本文選題：鼻咽癌 + 螺旋斷層放療　； 參考：《中國人民解放軍軍醫(yī)進(jìn)修學(xué)院》2011年博士論文

【摘要】：目的觀察鼻咽癌患者在調(diào)強(qiáng)放射治療過程中腮腺解剖學(xué)及劑量學(xué)的變化,并尋找影響該變化的因素。 方法采用螺旋斷層放療系統(tǒng)及其計(jì)劃系統(tǒng)和自適應(yīng)系統(tǒng),計(jì)算鼻咽癌患者腮腺每周體積、外界間距變化,及單分次V1和D50的變化,采用重復(fù)數(shù)據(jù)模型計(jì)算體積及劑量學(xué)參數(shù)在分次間的差異,以及影響該參數(shù)變化的因素。 結(jié)果35例患者左右側(cè)腮腺體積在放療結(jié)束時(shí)分別平均縮小29.47%和24.47%,每周間體積差異明顯(p0.05),第16次放療時(shí)腮腺體積變化率最高；腮腺外界間距平均縮小7.5±3.85%,左右側(cè)腮腺靶區(qū)內(nèi)外體積比值分別平均增加102.3±80.05%和86.43±122.1%；左右側(cè)腮腺單分次V1分別平均升高32.2%和28.6%,單分次D50分別平均升高33.9%和24.93%,第2～3周間劑量學(xué)參數(shù)差異顯著(p0.05)。放療過程中,腮腺體積變化因其初始體積(p=0.000)及治療方法(p=0.04)的不同而不同,而治療方式(p=0.007)、年齡(p=0.025)及初始計(jì)劃中Dmean(p=0.004)和V30(p=0.000)均影響其D50的變化趨勢。 結(jié)論放療過程中腮腺解剖學(xué)及劑量學(xué)參數(shù)存在著明顯的變化,該變化趨勢受療前腮腺體積、初始計(jì)劃劑量、治療方式及年齡的影響,在放療第四周時(shí)實(shí)施再次計(jì)劃可能有臨床應(yīng)用價(jià)值。 目的探尋鼻咽癌調(diào)強(qiáng)放療過程中影響腮腺體積變化的因素。 方法回顧性分析104例鼻咽癌臨床資料及計(jì)劃參數(shù),采用螺旋斷層放療計(jì)劃系統(tǒng)及其自適應(yīng)系統(tǒng),勾畫腮腺輪廓,獲得患者放療中期時(shí)腮腺的體積變化參數(shù),采用Spearman相關(guān)和Logistic多因素回歸模型分析腮腺體積變化與多個(gè)研究因素間的關(guān)系。 結(jié)果至第20次放療時(shí),左右側(cè)腮腺體積分別平均減少6.69cm3(25.51%)和6.43cm3(24.95%)。腮腺初始體積、體重、治療方式及腫瘤和轉(zhuǎn)移性淋巴結(jié)總體積與腮腺體積縮小的絕對值相關(guān),腫瘤分期、治療方式、淋巴結(jié)轉(zhuǎn)移情況及腫瘤和轉(zhuǎn)移性淋巴結(jié)總體積與腮腺體積縮小的相對值相關(guān)。Logistic多因素模型分析發(fā)現(xiàn),治療方式是影響腮腺體積縮小絕對值(p=0.009)和相對值(p=0.007)的獨(dú)立影響因子,而腮腺初始體積是其體積縮小絕對值的獨(dú)立影響因子(p=0.000) 結(jié)論對于接受放療同步聯(lián)合化療或靶向治療和擁有大體積腮腺的鼻咽癌患者,因腮腺變化較大,應(yīng)密切觀察,及時(shí)重新定位修正計(jì)劃。 目的尋找影響鼻咽癌患者放療后晚期口干癥的因素。 方法對本研究第二部分中的104例鼻咽癌患者采用門診接診和電話隨訪的方式,依據(jù)RTOG/EORTC標(biāo)準(zhǔn)評價(jià)晚期口干癥狀,以Spearman秩相關(guān)法分析與口干癥狀嚴(yán)重程度相關(guān)的各種因素。 結(jié)果患者在放療結(jié)束后6至12月時(shí),0級、1級及2級口干癥的分布分別為17例(16.3%)、78例(75%)和9例(8.6%)。本研究未發(fā)現(xiàn),口干癥嚴(yán)重程度與放療期間再計(jì)劃存在相關(guān)關(guān)系(p0.05)；放療同步聯(lián)合化療與單獨(dú)放療或放療同步靶向治療相比,會加重口干癥狀(p=0.006)；另外,腮腺初始體積大者口干癥狀更嚴(yán)重(p=0.024)。 結(jié)論評價(jià)放療期間再計(jì)劃改善口干癥狀的效果,可能需要大量病例和較長時(shí)間的觀察,對于同步放化療和腮腺初始體積大的患者,則應(yīng)進(jìn)行干預(yù)以減輕口干癥狀。
[Abstract]:Objective To investigate the changes of parotid anatomy and dosimetry in patients with nasopharyngeal carcinoma ( NPC ) during radiotherapy and to find out the factors affecting the changes .


Methods Spiral CT radiotherapy system and its planning system and adaptive system were used to calculate the weekly volume of parotid gland , the change of external space and the change of single - divided V1 and D50 in nasopharyngeal carcinoma patients . The difference between volume and dosimetry parameters was calculated by repeated data model , and the factors affecting the parameter change were calculated .


Results The volume of parotid gland was reduced by 29.47 % and 24.47 % at the end of radiotherapy , and the volume difference was significant ( p < 0.05 ) .
The mean reduction of the external space of parotid gland was 7.5 鹵 3.85 % , and the volume ratio of intra - and external volume of parotid gland was 102.3 鹵 80.05 % and 86.43 鹵 122.1 % , respectively .
In the course of radiotherapy , the volume change of parotid gland was significantly different ( p = 0.007 ) , age ( p = 0.025 ) and Dmean ( p = 0.004 ) and V30 ( p = 0.000 ) in the initial plan .


Conclusion There are significant changes in parotid anatomy and dosimetry parameters during radiotherapy . This change trend is influenced by the volume of parotid gland , initial planned dose , treatment modality and age , and it may have clinical application value at the fourth week of radiotherapy .


Objective To explore the factors influencing the volume change of parotid gland during radiotherapy of nasopharyngeal carcinoma ( NPC ) .


Methods The clinical data and planning parameters of 104 patients with nasopharyngeal carcinoma were retrospectively analyzed . Spiral CT radiotherapy planning system and its adaptive system were used to delineate the profile of parotid gland , and the parameters of volume change of parotid gland were obtained in the middle of radiotherapy . The relationship between the volume change of parotid gland and the multiple factors was analyzed by means of Pearson correlation and Logistic regression model .


Results The volume of parotid gland decreased by 6.69 cm3 ( 25.51 % ) and 6.43 cm3 ( 24.95 % ) on the left and right parotid gland , and the total volume of parotid gland was correlated with the absolute value of the volume of parotid gland .


Conclusion For patients with nasopharyngeal carcinoma receiving radiotherapy simultaneous chemotherapy or targeted therapy and large - volume parotid gland , due to the large change of parotid gland , the correction plan should be re - located in time .


Objective To find out the factors influencing the late oral dryness of patients with nasopharyngeal carcinoma ( NPC ) .


Methods 104 NPC patients in the second part of the study were followed up by outpatient visit and telephone follow - up . Based on the RTOG / EORTC standard , the symptoms of late mouth stem were evaluated , and the factors related to severity of dry mouth symptom were analyzed by means of Pearson ' s rank correlation method .


Results There were 17 cases ( 16.3 % ) , 78 cases ( 75 % ) and 9 cases ( 8.6 % ) of Grade 0 , Grade 1 and 2 dry mouth disease at 6 to 12 months after radiotherapy .
Compared with radiotherapy alone or radiotherapy alone , radiotherapy combined with chemotherapy could aggravate the symptom of dry mouth ( p = 0.006 ) .
In addition , the initial volume of parotid gland was more severe than that of dry mouth ( p = 0 . 024 ) .


Conclusion It may be necessary to evaluate the effect of re - planning to improve dry mouth symptoms during radiotherapy , which may require a large number of cases and longer observation . For patients with large initial volume of concurrent chemoradiotherapy and parotid gland , intervention should be made to relieve dry mouth symptoms .
【學(xué)位授予單位】：中國人民解放軍軍醫(yī)進(jìn)修學(xué)院
【學(xué)位級別】：博士
【學(xué)位授予年份】：2011
【分類號】：R739.63

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