【摘要】：目的：回顧性分析339例鼻咽癌調(diào)強放療計劃的劑量分布，重點分析局部治療失敗患者調(diào)強放療計劃的劑量學特點，，以評價治療計劃的合理性。 方法：2006年6月至2010年12月，339例病理證實的鼻咽癌（NPC）患者接受全程調(diào)強放療（IMRT）。利用劑量體積直方圖(dose volumehistogram，DVH)分析靶區(qū)及部分危及器官劑量學特點。將局部治療失敗患者療前和復發(fā)時局部病灶范圍于三維治療計劃系統(tǒng)進行對比，根據(jù)等劑量曲線進行劑量學評價，分為野內(nèi)復發(fā)、野邊緣復發(fā)及野外復發(fā)。并分析相關(guān)預(yù)后因素。 結(jié)果：中位隨訪時間為22.5個月（5~62個月），共12例局部治療失敗，12例均為野內(nèi)復發(fā)，全組1、2、3年局部控制率、區(qū)域控制率分別為98.1%、96.5%、95.7%；99.3%、98.5%、97.8%。不同T分期PGTVnx平均Dmin、Dmean和D95分別為T1：66.03Gy、74.16Gy、71.19Gy；T2：66.23Gy、73.26Gy、70.53Gy；T3：65.98Gy、73.62Gy、70.66Gy；T4：65.11Gy、72.36Gy、70.18Gy。多因素分析顯示PGTVnx-66.5Gy(p=0.026, HR=2.12)和年齡(p=0.013, HR=2.29)是局部控制率的獨立影響因子。放化綜合治療的副反應(yīng)可較好耐受。 結(jié)論：目前的鼻咽癌調(diào)強放療計劃取得了較好的局部控制率，同時有效保護了正常組織。原發(fā)腫瘤局部加量照射有望進一步提高局部控制率。 目的：報道首程無遠處轉(zhuǎn)移鼻咽癌調(diào)強放療的初步臨床療效。 方法：回顧性分析2006年6月至2010年12月采用調(diào)強放療的首程無遠處轉(zhuǎn)移鼻咽癌患者臨床資料。采用Kaplan-Meier法進行生存分析，Cox回歸模型進行多因素分析評價預(yù)后因子，RTOG／EORTC標準評價急性放療反應(yīng)和晚期損傷。 結(jié)果：339例初治鼻咽癌患者，男性244例，女性95例，男：女比例為2.57:1，中位年齡44歲。根據(jù)2010AJCC/UICC分期，76.1%（258例）為Ⅲ/Ⅳ期患者。中位隨訪時間為22.5個月,隨訪率為97.3%。全組1、2、3年總生存率分別為99.0%、94.9%、90.7%；疾病特異生存率分別為99.1%、97.0%、94.2%；無疾病生存率分別為96.4%、92.9%、86.4%；無遠處轉(zhuǎn)移生存率分別為97.1%、93.6%、88.1%。Cox多因素分析顯示年齡(p=0.026、HR=2.959)和PGTVnx-66.5Gy (p=0.032、HR=1.306)是無疾病生存的獨立預(yù)后因子，PGTVnx-66.5Gy (p=0.016、HR=3.065)是無遠處轉(zhuǎn)移生存的獨立預(yù)后因子。年齡和臨床分期是總生存率的獨立預(yù)后因子(p=0.036,HR=2.985；p=0.004, HR=3.718)；臨床分期是疾病特異生存的獨立預(yù)后因子(p=0.002, HR=4.096)。常見急性放療不良反應(yīng)為1、2級皮膚損傷(98.8%)及2、3級口腔黏膜損傷(95.0%)。隨訪超過2年的患者中12名仍存在1、2級腮腺損傷，未觀察到3、4級晚期損傷。 結(jié)論：本中心IMRT治療首程無轉(zhuǎn)移鼻咽癌可獲得理想的局部區(qū)域控制率及總生存率，對正常組織器官有較好的保護作用。急性不良反應(yīng)可較好耐受，遠處轉(zhuǎn)移是本中心治療失敗的主要模式。
[Abstract]:Objective: to analyze the dose distribution of 339 patients with nasopharyngeal carcinoma (NPC) treated by intensity modulated radiotherapy (IMRT), and to analyze the dosimetric characteristics of IMRT in patients with failed local treatment, and to evaluate the rationality of the treatment plan. Methods: from June 2006 to December 2010, 339 patients with pathologically proved nasopharyngeal carcinoma (NPC) received (IMRT). With full intensity modulated radiotherapy (IMRT). Dose volume histogram (dose volumehistogram,DVH) was used to analyze the dosimetric characteristics of target and partial organ hazards. The range of local focus before and after local treatment failure was compared with that of 3D treatment planning system. Dosimetric evaluation was carried out according to the isodose curve, which was divided into field recurrence, field marginal recurrence and field recurrence. The prognostic factors were analyzed. Results: the median follow-up time was 22.5 months (5 ~ 62 months). Twelve cases of local treatment failure and 12 cases of local recurrence were found. The local control rate was 98.1 96.5% and the regional control rate was 98.1 96.5% (99.5%) and 97.8% respectively. The average Dmin,Dmean and D95 of PGTVnx in different T stages were T 1: 66.03 Gy (74.16 Gy) and T 2: 66.23 Gy (73.26 Gy) 70.53 Gy (T3: 65.98 Gy / 73.66 Gy) T4: 65.11 72.36 Gy (70.18 Gy). Multivariate analysis showed that PGTVnx-66.5Gy (p0. 026, HR=2.12) and age (p0. 013, HR=2.29) were independent factors of local control rate. The side effects of combined radiotherapy and chemotherapy can be well tolerated. Conclusion: the current intensity-modulated radiotherapy program for nasopharyngeal carcinoma has achieved a good local control rate and effectively protected normal tissue. Local dose irradiation of primary tumor is expected to further improve the local control rate. Objective: to report the preliminary clinical effect of intensity modulated radiotherapy (IMRT) for nasopharyngeal carcinoma without distant metastasis. Methods: the clinical data of patients with primary metastatic nasopharyngeal carcinoma without distant metastasis were retrospectively analyzed from June 2006 to December 2010. Kaplan-Meier survival analysis Cox regression model was used to evaluate prognostic factors RTOG / ORTC criteria for acute radiation response and late injury. Results of 339 patients with nasopharyngeal carcinoma, 244 were males and 95 were females. The ratio of males to females was 2.57: 1. The median age was 44 years old. According to 2010AJCC/UICC staging, 76.1% (258 cases) were stage 鈪

本文編號：2201833