發(fā)布時(shí)間：2018-07-09 23:10

  本文選題：鼻咽癌/放射療法 + 生物有效劑量��； 參考：《中華腫瘤防治雜志》2014年09期

【摘要】：目的:比較局部晚期鼻咽癌同期加量(simultaneous integrated boost conformal radiotherapy,SIB-CRT)與傳統(tǒng)后期顱底加量適形放療技術(shù)(traditional later skull base boost technique,LB-CRT)生物等效劑量(biologically effective dose,BED)的分布差異,探討生物劑量概念對(duì)臨床應(yīng)用的影響。方法:選取2012-09-12-2012-12-19在中山大學(xué)腫瘤防治中心初治的10例鼻咽癌患者,在設(shè)計(jì)分段照射70Gy常規(guī)計(jì)劃的基礎(chǔ)上,每例患者均對(duì)生物加量靶區(qū)分別設(shè)計(jì)SIB-CRT及LB-CRT 2種計(jì)劃,用劑量體積直方圖比較2種技術(shù)在靶區(qū)及危及器官中的物理劑量學(xué)差異,并采用L-Q模型將其轉(zhuǎn)換成BED進(jìn)行比較。結(jié)果:物理劑量方面,2種照射技術(shù)的計(jì)劃靶體積(planning target volume,PTV)中,PTV2和PTV1的劑量分布差異無(wú)統(tǒng)計(jì)學(xué)意義;但SIB-CRT中PTV-G的95%處方劑量所包含靶體積百分?jǐn)?shù)(V95%)為99.3%,優(yōu)于LB-CRT的98.6%,P=0.005;SIB-CRT中PTV-B的V95%為97.1%,明顯優(yōu)于LB-CRT的48.3%,P=0.001;SIB-CRT在PTV-B的最小劑量(Dmin)為(70.2±2.1)Gy,優(yōu)于LB-CRT的(68.5±3.3)Gy,提高2.48%,P=0.010;SIB-CRT在PTV-B的最大劑量(Dmax)為(77.0±1.8)Gy,優(yōu)于LB-CRT的(75.6±1.1)Gy,提高1.85%,P=0.016;SIB-CRT在PTV-B的平均劑量(Dmean)為(74.2±0.8)Gy,優(yōu)于LB-CRT的(72.5±1.3)Gy,提高2.34%,P=0.015。SIB-CRT較LB-CRT同側(cè)顳頜關(guān)節(jié)Dmean減少了4.8%,50%體積所受最大劑量(D50)減少了5.1%,P值均為0.001;對(duì)側(cè)則相應(yīng)減少了5.9%和6.0%,P值均為0.007。生物學(xué)劑量方面,SIB-CRT物理處方劑量較LB-CRT低約1Gy,但兩者在PTV-B的Dmin、Dmax及Dmean的BED差異增大,SIB-CRT的Dmin為87.9Gy,優(yōu)于LB-CRT的85.2Gy,提高3.17%,P=0.010;SIB-CRT的Dmax為98.6Gy,優(yōu)于LB-CRT的94.4Gy,提高4.45%,P=0.001;SIB-CRT的Dmean為93.8Gy,優(yōu)于LB-CRT的89.8Gy,提高4.45%,P=0.001。校準(zhǔn)后物理劑量(adjusted physical dose,APD)與BED較一致,分別提高3.08%、4.23%及4.60%。SIB-CRT中PTV-G的105%與95%等劑量曲線間物理劑量差異為10.5%,BED差異增大,達(dá)22.1%,而APD差異為13.7%,反映生物特性的差異不如BED。結(jié)論:SIB-CRT技術(shù)更加適形和精確,且不明顯增加甚至可減少部分危及器官的照射。應(yīng)用BED對(duì)不同分割劑量及次數(shù)的放療方案之間生物效應(yīng)進(jìn)行量化評(píng)估是可行的。
[Abstract]:Objective: to compare the distribution of (simultaneous integrated boost conformal radiotherapyne (SIB-CRT) in locally advanced nasopharyngeal carcinoma (NPC) and the bioequivalent dose (biologically effective doseBed) of (traditional later skull base boost technique LB-CRT in late stage, and to explore the effect of biological dose concept on clinical application. Methods: ten patients with nasopharyngeal carcinoma (NPC) who were initially treated in Cancer Center of Sun Yat-sen University were selected from 2012-09-12-12-19. On the basis of designing a routine plan of 70Gy irradiation, each patient designed SIB-CRT and LB-CRT respectively for the target region of biological dosage. Dose volume histogram was used to compare the difference of physical dosimetry between the two techniques in target area and endangered organs, and the L-Q model was used to convert them to BED for comparison. Results: there was no significant difference in the dose distribution between PTV2 and PTV1 in the planned target volume (planning target volume) of the two irradiation techniques in terms of physical dose. 浣哠IB-CRT涓璓TV-G鐨，

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