage T3/T4 nasopharyngeal carcinoma, and reduce the incidence of radiation temporal lobe injury. The rate of radiation temporal lobe injury in single intensity modulated radiation therapy is 14.7%, and the rate of radiation temporal lobe injury in adaptive intensity modulated radiation therapy is 5%.
3, radioactive temporal lobe injury in patients with left and right temporal lobe D05 were 76.67 + 5.61Gy/33F and 74.52 + 5.82Gy/33F were significantly higher than that of non radioactive temporal lobe necrosis (64.52 + 4.82Gy/33F and 64.71 + 4.74/33F (P0.05). Adaptive radiotherapy of temporal lobe D05 (61.67 + 3.47/33F) significantly lower than single IMRT (65.67 + 4.56/33F) (P0.01).
4, when the split dose is less than or equal to 2Gy radioactive temporal lobe injury incidence rate was 6.4% (21/190) was significantly lower than the segmentation dose of 2Gy/F temporal lobe injury incidence (12.6%) (P0.01); age of 50 patients with temporal lobe injury rate was 14.1%, significantly higher than that of less than 50 years old patients with temporal lobe injury rate (7.6%) (P0.01).TP and PF chemotherapy on radiation-induced temporal lobe injury incidence was no significant (P0.05)
Conclusion:
The initial results of 1,5 follow-up showed that the adaptive radiotherapy for locally advanced nasopharyngeal carcinoma did not significantly improve the local control rate (LC) and the distant metastasis rate (D-MFS) compared with the single pass intensity modulated radiotherapy, but it increased the disease-free survival rate (DFS) and the overall survival rate (OS).
2, compared with one-way intensity modulated radiation therapy, adaptive radiotherapy can significantly reduce the incidence of temporal lobe injury in locally advanced nasopharyngeal carcinoma patients. Age and split dose are important factors.
3, dosimetric analysis showed that the radiation dose (D01, D05, D1cc) of the patients in the adaptive radiotherapy group was significantly lower than that of the single pass intensity modulated radiotherapy. The amount of left and right temporal lobe in the patients with temporal lobe injury was significantly higher than that in the patients without radiation temporal lobe injury.
4, this study recommended: temporal lobe radiotherapy limited dose D0565Gy/33F, D1cc75Gy/33F.

【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R739.63

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