本文關(guān)鍵詞： 鼻咽癌 螺旋斷層放療 靶體積 危及器官 急性反應(yīng)　出處：《中國人民解放軍軍醫(yī)進修學(xué)院》2010年碩士論文　論文類型：學(xué)位論文

【摘要】： 目的研究鼻咽癌螺旋斷層放射治療(Helical Tomotherapy, HT)過程中靶區(qū)和危及器官的變化及近期臨床觀察。 方法回顧性分析2008年3月至2010年1月收治的43例經(jīng)病理證實的、在我科接受螺旋斷層放療的鼻咽癌患者,所有病例均在治療第20次時重復(fù)行CT掃描及治療計劃設(shè)計。比較兩次定位CT中原發(fā)腫瘤(GTVnx)、轉(zhuǎn)移性淋巴結(jié)(GTVnd)、腮腺的體積和面部輪廓橫徑的變化,并分析其變化規(guī)律。根據(jù)RTOG/EORTC標準,在治療結(jié)束時及結(jié)束后1個月評價急性反應(yīng),同時觀察近期療效。 結(jié)果兩次CT掃描間隔23-28天,中位間隔時間25天。比較兩次CT掃描圖像觀察到,GTVnx、GTVnd、腮腺體積及面部輪廓橫徑均發(fā)生了明顯的變化,其中GTVnx體積平均縮小了30.1%、中位29.8%,GTVnd體積平均縮小了41.6%、中位45.9%,左側(cè)腮腺體積平均縮小了35.5%、中位33.4%,右側(cè)腮腺體積平均縮小了36.8%、中位33.5%,面部輪廓橫徑縮小了9.4%(1.6cm)、中位9.1%(1.6cm)。其中GTVnx和GTVnd體積的縮小與其初始體積有顯著相關(guān)性,且GTVnd體積的縮小與體重下降程度有相關(guān)性,但均與不同治療方式無相關(guān)性。急性放射反應(yīng)以1、2級為主,其中皮膚為95%,唾液腺和粘膜分別為100%和93%。6例原發(fā)病灶完全緩解(CR,14.0%),32例部分緩解(PR,74.4%),5例病灶穩(wěn)定(SD,11.6%)；在有淋巴結(jié)轉(zhuǎn)移的39例患者中,16例CR(37.2%),21例PR(48.8%),1例SD(2.3%)；鼻咽原發(fā)灶和頸部轉(zhuǎn)移淋巴結(jié)消退率分別為88.37%和94.87%。中位隨訪9個月,無腫瘤局部復(fù)發(fā),2例患者出現(xiàn)骨轉(zhuǎn)移,2例患者死亡,均死于局部大出血。 結(jié)論鼻咽癌患者在螺旋斷層放療過程中,存在著明顯的靶區(qū)及腮腺體積的縮小和面部輪廓等解剖結(jié)構(gòu)的變化,這將會影響劑量分布,及治療的精確性,因而對于有明顯解剖體積變化的患者,應(yīng)選擇合適的時機重新行CT掃描并及時調(diào)整治療計劃。鼻咽癌螺旋斷層放療急性放射反應(yīng)較輕,遠期結(jié)果需要進一步觀察。
[Abstract]:Objective to study the changes of target area and dangerous organs during helical tomography radiotherapy (HTT) in nasopharyngeal carcinoma (NPC). Methods from March 2008 to January 2010, 43 patients with nasopharyngeal carcinoma (NPC) who had been treated with spiral radiation in our department were retrospectively analyzed. The CT scan and treatment plan design were performed repeatedly in all patients at the 20th time of treatment. The changes of the volume of parotid gland and the transverse diameter of facial contour were compared and analyzed according to RTOG/EORTC standard. Acute response was evaluated at the end of treatment and 1 month after treatment. Results the interval between two CT scans was 23-28 days and the median interval was 25 days. The volume of GTVnx was reduced by 30.1 on average, the volume of GTVnd by 29.8m was reduced by 41.6 on average, the volume of left parotid gland was reduced by 45.9, the volume of left parotid gland was reduced by 35.5. the median was 33.4, the volume of right parotid gland was reduced by 36.8, the median by 33.5. the transverse diameter of facial contour was reduced by 9.41.6cmand the median by 9.1cm. The reduction of GTVnx and GTVnd volumes was significantly correlated with their initial volumes. The reduction of GTVnd volume was correlated with the degree of weight loss, but not with different treatment methods. The skin was 95, the salivary gland and mucous membrane were 100% and 93.6, respectively, and there were 32 cases with partial remission of PRN 74.4% and 5 cases with stable SDN 11.6D, among 39 cases with lymph node metastasis, 16 cases with CR37.221 cases with PRT 48.8% and 1 case with SD2. 3% with primary nasopharynx focus and cervical metastasis. The lymph node regression rates were 88.37% and 94.87, respectively. No tumor recurrence occurred in 2 patients with bone metastasis and 2 patients died of local hemorrhage. Conclusion there are obvious changes in target area, parotid gland volume and facial contour in patients with nasopharyngeal carcinoma, which will affect the dose distribution and the accuracy of treatment. Therefore, for patients with obvious anatomical volume changes, CT scan and timely adjustment of treatment plan should be chosen at the appropriate time. The acute radiation response of nasopharyngeal carcinoma treated by spiral tomography radiotherapy is mild, and the long-term results need to be further observed.
【學(xué)位授予單位】：中國人民解放軍軍醫(yī)進修學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2010
【分類號】：R739.63

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