鼻咽癌放療前后腮腺、頜下腺、甲狀腺體積變化與劑量學的研究
發(fā)布時間：2019-06-07 08:23
【摘要】：目的:探討鼻咽癌(nasopharyngeal carcinoma,NPC)根治性放化療前后腮腺、頜下腺、甲狀腺體積的變化趨勢與放療劑量學之間的關(guān)系。 資料和方法:縱向研究分析汕頭大學醫(yī)學院附屬腫瘤醫(yī)院2008年2月至2009年12月以來我院接受根治性放化療的鼻咽癌患者65例,所有患者均經(jīng)病理確診,無遠處轉(zhuǎn)移,既往無頭頸部手術(shù)史和唾液腺疾病病史。每個患者通過CT增強掃描記錄放療前、放療后6個月、12個月腮腺、頜下腺、甲狀腺體積,并通過治療計劃系統(tǒng)(TPS)計算腮腺、頜下腺、甲狀腺受照射劑量,統(tǒng)計分析腮腺、頜下腺、甲狀腺體積的變化趨勢與放療劑量學之間的關(guān)系。 結(jié)果:腮腺、頜下腺、甲狀腺體積在放療后12個月內(nèi)總體均呈縮小趨勢。1.放療前腮腺平均體積為39.40±11.08 cm~3,至放療后6個月、12個月分別縮小為30.00±8.12 cm~3、26.55±8.30 cm~3,其中6個月時平均縮小22.9%,12個月時平均縮小32.1%,差異均有統(tǒng)計學意義(P值均0.01)。從放療后6個月至放療后12個月之間體積縮小9.2%,差異沒有統(tǒng)計學意義(P=0.231)。常規(guī)放療組與調(diào)強適形放療組體積縮小率比較,6個月時差異有統(tǒng)計學意義(21.1% :27.2%,P0.01),12個月時差異沒有統(tǒng)計學意義(32.8% :30.6%,P=0.625)。放療后6個月腮腺體積變化與腮腺平均照射劑量相關(guān)(P值為0.028,所對應(yīng)的相關(guān)系數(shù)r為0.239),放療后12個月腮腺體積變化與腮腺平均照射劑量相關(guān)性很弱(P值為0.171,所對應(yīng)的相關(guān)系數(shù)r為-0.120),放療后6個月、12個月腮腺體積變化與最大照射劑量相關(guān)性很弱(P值分別為0.457、0.284,所對應(yīng)的相關(guān)系數(shù)r分別為0.094、-0.135)。在調(diào)強適形放療組,利用直線回歸分析放療后6個月及12個月時腮腺體積變化百分比與腮腺平均照射劑量的關(guān)系,分別可以得到2個最佳直線方程:y = -0.0086x + 35.651,y = -0.1215x + 32.173(x為腮腺的體積變化百分比,y為腮腺的平均照射劑量,單位Gy)。 2.放療前頜下腺平均體積為16.65±4.58 cm~3,至放療后6個月、12個月分別縮小為10.58±3.10 cm~3、9.56±2.94 cm~3,其中6個月時平均縮小35.3%,12個月時平均縮小42.0%,差異均有統(tǒng)計學意義(P值均0.01)。從放療后6個月至放療后12個月之間體積縮小6.7%,差異沒有統(tǒng)計學意義(P=0.268)。常規(guī)放療組與調(diào)強適形放療組體積下降率比較,6個月及12個月時差異均沒有統(tǒng)計學意義(P值分別為0.426、0.845)。放療后6個月、12個月頜下腺體積變化與頜下腺平均照射劑量相關(guān)性很弱(P值分別為0.797、0.636,所對應(yīng)的相關(guān)系數(shù)r分別為0.032、0.060),與最大照射劑量相關(guān)性也很弱(P值分別為0.128、0.120,所對應(yīng)的相關(guān)系數(shù)r分別為0.191、0.195)。 3.放療前甲狀腺平均體積為16.50±4.88 cm~3,至放療后6個月、12個月分別縮小為13.80±4.21 cm~3、13.11±4.52 cm~3,其中6個月時平均縮小15.5%,12個月時平均縮小20.6%,差異均有統(tǒng)計學意義(P值分別為0.013、0.001)。從放療后6個月至放療后12個月之間體積縮小5.1%,差異沒有統(tǒng)計學意義(P=0.738)。常規(guī)放療組與調(diào)強適形放療組體積下降率比較,6個月及12個月時差異均有統(tǒng)計學意義(P值均0.01)。放療后6個月、12個月甲狀腺體積變化與甲狀腺平均照射劑量均相關(guān)(P值分別為0.006、0.002,所對應(yīng)的相關(guān)系數(shù)r分別為-0.336、-0.380),與最大照射劑量相關(guān)性很弱(P值分別為0.085、0.456,所對應(yīng)的相關(guān)系數(shù)r分別為-0.215、-0.094)。利用直線回歸分析放療后6個月及12個月時甲狀腺體積變化百分比與甲狀腺平均照射劑量的關(guān)系,分別可以得到2個最佳直線方程:y = -0.245x + 35.221,y = -0.2821x + 33.199,(x為甲狀腺的體積變化百分比,y為甲狀腺的平均照射劑量,單位Gy)。 結(jié)論:本研究表明鼻咽癌患者接受根治性放化療后均可引起腮腺、頜下腺及甲狀腺體積的縮小,其中頜下腺的體積縮小最大。從本研究的結(jié)果發(fā)現(xiàn),腮腺在放療后6個月和甲狀腺在放療后6個月及12個月的體積變化與放療平均照射劑量具相關(guān)性(P值分別為0.028、0.006、0.002),而頜下腺放療前后體積變化趨勢與放療劑量之間沒有明顯統(tǒng)計學意義(P0.05)。腮腺在調(diào)強適形放療后6個月評價認為,平均照射劑量的閾值可能為35.7Gy,在調(diào)強適形放療后12個月評價認為,平均照射劑量的閾值可能為32.2Gy;而甲狀腺在放療后6個月評價認為,平均照射劑量的閾值可能為35.2Gy,在放療后12個月評價認為,平均照射劑量的閾值可能為33.2Gy。
[Abstract]:Objective: To study the relationship between the change of parotid gland, submandibular gland and thyroid volume before and after radical chemoradiotherapy of nasopharyngeal carcinoma (NPC) and the dosimetry of radiotherapy. Materials and Methods: From February 2008 to December 2009,65 patients with nasopharyngeal carcinoma undergoing radical chemoradiotherapy were analyzed and analyzed in the longitudinal study. All the patients were confirmed by pathology and no distant rotation. removed, no history of head and neck surgery and salivary gland disease History. Each patient recorded the parotid gland, submandibular gland and thyroid by the treatment planning system (TPS) before and after radiotherapy,6 months after radiotherapy,12 months after radiotherapy, and the parotid gland, submandibular gland and thyroid by the treatment planning system (TPS), and the parotid gland and submandibular gland were statistically analyzed. The correlation between the change of the volume of the gland and the thyroid and the dosimetry of radiotherapy Results: The total of the parotid gland, submandibular gland and thyroid volume decreased in 12 months after radiotherapy. 1. The mean volume of parotid gland was 39.40-11.08 cm ~ 3 after radiotherapy and 30.00-8.12 cm ~ 3, 26.55-8.30 cm ~ 3 in 12 months after radiotherapy. The mean reduction of the parotid was 22.9% at 6 months and 32.1% in the 12-month period, and the difference was statistically significant (P = 0). 01). The volume was reduced by 9.2% between 6 months after radiotherapy and 12 months after radiotherapy, and the difference was not statistically significant (P = 0.2 31) The difference between the conventional radiotherapy group and the intensity-modulated conformal radiotherapy group was statistically significant at 6 months (21.1%: 27.2%, P0.01), and there was no statistical difference in the 12-month period (32.8%: 30.6%, P = 0.6). 25) Parotid volume change of parotid gland in 6 months after radiotherapy was related to the average dose of parotid gland (P = 0.028, the corresponding correlation coefficient r was 0.239), the volume of parotid gland in 12 months after radiotherapy was very weak (P = 0.171, and the corresponding correlation coefficient r was-0.1). 20) The correlation between the volume change of the parotid gland and the maximum irradiation dose in the 12-month period after radiotherapy was very weak (P = 0.457, 0.284, and the corresponding correlation coefficient r was 0.094,-0.1, respectively). 35) According to the relationship between the percentage of parotid volume and the mean irradiation dose of parotid gland at 6 and 12 months after radiotherapy, two best linear equations can be obtained: y =-0.0086x + 35.651, y =-0.1215x + 32.173 (x is the volume change of parotid gland). %, y is the mean exposure dose of the parotid gland, in unit 2. The mean volume of submandibular gland was 16.65-4.58cm ~ 3, and the mean volume of submandibular gland decreased to 10.58-3.10 cm ~ 3, 9.56-2.94cm ~ 3 in 12 months. The mean reduction of the submandibular gland was 35.3% at 6 months and 42.0% in the 12-month period, and the difference was statistically significant (P-value). 0.01). The volume between 6 months after radiotherapy and 12 months after radiotherapy was reduced by 6.7%, and the difference was not statistically significant (P = 0 .268) There was no statistical significance (P = 0.426,0, respectively) at 6 and 12 months after the comparison of the volume drop rate of the conventional radiotherapy group and the intensity-modulated conformal radiotherapy group. .845) The correlation between the volume change of submandibular gland and the mean irradiation dose of submandibular gland was very weak at 6 months after radiotherapy (P = 0.797, 0.636, the corresponding correlation coefficient r was 0.032, 0.060), and the correlation with the maximum irradiation dose was also weak (P = 0.128, 0.120, and the corresponding correlation coefficient r was 0.191,0, respectively). .3. The mean volume of the thyroid before radiotherapy was 16.50 to 4.88 cm ~ 3, and it was reduced to 13.80 to 4.21 cm ~ 3 and 13.11 to 4.52 cm ~ 3 in 12 months after the radiotherapy. The mean reduction was 15.5% at 6 months and 20.6% in 12 months. The difference was statistically significant (P = 0.013, respectively). (0.001). The volume was reduced by 5.1% between 6 months after radiotherapy and 12 months after radiotherapy, and there was no statistical significance (P = 0.738). There was a significant difference in the volume drop rate of the conventional radiotherapy group and the intensity-modulated conformal radiotherapy group (P <0.05). The correlation between the thyroid volume change and the mean dose of the thyroid (P = 0.006, 0.002, the corresponding correlation coefficient r was-0.336,-0.380, respectively), and the correlation with the maximum exposure dose was very weak (P = 0.08, respectively). 5, 0.456, the corresponding correlation coefficient r is-0.215, -0.094). The relationship between the percentage of thyroid volume change and the mean thyroid irradiation dose at 6 and 12 months after radiotherapy was analyzed by linear regression, and two best linear equations can be obtained: y =-0.245 x + 35.221, y =-0.2821 x + 33.199, (x is thyroid Percent change in volume, y is the average dose of the thyroid Conclusion: The study shows that the patients with nasopharyngeal carcinoma can cause the reduction of parotid gland, submandibular gland and thyroid volume after radical chemoradiotherapy, in which the jaw The results of this study showed that the volume change of parotid gland in 6 months after radiotherapy and 12 months after radiotherapy was related to the mean dose of radiotherapy (P = 0.028, 0.0, respectively). 06, 0.002), and there was no significant difference between the volume change of the submandibular gland before and after radiotherapy and the dose of radiotherapy. The mean exposure dose may be 35.7 Gy, and the threshold of the mean exposure dose may be 32.2 Gy in the 12-month evaluation after the intensity-modulated conformal radiotherapy. The mean exposure dose was considered to be 35.2 Gy in the 6-month post-treatment evaluation and the mean exposure dose was considered to be the threshold for the 12-month post-treatment
【學位授予單位】：汕頭大學
【學位級別】：碩士
【學位授予年份】：2011
【分類號】：R739.6
[Abstract]:Objective: To study the relationship between the change of parotid gland, submandibular gland and thyroid volume before and after radical chemoradiotherapy of nasopharyngeal carcinoma (NPC) and the dosimetry of radiotherapy. Materials and Methods: From February 2008 to December 2009,65 patients with nasopharyngeal carcinoma undergoing radical chemoradiotherapy were analyzed and analyzed in the longitudinal study. All the patients were confirmed by pathology and no distant rotation. removed, no history of head and neck surgery and salivary gland disease History. Each patient recorded the parotid gland, submandibular gland and thyroid by the treatment planning system (TPS) before and after radiotherapy,6 months after radiotherapy,12 months after radiotherapy, and the parotid gland, submandibular gland and thyroid by the treatment planning system (TPS), and the parotid gland and submandibular gland were statistically analyzed. The correlation between the change of the volume of the gland and the thyroid and the dosimetry of radiotherapy Results: The total of the parotid gland, submandibular gland and thyroid volume decreased in 12 months after radiotherapy. 1. The mean volume of parotid gland was 39.40-11.08 cm ~ 3 after radiotherapy and 30.00-8.12 cm ~ 3, 26.55-8.30 cm ~ 3 in 12 months after radiotherapy. The mean reduction of the parotid was 22.9% at 6 months and 32.1% in the 12-month period, and the difference was statistically significant (P = 0). 01). The volume was reduced by 9.2% between 6 months after radiotherapy and 12 months after radiotherapy, and the difference was not statistically significant (P = 0.2 31) The difference between the conventional radiotherapy group and the intensity-modulated conformal radiotherapy group was statistically significant at 6 months (21.1%: 27.2%, P0.01), and there was no statistical difference in the 12-month period (32.8%: 30.6%, P = 0.6). 25) Parotid volume change of parotid gland in 6 months after radiotherapy was related to the average dose of parotid gland (P = 0.028, the corresponding correlation coefficient r was 0.239), the volume of parotid gland in 12 months after radiotherapy was very weak (P = 0.171, and the corresponding correlation coefficient r was-0.1). 20) The correlation between the volume change of the parotid gland and the maximum irradiation dose in the 12-month period after radiotherapy was very weak (P = 0.457, 0.284, and the corresponding correlation coefficient r was 0.094,-0.1, respectively). 35) According to the relationship between the percentage of parotid volume and the mean irradiation dose of parotid gland at 6 and 12 months after radiotherapy, two best linear equations can be obtained: y =-0.0086x + 35.651, y =-0.1215x + 32.173 (x is the volume change of parotid gland). %, y is the mean exposure dose of the parotid gland, in unit 2. The mean volume of submandibular gland was 16.65-4.58cm ~ 3, and the mean volume of submandibular gland decreased to 10.58-3.10 cm ~ 3, 9.56-2.94cm ~ 3 in 12 months. The mean reduction of the submandibular gland was 35.3% at 6 months and 42.0% in the 12-month period, and the difference was statistically significant (P-value). 0.01). The volume between 6 months after radiotherapy and 12 months after radiotherapy was reduced by 6.7%, and the difference was not statistically significant (P = 0 .268) There was no statistical significance (P = 0.426,0, respectively) at 6 and 12 months after the comparison of the volume drop rate of the conventional radiotherapy group and the intensity-modulated conformal radiotherapy group. .845) The correlation between the volume change of submandibular gland and the mean irradiation dose of submandibular gland was very weak at 6 months after radiotherapy (P = 0.797, 0.636, the corresponding correlation coefficient r was 0.032, 0.060), and the correlation with the maximum irradiation dose was also weak (P = 0.128, 0.120, and the corresponding correlation coefficient r was 0.191,0, respectively). .3. The mean volume of the thyroid before radiotherapy was 16.50 to 4.88 cm ~ 3, and it was reduced to 13.80 to 4.21 cm ~ 3 and 13.11 to 4.52 cm ~ 3 in 12 months after the radiotherapy. The mean reduction was 15.5% at 6 months and 20.6% in 12 months. The difference was statistically significant (P = 0.013, respectively). (0.001). The volume was reduced by 5.1% between 6 months after radiotherapy and 12 months after radiotherapy, and there was no statistical significance (P = 0.738). There was a significant difference in the volume drop rate of the conventional radiotherapy group and the intensity-modulated conformal radiotherapy group (P <0.05). The correlation between the thyroid volume change and the mean dose of the thyroid (P = 0.006, 0.002, the corresponding correlation coefficient r was-0.336,-0.380, respectively), and the correlation with the maximum exposure dose was very weak (P = 0.08, respectively). 5, 0.456, the corresponding correlation coefficient r is-0.215, -0.094). The relationship between the percentage of thyroid volume change and the mean thyroid irradiation dose at 6 and 12 months after radiotherapy was analyzed by linear regression, and two best linear equations can be obtained: y =-0.245 x + 35.221, y =-0.2821 x + 33.199, (x is thyroid Percent change in volume, y is the average dose of the thyroid Conclusion: The study shows that the patients with nasopharyngeal carcinoma can cause the reduction of parotid gland, submandibular gland and thyroid volume after radical chemoradiotherapy, in which the jaw The results of this study showed that the volume change of parotid gland in 6 months after radiotherapy and 12 months after radiotherapy was related to the mean dose of radiotherapy (P = 0.028, 0.0, respectively). 06, 0.002), and there was no significant difference between the volume change of the submandibular gland before and after radiotherapy and the dose of radiotherapy. The mean exposure dose may be 35.7 Gy, and the threshold of the mean exposure dose may be 32.2 Gy in the 12-month evaluation after the intensity-modulated conformal radiotherapy. The mean exposure dose was considered to be 35.2 Gy in the 6-month post-treatment evaluation and the mean exposure dose was considered to be the threshold for the 12-month post-treatment
【學位授予單位】：汕頭大學
【學位級別】：碩士
【學位授予年份】：2011
【分類號】：R739.6
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