肿瘤容积在早期鼻咽癌治疗方案选择中的临床研究
|
摘要
目的:
探讨肿瘤容积在早期鼻咽癌治疗方案选择的临床意义及其在早期鼻咽癌实施分层治疗的价值。
方法:
在2005年1月1日至2006年10月31日期间,60例经病理证实初治临床早期鼻咽癌,随机分组为对照组(A组)和治疗组(B组)。所有鼻咽癌患者行CT模拟定位,做CT时均采用增强、薄层扫描,范围是从头顶扫至胸锁关节水平,并体罩固定。由两位(副主任医师以上)肿瘤放疗医师与放射诊断医师一起在每一层面上勾画原发肿瘤范围,利用计算机软件系统计算出大体肿瘤容积(GTV)。A组:单纯常规放射治疗原发灶DT70Gy/35F/7W,双上颈加8Mev或10Mev电子线垂直照射,颈前切线野照射36Gy/18F/3.5W后改用8Mev或10Mev电子线垂直照射,治疗区66～70Gy/33～35F/6.5～7W,预防区50～56 Gy/25～28F/5～5.5W;B组:采用常规分割放射治疗和PF方案同步化疗,放疗第一天开始行同步化疗DDP 30mg/m~2/d,d1-3,5-Fu 0.5g/m~2/d,d1-3,每3周重复一次,总疗程为3周期,常规分割放射治疗方法及剂量同A组。放射损伤程度参考RTOG急性放射损伤评分标准及LENT SOMA评分标准进行分级。
结果:
所有患者按期完成放疗计划,治疗组中患者完成化疗计划。60例患者均可评价毒副反应及客观疗效。原发灶完全缓解率A组80%,B组96.7%(X~2=4.043,p=0.044),两组差异有统计学意义。急性皮肤反应A组1、2级与3、4级分别为90%、10%和B组分别为80%、20%(X~2=1.176,P=0.278);急性黏膜炎反应A组分别为83.3%、16.7%和B组分别为66.7%、33.3%(X~2=2.222,P=0.136),少见严重的毒副反应。
结论:
对大体肿瘤容积大于25cm~3的早期鼻咽癌同步放化疗是安全可行的,初步结果显示较好的近期疗效,但有待于进一步结果。其远期并发症如严重张口困难、后组颅神经损伤有待于进一步观察或随访。
Objective:
To study clinical value of the tumor volume in the modality of choice for treatment of early stage nasopharyngeal carcinoma.
Method:
From January 1 2005 to October 31 2006,sixty patients with nasopharyngeal carcinoma were proved pathologically and randomized into either the group of radiotherapy alone(control group、A group) or the concurrent chemoradiotherapy (treated group、B group).Each group consisted of thirty patients.According to the 1992 Fuzhou staging system,all patients had T_(1-2)N_1M_0.All patients underwent a CT simulation scan with contrast injection on the spiral CT scanner(GE) in the treatment position and immobilization in the radiotherapy department.The scope from the top of the head to below clavicles was scanned at 5-mm increments.The primary tumor volume in nasopharynx was localized on each CT image by more than two radiation oncologist and one radiologist and computed by treatment planning system.The patients in control group received only conventional radiotherapy.The dose of nasopharynx、upper neck、lower neck and superclavicular was 70Gy/35F/7W、66～70Gy/33～35F/6.5～7W、50～56 Gy/25～28F/5～5.5W,respectively.But the patients in treated group received chemoradiotherapy.The concurrent chemotherapy with PF(cisplatin,30mg/m~2/d, on Days 1 to 3 and 5-fluorouracil,0.5g/m~2/d on Days 1 to 3) was given every three week for three cycles from the first day of radiotherapy.Radiotherapy was administered with the same way in both group.Acute normal tissue effects were graded according to the Radiation Therapy Ontology Group(RTOG) and LENT SOMA radiation morbidity scoring criteria.
Results:
All patients completed planned doses of radiotherapy and thirty patients in the treatment group completed planned chemotherapy.60 patients were eligible for toxicity and response analysis.After a median follow-up of 16 months,the complete response rates were 96.7%for A group and 80.0%for B group (X~2=4.043,P=0.044),there was a significant difference in complete response in favor of the B group.Acute skin toxicity rates in these two guoups were 90%and 80%in grade 1～2 and 10%and 20%in grade 3～4(X~2=1.176,P=0.278), respectively.Accordingly,the acute mucositis rates were 83.3%and 66.7%in grade 1～2 and 16.7%and 33.3%in grade 3～4(X~2=2.222,P=0.136),respectively. The lack of high-grade toxicity was observed.
Conclutions:
Chemoradiotherapy was feasible with the gross tumor volume more than 25cm~3 for early stage nasopharyngeal carcinoma.Initial results showed good complete response and local control.The remote local control rate and survival rate await further follow-up.The severe late complications also have to be following up.
探讨肿瘤容积在早期鼻咽癌治疗方案选择的临床意义及其在早期鼻咽癌实施分层治疗的价值。
方法:
在2005年1月1日至2006年10月31日期间,60例经病理证实初治临床早期鼻咽癌,随机分组为对照组(A组)和治疗组(B组)。所有鼻咽癌患者行CT模拟定位,做CT时均采用增强、薄层扫描,范围是从头顶扫至胸锁关节水平,并体罩固定。由两位(副主任医师以上)肿瘤放疗医师与放射诊断医师一起在每一层面上勾画原发肿瘤范围,利用计算机软件系统计算出大体肿瘤容积(GTV)。A组:单纯常规放射治疗原发灶DT70Gy/35F/7W,双上颈加8Mev或10Mev电子线垂直照射,颈前切线野照射36Gy/18F/3.5W后改用8Mev或10Mev电子线垂直照射,治疗区66～70Gy/33～35F/6.5～7W,预防区50～56 Gy/25～28F/5～5.5W;B组:采用常规分割放射治疗和PF方案同步化疗,放疗第一天开始行同步化疗DDP 30mg/m~2/d,d1-3,5-Fu 0.5g/m~2/d,d1-3,每3周重复一次,总疗程为3周期,常规分割放射治疗方法及剂量同A组。放射损伤程度参考RTOG急性放射损伤评分标准及LENT SOMA评分标准进行分级。
结果:
所有患者按期完成放疗计划,治疗组中患者完成化疗计划。60例患者均可评价毒副反应及客观疗效。原发灶完全缓解率A组80%,B组96.7%(X~2=4.043,p=0.044),两组差异有统计学意义。急性皮肤反应A组1、2级与3、4级分别为90%、10%和B组分别为80%、20%(X~2=1.176,P=0.278);急性黏膜炎反应A组分别为83.3%、16.7%和B组分别为66.7%、33.3%(X~2=2.222,P=0.136),少见严重的毒副反应。
结论:
对大体肿瘤容积大于25cm~3的早期鼻咽癌同步放化疗是安全可行的,初步结果显示较好的近期疗效,但有待于进一步结果。其远期并发症如严重张口困难、后组颅神经损伤有待于进一步观察或随访。
Objective:
To study clinical value of the tumor volume in the modality of choice for treatment of early stage nasopharyngeal carcinoma.
Method:
From January 1 2005 to October 31 2006,sixty patients with nasopharyngeal carcinoma were proved pathologically and randomized into either the group of radiotherapy alone(control group、A group) or the concurrent chemoradiotherapy (treated group、B group).Each group consisted of thirty patients.According to the 1992 Fuzhou staging system,all patients had T_(1-2)N_1M_0.All patients underwent a CT simulation scan with contrast injection on the spiral CT scanner(GE) in the treatment position and immobilization in the radiotherapy department.The scope from the top of the head to below clavicles was scanned at 5-mm increments.The primary tumor volume in nasopharynx was localized on each CT image by more than two radiation oncologist and one radiologist and computed by treatment planning system.The patients in control group received only conventional radiotherapy.The dose of nasopharynx、upper neck、lower neck and superclavicular was 70Gy/35F/7W、66～70Gy/33～35F/6.5～7W、50～56 Gy/25～28F/5～5.5W,respectively.But the patients in treated group received chemoradiotherapy.The concurrent chemotherapy with PF(cisplatin,30mg/m~2/d, on Days 1 to 3 and 5-fluorouracil,0.5g/m~2/d on Days 1 to 3) was given every three week for three cycles from the first day of radiotherapy.Radiotherapy was administered with the same way in both group.Acute normal tissue effects were graded according to the Radiation Therapy Ontology Group(RTOG) and LENT SOMA radiation morbidity scoring criteria.
Results:
All patients completed planned doses of radiotherapy and thirty patients in the treatment group completed planned chemotherapy.60 patients were eligible for toxicity and response analysis.After a median follow-up of 16 months,the complete response rates were 96.7%for A group and 80.0%for B group (X~2=4.043,P=0.044),there was a significant difference in complete response in favor of the B group.Acute skin toxicity rates in these two guoups were 90%and 80%in grade 1～2 and 10%and 20%in grade 3～4(X~2=1.176,P=0.278), respectively.Accordingly,the acute mucositis rates were 83.3%and 66.7%in grade 1～2 and 16.7%and 33.3%in grade 3～4(X~2=2.222,P=0.136),respectively. The lack of high-grade toxicity was observed.
Conclutions:
Chemoradiotherapy was feasible with the gross tumor volume more than 25cm~3 for early stage nasopharyngeal carcinoma.Initial results showed good complete response and local control.The remote local control rate and survival rate await further follow-up.The severe late complications also have to be following up.
引文
[1]唐启信.放射治疗肿瘤容积对局部控制率的影响[M].见唐启信编著.实用临床放射生物学.第一版.北京:人民卫生出版社.2002年.
[2]Johnson CR,Khandewal SK,Schmilt-Ulrick RK,et al.The influence of quantitative tumor volume measurements on local control in advanced head and neck cancer using concomitant boost accelerated superfractionated irradiation[J].Int J Radiat Oncol Biol Phys,1995,32(3):635-641.
[3]Chau DT,Sham J ST,Kwong DLW,et al.Volumetric analysis of tumor extent in nasopharyngeal carcinoma and correlation with treatment outcome[J].Int J Radiat Oncol Biol Phys,1997,39(3):711-719.
[4]Mukherji SK,O Brien SM,Gerstle KJ,et al.The ability of tumor volume to predict local control in surgically treated squamous cell carcinoma of the supraglottic larynx[J].Head Neck,2000,22(3):282-287.
[5]Natha RM,Mancusl AA,Zhu TC,et al.The impact of primary tumor volume on local control for oropharyngeal squamous cell carcinoma treated with radiotherapy[J].Head Neck,2000,22(1):1-5.
[6]雷风,陆小军,何伟基,等.早期鼻咽癌治疗后复发及远处转移48例分析[J].实用医学杂志,2002,18(7):709-710.
[7]Patrick Therase,SuSan G,Elizabeth A,et al.New guidelines to evaluate the response to treatment in solid tumors[J].Journal of the National Cancer Institute,2000,92(3):205-216.
[8]殷蔚伯,谷铣之.肿瘤放射治疗学[A].附录Ⅱ RTOG急性放射损伤分级 标准[C].北京:中国协和医科大学出版社,2002:1108-1109.
[9]申文江,王绿化.放射治疗损伤[A].罗京伟.头颈部肿瘤放疗的晚期并发症[C].北京:中国医药科技出版社,2001:66-81.
[10]Chan A T,Ngan R,Teo P,et al.Overall survival after concurrent cisplatin-radiotherapy compared with radiotherapy alone in locoregionally advanced nasopharyngeal carcinoma[J].Journal of the National Cancer Institute,2005,97(7):536-539.
[11]Zhang L,Zhao C,Peng PJ,et al.Phase Ⅱ study comparing standard radiotherapy with or without weekly oxaliplatin in treatment of locoregionally advanced nasopharyngeal carcinoma:Preliminary results[J].J Clin Oncol,2005,33(5):8461-8468.
[12]Lee A W M,Lau W H,Tung S Y,et al.Preliminary results of a randomized study on therapeutic gain by concurrent chemotherapy for regionally-advanced nasopharyngeal carcinoma:NPC-9901 trial by the Hong Kong Nasopharyngeal Cancer Study Group[J].J Clin Oncol,2005,28(3):6966-6975.
[13]Baujat B,Audry H,Bourhis J,et al.Chemotherapy in locally advanced nasopharyngeal carcinoma:an individual patient data meta-analysis of eight randomized trials and 1753 patients[J].Int J Radiat Oncol Biol Phys,2006,64(1):47-56.
[14]雷风,陆小军,何伟基,等.早期鼻咽癌治疗后复发及远处转移48例分析[J].实用医学杂志,2002,18(7):709-710.
[15]Willner J,Baier K,Pfreundner L,et al.Tumor volume and local control in primary radiotherapy of nasopharyngeal carcinoma[J].Acta Oncol, 1999,38(3):1025-1029.
[16]Chang CC,Cheu MK,Liu MT,et al.The effect of primary tumor volumes in advanced T staged nasopharyngeal tumor[J].Head Neck,2002,24(3):940-946.
[17]沈春英,胡超苏,顾雅佳,等.鼻咽癌原发肿瘤容积与放射治疗疗效关系的研究[J].中华放射肿瘤学杂志,2004,13(2):73-77.
[18]Sze WM,Lee AW,Yau TK,et al.Primary tumor volume of nasopharyngeal carcinoma:prognostic significance for local control[J].Int J Radiat Oncol Biol Phys,2004,59(1)21-27.
[19]Chen MK,Chen TH,Liu JP,et al.Better prediction of prognosis for patients with nasopharyngeal carcinoma using primary rumor volume[J].Cancer,2004,100(10):2160-2166.
[20]崔魏,胡国清,唐曦,等.鼻咽癌原发肿瘤容积和临床T分期关系探讨[J].中国肿瘤临床,2006,33(3):163-166.
[1]Collins C D,Constant O,Faratt Ⅰ,et al.Relationship of computed to mography tumor volume to patient survival in carcinoma of the cervix treated by radical radiotherapy[J].Br J Radio,1994,67(795):252-256.
[2]Ito H,Kutuki S,Nishiguchi N,et al.Radiotherapy for cervical cancer with high dose rate brachytherapy correlation between tumor size,does and failure[J].RadiotherOncol,1994,31(3):240-247.
[3]Cal J,Andersen L J,Pedersen M,et al.Prognostic factors of local control after radiotherapy in Tl glottic and supraglottic carcinoma of the larynx[J].RadiotherOncol,1996,39(3):229-233.
[4]Sorensen AG,Patel S,Harmath C,et al.Comparison of diameter and perimetermethods for tumor volume calculation.J Clin Oncol 2001;19:551-557.
[5]Clarke LP,Velthuizen RP,Camacho MA,et al.MRI segmentation:methods and applications.Magn Reson Imaging 1995;13:343-368.
[6]Zijistra EJ,Taphoorn MJ,Barkhof F,et al.Radiotherapy response of cerebral metastases quantified by serial MR imaging.J Neurooncol 1994;21:171-176.
[7][7]Ten Haken RK,Thorton AF Jr,Sandlesr HM,et al.A quantitative assessment of the addition of MRI to CT-based,3-D treatment planning of brain tumors.Radiother Oncol 1992;25:121-133.
[8]Schad LR,Bluml S,Zuna I.MR tissue characterization of intracranial tumors by means of textual analysis.Magn Reson Imaging 1993;11:889-896.
[9]Velthuizen RP,Clark LP,Phuphanich S,et al.Unsupervised measurement of brain tumor volume on MR images.J Magn Reson Imaging 1995; 5:594-605.
[10]Phillips WE,Velthuizen RP,Phuphanich S,et al.Applications of fuzzy c-means segmentation technique for tissue differentiation in MR images of hemorrhagic glioblastoma multiforme.Magn Reson Imaging 1995;13:277-290.
[11]Brenner D E,Whitley N O,Houk T H,et aLVolumedeterminations in computed tomography[J].JAMA,1982,247(19):1299-1302.
[12]Willner J,Baier K,Pfreundner L,et al.Tumor volume and local control in primary radiotherapy of nasopharygeal carcinoma[J].Acta Oncol,1999,38(8):1025-1030.
[13]Hermans R,Bogaert W M,Hilgers F J M,et al.Value of computed tomography as outcome predictor of supraglottic squamous cell carcinoma treated by definitive radiation therapy[J].Int J Radiat Oncol Biol Phys,1999,44(4):755-765.
[14]Chua D T T,Sham J S T,Kwong D L W,et al.Volumetric analysis of tumor extentin nasopharyngeal carcinoma and correlation with treatment outcome[J].Int J Radiat Oncol Biol Phys,1997,39(3):711-719.
[15]Wu P M,Chua D T T,Sham J S T,et al.Tumor control probability of nasopharyngeal carcinoma acomparison of different mathematical models[J].Int J Radiat Oncol Biol Phys,1997,37(4):913-920.
[16]Narayana A,Vaughan ATM,Kathuria S,et al.P53 overexpressionis associated with bulky tumor and poor local control in T1 glottic cancer[J].Int J Radiat Oncol Biol Phys,2000,46(1):21-26.
[17]Pameijer F A,Mancuso A A,Mendenhall W M,et al.Can pretreatment computed tomography predict local control in T3 squamous cell carcinoma of the glottic larynx treated with definitive radiotherapy[J]? Int J Radiat Oncol Biol Phys,1997,37(5):1011-1021.
[18]Pameijer F A,Mancuso A A,Mendenhall W M,et al.Evaluation of pretreatment computed tomography as a predictor of local control in T1/T2pyriform sinus carcinoma treated with definitive radiotherapy[J].Head Neck,1998,20(2):159-168.
[19]Pameijer F A,Balm A J M,Hilgers F J M,et al.Variability of tumor volumes in T3-stage head and neck tumors[J].Head Neck,1997,1(1):6-13.
[20]Kuriakose M A,Loree T R,Hicks W L,et al.Tumour volume estimated by computed tomography as a predictive factor in carcinoma of the tongue[J].Br J Oral Maxillofac Surg,2000,38(5):460-465.
[21]Cavalcanti M G,Vannier M W.Measurement of the volume of oral tumors by three-dimensional spiral computed tomography[J].Dentomaxillofac Radiol,2000,29(1):35-40.
[22]Sanguineti G,Foppiano F,Marcenaro M,et al.On the delineation of the gross tumor volume and clinical target volume for head and neck squamous cell carcinomas[J].Tumori,2001,87(3):153-161.
[23]唐启信.放射治疗肿瘤容积对局部控制率的影响[M].见唐启信编著.实用临床放射生物学.第一版.北京:人民卫生出版社.2002年.
[24]Johnson CR,Khandewal SK,Schmilt-Ulrick RK,et al.The influence of quantitative tumor volume measurements on local control in advanced head and neck cancer using concomitant boost accelerated superfractionated irradiation[J].Int J Radiat Oncol Biol Phys,1995,32(3):635-641.
[25]Mukherji SK,O Brien SM,Gerstle KJ,et al.The ability of tumor volume to predict local control in surgically treated squamous cell carcinoma of the supraglottic larynx[J].Head Neck,2000,22(3):282-287.
[26]沈春英,胡超苏,顾雅佳,等.鼻咽癌原发肿瘤容积与放射治疗疗效关系的研究[J].中华放射肿瘤学杂志,2004,13(2):73-77.
[27]Sze WM,Lee AW,Yau TK,et al.Primary tumor volume of nasopharyngeal carcinoma:prognostic significance for local control[J].Int J Radiat Oncol Biol Phys,2004,59(1)21-27.
[28]Chen MK,Chen TH,Liu JP,et al.Better prediction of prognosis for patients with nasopharyngeal carcinoma using primary rumor volume[J].Cancer,2004,100(10):2160-2166.
[29]崔魏,胡国清,唐曦,等.鼻咽癌原发肿瘤容积和临床T分期关系探讨[J].中国肿瘤临床,2006,33(3):163-166.
[30]Reddy S P,Mohideen N,Marra S,etal.Effect of tumor bulk on local control and survival of patients with T1 glottic cancer[J].Radiother Oncol,1998,47(2):161-166.
[31]Mancuso A A,Mukherji S K,Schmalfuss I,et al.Preradiotherapy computed tomography as a predictor of local control in supraglottic carcinoma[J].J Clin Oncol,1999,17(2):631-637.
[32]Parsons J T,Mendenhall W M,Stringer S P,et al,T4 laryngeal carcinoma:radiotherapy alone with surgery reserved for salvage[J].Int J Radiat Oncol Biol Phys,1998,40(3):549-552.
[33]Mukherji S K,O.Brien S M,Gerstle R J,et al.The ability of tumor volume to predict local control in surgically treated squamous cell carcinoma of the suqraglottic[J].Head Neck,2000,22(3):282-287.
[34]Vanden Bogaert W V,vander Schueren E,Horiot J C,et al.The EORTC randomized trial on three fractions per day and misonidazole in advanced head and neck cancer:prognostic factors[J],Radiother Oncol,1995,35(2):100-106.
[35]Grabenbauer R G,Steininger H,Meyer M,et al.Nodal CT denstity and total tumor volume as prognostic factors after radiation therapy of stage/head and neck cancer[J].Radiother Oncol,1998,47(2):175-183.
[36]Johnson C R,Khandelwal S R,Schmidt-Ulrich R K,et al.The influence of quantitative tumor volume measurements on local control inadvanced head and neck cancer using concomitant boost accelerated superfractionated irradiation[J].Int J Radiat Oncol Biol Phys,1995,32(3):635-641.
[37]Hermans R,Opdebeeck K,Vanden Bogaert W,et al.The relation of CT-determined tumor parameters and local and regional outcome of tonsillar cancer after definitive radiation treatment[J].Int J Radiat Oncol Biol Phys,2001,50(1):37-45.
[38]Johnson C R,Thames H D,Huang D T,et al.The tumor volume and clonogen number relationship:tumor control predictions based upon tumor volume estimates derived from computed Tomography[J].Int J Radiat Oncol Biol Phys,1995,33(2):281-287.
[39]Zitsch R P,Lee B W,Smith R B.Cervical lymphnode metastases and squamous cell carcinoma of the lip[J].Head Neck,1999,21(5):447-453.
[40]Nathu R M,Mancuso A A,Zhu T C,et al.The impact of primary tumor volume on local control for or opharyngeal squamous cell carcinoma treated with radiotherapy[J],Head Neck,2000,1(1):1-5.
[41]Fang F M,Tsai W L,Go S F,et al.Implications of quantitative tumor and nodal regression rates for nasopharyngeal carcinomas after 45 Gy of radiotherapy[J].Int J Radiat Oncol Biol Phys,2001,50(4):961-969.
[42]Brenner D J.Does volume and tumor control predictions in radiotherapy[J].Int J Radiat Oncol Biol Phys,1993,26(1):171-179.
[43]Bentzen S M,Thames H D.Tumor volume and local control probability:chinical data and radiobiological interpretations[J].Int J Radiat Oncol Biol Phys,1996,36(1):247-251.
[44]Bentzen S M,Johansen L V,Overgaard J,et al.Clinical radiobiology of squamous cell carcinoma of the oropharynx[J].Int J Radiat Oncol Biol Phys,1991,20(6):1997-1206.
[45]Bentzen S M,Overgarrd J,Thames H D,et al.Clinical radiobiology of malignant melanoma[J].Radiother Oncol,1989,16(13):169-182.
[46]Stuben G,Thews O,Pottgen C,et al.Tumor oxygenation during fractionated radiotherapy-comparison with size-matched controls[J].Acta Oncol,1999,38(2):209-213.
[47]De J K,Merlo F M,Kavanagh M C,et al.Heterogeneity of tumor oxygenation:relationship to tumor necrosis,tumor size and metastasis[J].Int J Radiat Oncol Biol Phys,1998,42(4):717-721.
[48]Milross C G,Tucker S L,Mason K A,et al.The effect of tumor size on necrosis and polarographically measured P02[J],Acta Oncol,1997,36(2):183-189.
[49]Stadler P,Bedker A,Feldmann H J,et al.Influence of the hypoxic subvolume on the survival of patients with head and neck cancer[J].Int J Radiat Oncol Biol Phys,1999,44(4):749-754.
[50]Hockel M,Schlenger K,Aral B,et al.Association between tumor hypoxia and malingnant progression in advanced cancer of the uterine cervix[J].Cancer Res,1996,56(19):4509-4515.
[2]Johnson CR,Khandewal SK,Schmilt-Ulrick RK,et al.The influence of quantitative tumor volume measurements on local control in advanced head and neck cancer using concomitant boost accelerated superfractionated irradiation[J].Int J Radiat Oncol Biol Phys,1995,32(3):635-641.
[3]Chau DT,Sham J ST,Kwong DLW,et al.Volumetric analysis of tumor extent in nasopharyngeal carcinoma and correlation with treatment outcome[J].Int J Radiat Oncol Biol Phys,1997,39(3):711-719.
[4]Mukherji SK,O Brien SM,Gerstle KJ,et al.The ability of tumor volume to predict local control in surgically treated squamous cell carcinoma of the supraglottic larynx[J].Head Neck,2000,22(3):282-287.
[5]Natha RM,Mancusl AA,Zhu TC,et al.The impact of primary tumor volume on local control for oropharyngeal squamous cell carcinoma treated with radiotherapy[J].Head Neck,2000,22(1):1-5.
[6]雷风,陆小军,何伟基,等.早期鼻咽癌治疗后复发及远处转移48例分析[J].实用医学杂志,2002,18(7):709-710.
[7]Patrick Therase,SuSan G,Elizabeth A,et al.New guidelines to evaluate the response to treatment in solid tumors[J].Journal of the National Cancer Institute,2000,92(3):205-216.
[8]殷蔚伯,谷铣之.肿瘤放射治疗学[A].附录Ⅱ RTOG急性放射损伤分级 标准[C].北京:中国协和医科大学出版社,2002:1108-1109.
[9]申文江,王绿化.放射治疗损伤[A].罗京伟.头颈部肿瘤放疗的晚期并发症[C].北京:中国医药科技出版社,2001:66-81.
[10]Chan A T,Ngan R,Teo P,et al.Overall survival after concurrent cisplatin-radiotherapy compared with radiotherapy alone in locoregionally advanced nasopharyngeal carcinoma[J].Journal of the National Cancer Institute,2005,97(7):536-539.
[11]Zhang L,Zhao C,Peng PJ,et al.Phase Ⅱ study comparing standard radiotherapy with or without weekly oxaliplatin in treatment of locoregionally advanced nasopharyngeal carcinoma:Preliminary results[J].J Clin Oncol,2005,33(5):8461-8468.
[12]Lee A W M,Lau W H,Tung S Y,et al.Preliminary results of a randomized study on therapeutic gain by concurrent chemotherapy for regionally-advanced nasopharyngeal carcinoma:NPC-9901 trial by the Hong Kong Nasopharyngeal Cancer Study Group[J].J Clin Oncol,2005,28(3):6966-6975.
[13]Baujat B,Audry H,Bourhis J,et al.Chemotherapy in locally advanced nasopharyngeal carcinoma:an individual patient data meta-analysis of eight randomized trials and 1753 patients[J].Int J Radiat Oncol Biol Phys,2006,64(1):47-56.
[14]雷风,陆小军,何伟基,等.早期鼻咽癌治疗后复发及远处转移48例分析[J].实用医学杂志,2002,18(7):709-710.
[15]Willner J,Baier K,Pfreundner L,et al.Tumor volume and local control in primary radiotherapy of nasopharyngeal carcinoma[J].Acta Oncol, 1999,38(3):1025-1029.
[16]Chang CC,Cheu MK,Liu MT,et al.The effect of primary tumor volumes in advanced T staged nasopharyngeal tumor[J].Head Neck,2002,24(3):940-946.
[17]沈春英,胡超苏,顾雅佳,等.鼻咽癌原发肿瘤容积与放射治疗疗效关系的研究[J].中华放射肿瘤学杂志,2004,13(2):73-77.
[18]Sze WM,Lee AW,Yau TK,et al.Primary tumor volume of nasopharyngeal carcinoma:prognostic significance for local control[J].Int J Radiat Oncol Biol Phys,2004,59(1)21-27.
[19]Chen MK,Chen TH,Liu JP,et al.Better prediction of prognosis for patients with nasopharyngeal carcinoma using primary rumor volume[J].Cancer,2004,100(10):2160-2166.
[20]崔魏,胡国清,唐曦,等.鼻咽癌原发肿瘤容积和临床T分期关系探讨[J].中国肿瘤临床,2006,33(3):163-166.
[1]Collins C D,Constant O,Faratt Ⅰ,et al.Relationship of computed to mography tumor volume to patient survival in carcinoma of the cervix treated by radical radiotherapy[J].Br J Radio,1994,67(795):252-256.
[2]Ito H,Kutuki S,Nishiguchi N,et al.Radiotherapy for cervical cancer with high dose rate brachytherapy correlation between tumor size,does and failure[J].RadiotherOncol,1994,31(3):240-247.
[3]Cal J,Andersen L J,Pedersen M,et al.Prognostic factors of local control after radiotherapy in Tl glottic and supraglottic carcinoma of the larynx[J].RadiotherOncol,1996,39(3):229-233.
[4]Sorensen AG,Patel S,Harmath C,et al.Comparison of diameter and perimetermethods for tumor volume calculation.J Clin Oncol 2001;19:551-557.
[5]Clarke LP,Velthuizen RP,Camacho MA,et al.MRI segmentation:methods and applications.Magn Reson Imaging 1995;13:343-368.
[6]Zijistra EJ,Taphoorn MJ,Barkhof F,et al.Radiotherapy response of cerebral metastases quantified by serial MR imaging.J Neurooncol 1994;21:171-176.
[7][7]Ten Haken RK,Thorton AF Jr,Sandlesr HM,et al.A quantitative assessment of the addition of MRI to CT-based,3-D treatment planning of brain tumors.Radiother Oncol 1992;25:121-133.
[8]Schad LR,Bluml S,Zuna I.MR tissue characterization of intracranial tumors by means of textual analysis.Magn Reson Imaging 1993;11:889-896.
[9]Velthuizen RP,Clark LP,Phuphanich S,et al.Unsupervised measurement of brain tumor volume on MR images.J Magn Reson Imaging 1995; 5:594-605.
[10]Phillips WE,Velthuizen RP,Phuphanich S,et al.Applications of fuzzy c-means segmentation technique for tissue differentiation in MR images of hemorrhagic glioblastoma multiforme.Magn Reson Imaging 1995;13:277-290.
[11]Brenner D E,Whitley N O,Houk T H,et aLVolumedeterminations in computed tomography[J].JAMA,1982,247(19):1299-1302.
[12]Willner J,Baier K,Pfreundner L,et al.Tumor volume and local control in primary radiotherapy of nasopharygeal carcinoma[J].Acta Oncol,1999,38(8):1025-1030.
[13]Hermans R,Bogaert W M,Hilgers F J M,et al.Value of computed tomography as outcome predictor of supraglottic squamous cell carcinoma treated by definitive radiation therapy[J].Int J Radiat Oncol Biol Phys,1999,44(4):755-765.
[14]Chua D T T,Sham J S T,Kwong D L W,et al.Volumetric analysis of tumor extentin nasopharyngeal carcinoma and correlation with treatment outcome[J].Int J Radiat Oncol Biol Phys,1997,39(3):711-719.
[15]Wu P M,Chua D T T,Sham J S T,et al.Tumor control probability of nasopharyngeal carcinoma acomparison of different mathematical models[J].Int J Radiat Oncol Biol Phys,1997,37(4):913-920.
[16]Narayana A,Vaughan ATM,Kathuria S,et al.P53 overexpressionis associated with bulky tumor and poor local control in T1 glottic cancer[J].Int J Radiat Oncol Biol Phys,2000,46(1):21-26.
[17]Pameijer F A,Mancuso A A,Mendenhall W M,et al.Can pretreatment computed tomography predict local control in T3 squamous cell carcinoma of the glottic larynx treated with definitive radiotherapy[J]? Int J Radiat Oncol Biol Phys,1997,37(5):1011-1021.
[18]Pameijer F A,Mancuso A A,Mendenhall W M,et al.Evaluation of pretreatment computed tomography as a predictor of local control in T1/T2pyriform sinus carcinoma treated with definitive radiotherapy[J].Head Neck,1998,20(2):159-168.
[19]Pameijer F A,Balm A J M,Hilgers F J M,et al.Variability of tumor volumes in T3-stage head and neck tumors[J].Head Neck,1997,1(1):6-13.
[20]Kuriakose M A,Loree T R,Hicks W L,et al.Tumour volume estimated by computed tomography as a predictive factor in carcinoma of the tongue[J].Br J Oral Maxillofac Surg,2000,38(5):460-465.
[21]Cavalcanti M G,Vannier M W.Measurement of the volume of oral tumors by three-dimensional spiral computed tomography[J].Dentomaxillofac Radiol,2000,29(1):35-40.
[22]Sanguineti G,Foppiano F,Marcenaro M,et al.On the delineation of the gross tumor volume and clinical target volume for head and neck squamous cell carcinomas[J].Tumori,2001,87(3):153-161.
[23]唐启信.放射治疗肿瘤容积对局部控制率的影响[M].见唐启信编著.实用临床放射生物学.第一版.北京:人民卫生出版社.2002年.
[24]Johnson CR,Khandewal SK,Schmilt-Ulrick RK,et al.The influence of quantitative tumor volume measurements on local control in advanced head and neck cancer using concomitant boost accelerated superfractionated irradiation[J].Int J Radiat Oncol Biol Phys,1995,32(3):635-641.
[25]Mukherji SK,O Brien SM,Gerstle KJ,et al.The ability of tumor volume to predict local control in surgically treated squamous cell carcinoma of the supraglottic larynx[J].Head Neck,2000,22(3):282-287.
[26]沈春英,胡超苏,顾雅佳,等.鼻咽癌原发肿瘤容积与放射治疗疗效关系的研究[J].中华放射肿瘤学杂志,2004,13(2):73-77.
[27]Sze WM,Lee AW,Yau TK,et al.Primary tumor volume of nasopharyngeal carcinoma:prognostic significance for local control[J].Int J Radiat Oncol Biol Phys,2004,59(1)21-27.
[28]Chen MK,Chen TH,Liu JP,et al.Better prediction of prognosis for patients with nasopharyngeal carcinoma using primary rumor volume[J].Cancer,2004,100(10):2160-2166.
[29]崔魏,胡国清,唐曦,等.鼻咽癌原发肿瘤容积和临床T分期关系探讨[J].中国肿瘤临床,2006,33(3):163-166.
[30]Reddy S P,Mohideen N,Marra S,etal.Effect of tumor bulk on local control and survival of patients with T1 glottic cancer[J].Radiother Oncol,1998,47(2):161-166.
[31]Mancuso A A,Mukherji S K,Schmalfuss I,et al.Preradiotherapy computed tomography as a predictor of local control in supraglottic carcinoma[J].J Clin Oncol,1999,17(2):631-637.
[32]Parsons J T,Mendenhall W M,Stringer S P,et al,T4 laryngeal carcinoma:radiotherapy alone with surgery reserved for salvage[J].Int J Radiat Oncol Biol Phys,1998,40(3):549-552.
[33]Mukherji S K,O.Brien S M,Gerstle R J,et al.The ability of tumor volume to predict local control in surgically treated squamous cell carcinoma of the suqraglottic[J].Head Neck,2000,22(3):282-287.
[34]Vanden Bogaert W V,vander Schueren E,Horiot J C,et al.The EORTC randomized trial on three fractions per day and misonidazole in advanced head and neck cancer:prognostic factors[J],Radiother Oncol,1995,35(2):100-106.
[35]Grabenbauer R G,Steininger H,Meyer M,et al.Nodal CT denstity and total tumor volume as prognostic factors after radiation therapy of stage/head and neck cancer[J].Radiother Oncol,1998,47(2):175-183.
[36]Johnson C R,Khandelwal S R,Schmidt-Ulrich R K,et al.The influence of quantitative tumor volume measurements on local control inadvanced head and neck cancer using concomitant boost accelerated superfractionated irradiation[J].Int J Radiat Oncol Biol Phys,1995,32(3):635-641.
[37]Hermans R,Opdebeeck K,Vanden Bogaert W,et al.The relation of CT-determined tumor parameters and local and regional outcome of tonsillar cancer after definitive radiation treatment[J].Int J Radiat Oncol Biol Phys,2001,50(1):37-45.
[38]Johnson C R,Thames H D,Huang D T,et al.The tumor volume and clonogen number relationship:tumor control predictions based upon tumor volume estimates derived from computed Tomography[J].Int J Radiat Oncol Biol Phys,1995,33(2):281-287.
[39]Zitsch R P,Lee B W,Smith R B.Cervical lymphnode metastases and squamous cell carcinoma of the lip[J].Head Neck,1999,21(5):447-453.
[40]Nathu R M,Mancuso A A,Zhu T C,et al.The impact of primary tumor volume on local control for or opharyngeal squamous cell carcinoma treated with radiotherapy[J],Head Neck,2000,1(1):1-5.
[41]Fang F M,Tsai W L,Go S F,et al.Implications of quantitative tumor and nodal regression rates for nasopharyngeal carcinomas after 45 Gy of radiotherapy[J].Int J Radiat Oncol Biol Phys,2001,50(4):961-969.
[42]Brenner D J.Does volume and tumor control predictions in radiotherapy[J].Int J Radiat Oncol Biol Phys,1993,26(1):171-179.
[43]Bentzen S M,Thames H D.Tumor volume and local control probability:chinical data and radiobiological interpretations[J].Int J Radiat Oncol Biol Phys,1996,36(1):247-251.
[44]Bentzen S M,Johansen L V,Overgaard J,et al.Clinical radiobiology of squamous cell carcinoma of the oropharynx[J].Int J Radiat Oncol Biol Phys,1991,20(6):1997-1206.
[45]Bentzen S M,Overgarrd J,Thames H D,et al.Clinical radiobiology of malignant melanoma[J].Radiother Oncol,1989,16(13):169-182.
[46]Stuben G,Thews O,Pottgen C,et al.Tumor oxygenation during fractionated radiotherapy-comparison with size-matched controls[J].Acta Oncol,1999,38(2):209-213.
[47]De J K,Merlo F M,Kavanagh M C,et al.Heterogeneity of tumor oxygenation:relationship to tumor necrosis,tumor size and metastasis[J].Int J Radiat Oncol Biol Phys,1998,42(4):717-721.
[48]Milross C G,Tucker S L,Mason K A,et al.The effect of tumor size on necrosis and polarographically measured P02[J],Acta Oncol,1997,36(2):183-189.
[49]Stadler P,Bedker A,Feldmann H J,et al.Influence of the hypoxic subvolume on the survival of patients with head and neck cancer[J].Int J Radiat Oncol Biol Phys,1999,44(4):749-754.
[50]Hockel M,Schlenger K,Aral B,et al.Association between tumor hypoxia and malingnant progression in advanced cancer of the uterine cervix[J].Cancer Res,1996,56(19):4509-4515.