【摘要】：目的：探討自適應放療(adaptive radiation therapy, ART)在鼻咽癌患者(nasopharyngeal carcinoma, NPC)調強放療(intensity-modulated radiation therapy, IMRT)過程中對靶區(qū)和危及器官劑量的影響。方法：前瞻性分析11例鼻咽癌調強放療患者,放療至5次、15次時重新獲取新的定位CT圖像(CT1、CT2),制定新的放療計劃(replanl、replan2),并用于后續(xù)治療,即自適應放療。將原始計劃(plan0)傳遞到新CT圖像上生成計劃(plan1、plan2),通過勾畫系統(tǒng)中的工作流進行劑量疊加,合成計劃plan0+replanl+replan2與plan0+planl+plan2,為自適應與非自適應放療時的劑量分布情況,觀察并比較兩者靶區(qū)及危及器官劑量學差異。結果：與非白適應放療比較,自適應放療時靶區(qū)PTVnd、PTV1和PTV2的CI值上升,差異具有統(tǒng)計學意義,HI值變化不大。PTVnx中的V95中位值升高(P=0.013),PTVnd中的D95、D99、V100、V95和V93值分別升高2.16±2.52Gy、4.52±6.24Gy、5.47±7.27、2.6±3.5%和2.01±2.77%,PTVl的D95、V100值分別升高0.71±0.97Gy、0.56±0.65%、PTV2的D95、D99、V100、V95、V93值分別升高0.47±0.61 Gy、1.06±1.45 Gy、0.99±1.13%、0.50 ±0.61%和0.38±0.50%,以上差異均具有統(tǒng)計學意義。在危及器官中,經(jīng)2次計劃優(yōu)化后,與非自適應放療比較,自適應放療中腦干、右側顳葉Dmax分別下降2.34±2.63Gy和0.73±1.06Gy,右側視神經(jīng)Dmax中位值下降,聲門、聲門上Dmean分別降低3.95±3.99Gy和2.98±3.85Gy,左側腮腺Dmean、V30分別下降1.36±1.90Gy和3.12±4.42%,皮膚V55下降0.85±1.20%,以上差異均具有統(tǒng)計學意義,其余OARs如眼球、晶體、視交叉、視神經(jīng)、下頜骨、顳下頜關節(jié)、食管、口腔、耳蝸等劑量學改變均無統(tǒng)計學意義結論：鼻咽癌患者在放療至5次、15次時進行自適應放療,可以使靶區(qū)適形度和劑量覆蓋得到改善,部分危及器官照射劑量下降,彌補了放療過程中發(fā)生的劑量學變化。
[Abstract]:Objective: to investigate the effect of adaptive radiotherapy (adaptive radiation therapy, ART) on target area and endangered organ dose during (nasopharyngeal carcinoma, NPC) intensity modulation radiotherapy (intensity-modulated radiation therapy, IMRT) in patients with nasopharyngeal carcinoma (NPC). Methods: 11 patients with nasopharyngeal carcinoma undergoing intensity modulation radiotherapy were analyzed prospectively. new localized CT images (CT1,CT2) were obtained after radiotherapy for 5 times and 15 times, and a new radiotherapy plan (replanl,replan2) was made and used for follow-up treatment, that is, adaptive radiotherapy. The original plan (plan0) was transferred to the new CT image generation plan (plan1,plan2). By sketching the workflow in the system for dose superposition, the dose distribution of the synthetic plan plan0 replanl replan2 and plan0 planl plan2, for adaptive and non-adaptive radiotherapy was observed and compared, and the dosimetric differences between the target area and the endangered organ were observed and compared. Results: compared with non-white adaptive radiotherapy, the CI values of PTVnd,PTV1 and PTV2 in adaptive radiotherapy were significantly higher than those in non-white adaptive radiotherapy. The median value of V95 in PTVnx was higher than that in non-white adaptive radiotherapy (D95, D99, V100, V95 and V93 in P 鈮，

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