单侧茎突后间隙受侵的T_（3-4）N_0M_0Ⅲ-Ⅳ期鼻咽癌常规和调强放疗计划的对比研究
摘要
目的:研究单侧茎突后间隙受侵的T_(3-4)N_0M_0Ⅲ-Ⅳa期鼻咽癌常规放疗和调强放疗中计划靶体积(PTV)及危及器官(OAR)的剂量学分布情况,为此期鼻咽癌的放射治疗提供物理学依据。
方法:对五例单侧茎突后间隙受侵的T_(3-4)N_0M_0Ⅲ-Ⅳa期鼻咽癌患者分别进行头颈部CT和MRI扫描后,在Eclipse三维逆向治疗计划系统中进行图像的三维重建及融合,分别作出常规放疗计划和调强放疗计划,依据ICRU50号报告和62号报告提出的物理学指标进行评估。
结果:
1.常规计划的PGTVD_(05)、PTV1D_(05)高于调强计划;PGTVD_(95)、PTV1D_(95)、PTV1Mean、PTV2D_(05)、PTV2D_(95)、PTV2Mean均低于调强计划。
2.常规计划中脊髓D_1、双侧腮腺D_(50)、双侧视神经D_1、双侧颞颌关节D_(50)、视交叉D_1、颞叶D_(05)高于调强计划;晶体D_0低于调强计划。
3.常规计划中BodyDmean低于调强计划。
结论:
对于单侧茎突后间隙受侵的T_(3-4)N_0M_0Ⅲ-Ⅳa期鼻咽癌:
1.调强计划中计划靶区的剂量分布优于常规计划;
2.调强计划中脊髓、视神经、视交叉、腮腺、颞颌关节、颞叶剂量分布较常规计划有一定优势。
3.调强计划中正常组织受照体积较常规计划增大。
Objective:To make a guideline for radiatiotherapy of single side post styloid prosess parapharyngeal space(PSPS)invaded NPC in stage T_(3-4)N_0M_0,Ⅲ-Ⅳa with 92'Fuzhou Staging System,the different dose distribution of PTV and OAR were studied by comparing conventional radiatiotherapy plan with IMRT plan.
Methods:After CT and MRI scanning of 5 PSPS invaded NPC patients,the image were restituted and syncretized in Eclipse External Beam Planning System,after that,we made the conventional radiatiotherapy plan and IMRT one for each patient to evaluate dose distribution according as ICRU 50 and 62 report.
Results:
1.PGTVD_5、PTV1D_(05)in convention plan is higher than IMRT, PGTVD_(95)、PTV1D_(95)、PTV1Mean、PTV2D_(05)、PTV2D_(95)、PTV2Mean in convention plan are lower than IMRT.
2.Spinal cord D_1,optic chiasmaD_1,both sides of temporal lobe D_(05), parotid D_(50),optic nervesD_1,temporomandibular joints D_(50)are lower in IMRT plan;lens D_0 are higher in IMRT plan.
3.Body Dmean is higher in IMRT plan.
Conclusion:To single side PSPS invaded NPC in stage T_(3-4)N_0M_0,Ⅲ-Ⅳa:
1.Dose distribution in IMRT plan is better than the convention one.
2.Dose distribution of spinal cord,optic chiasma,both sides of temporal lobe,parotids,optic nerves,temporomandibular joints and are better in IMRT pian。
3.Volume of irradiated normal tussue is larger in IMRT plan.
方法:对五例单侧茎突后间隙受侵的T_(3-4)N_0M_0Ⅲ-Ⅳa期鼻咽癌患者分别进行头颈部CT和MRI扫描后,在Eclipse三维逆向治疗计划系统中进行图像的三维重建及融合,分别作出常规放疗计划和调强放疗计划,依据ICRU50号报告和62号报告提出的物理学指标进行评估。
结果:
1.常规计划的PGTVD_(05)、PTV1D_(05)高于调强计划;PGTVD_(95)、PTV1D_(95)、PTV1Mean、PTV2D_(05)、PTV2D_(95)、PTV2Mean均低于调强计划。
2.常规计划中脊髓D_1、双侧腮腺D_(50)、双侧视神经D_1、双侧颞颌关节D_(50)、视交叉D_1、颞叶D_(05)高于调强计划;晶体D_0低于调强计划。
3.常规计划中BodyDmean低于调强计划。
结论:
对于单侧茎突后间隙受侵的T_(3-4)N_0M_0Ⅲ-Ⅳa期鼻咽癌:
1.调强计划中计划靶区的剂量分布优于常规计划;
2.调强计划中脊髓、视神经、视交叉、腮腺、颞颌关节、颞叶剂量分布较常规计划有一定优势。
3.调强计划中正常组织受照体积较常规计划增大。
Objective:To make a guideline for radiatiotherapy of single side post styloid prosess parapharyngeal space(PSPS)invaded NPC in stage T_(3-4)N_0M_0,Ⅲ-Ⅳa with 92'Fuzhou Staging System,the different dose distribution of PTV and OAR were studied by comparing conventional radiatiotherapy plan with IMRT plan.
Methods:After CT and MRI scanning of 5 PSPS invaded NPC patients,the image were restituted and syncretized in Eclipse External Beam Planning System,after that,we made the conventional radiatiotherapy plan and IMRT one for each patient to evaluate dose distribution according as ICRU 50 and 62 report.
Results:
1.PGTVD_5、PTV1D_(05)in convention plan is higher than IMRT, PGTVD_(95)、PTV1D_(95)、PTV1Mean、PTV2D_(05)、PTV2D_(95)、PTV2Mean in convention plan are lower than IMRT.
2.Spinal cord D_1,optic chiasmaD_1,both sides of temporal lobe D_(05), parotid D_(50),optic nervesD_1,temporomandibular joints D_(50)are lower in IMRT plan;lens D_0 are higher in IMRT plan.
3.Body Dmean is higher in IMRT plan.
Conclusion:To single side PSPS invaded NPC in stage T_(3-4)N_0M_0,Ⅲ-Ⅳa:
1.Dose distribution in IMRT plan is better than the convention one.
2.Dose distribution of spinal cord,optic chiasma,both sides of temporal lobe,parotids,optic nerves,temporomandibular joints and are better in IMRT pian。
3.Volume of irradiated normal tussue is larger in IMRT plan.
引文
[1]赵充,陈明,曾祥发,等.鼻咽癌茎突后间隙侵犯的临床意义探讨.中华耳鼻喉科杂志,2000,35(3):172-174
[2]肖光莉,徐国镇,高黎,等.鼻咽癌咽旁间隙受侵对预后的影响.中华肿瘤杂志,2001,23(3):244-246
[3]Sham J S,Cheung Y K,Choy D,et al.Nasopharyngeal carcinoma;CT evaluation of pattern of tumor spread.Am J Neuroradial,1991,12(2):265-270
[4]Teo P,Lee W Y,Yu P.The prognostic significance of parapharyngealtumor involvement in nasopharyngeal carcinoma.Radiother Onco1,1996,39(3):209-221
[5]孙折玉,麦海强,谢传森,等.鼻咽癌咽旁间隙侵犯对预后的影响.中华肿瘤防治杂志,2006,13(10):756-759
[6]Parliament MB,Scrimger RA,Anderson SG,et al Preservation of oralhealth2related quality of life and salivary flow rates after inverse planned IMRT for head and neck cancer.Int J Radiat Oncol Biol Phys,2004,58(3):663-673
[7]Chao KS,Ozyigit G,Thorsdad WL.Toxicity profile of IMRT for head and neck carcinoma and potential role of amifostine.Semin Oncol,2003,30(1):101-108
[8]Lin A,Kim HM,Terrell JE,et al.Quality of life after parotid sparing IMRT for head and neck cancer:a prospective longitudinal study.IntJ Radiat Oncol Biol Phys,2003,57(1):61-70
[9]ICRU.Prescribing,recording and repirting photon beam therapy.ICRU Report 50,1993
[10]ICRU.Prescribing,recording and repirting photon beam therapy.ICRU Report 62,1999
[11]Hunt MA,Zelefsky MJ,Wolden S,et al.Treatment planning and delivery of intensity-modulated radiation therapy for primary nasopharynx cancer.Int J Radiat Oncol Biol Phys,2001,49(3):623-632
[12]胡自省,胡炳强,廖遇平,等.肿瘤放射治疗手册.湖南科学技术出版社,1999,107-116
[13]Andrea pirzkam,Markcarol,Frank lohr,et al.Comparison of intensity-modulated radiotherapy with conventional conformal radiotherapy for complex-shaped tumors.Int.J.Radiation Oncology Biol.Phys,2000,48(5):1371-1380
[14]魏宝清.从鼻咽癌放疗后颅神经损伤探讨当前放疗技术的问题.中华放射肿瘤学杂志,1994,3(3):209-221
[15]张恩罴,罗伟,钱剑扬.改进鼻咽癌放射治疗技术的研究一(1)靶区剂量分布.癌症,1996,15(2):136
[16]Teo P,YuLP.The prognostic significance of parapharyngeal tumor involvetment in nasopharygeal carcinoma.Radiother Onco1,1996,39(3):209-221
[17]彭逊,林志雄.鼻咽癌常规外照射放疗不同设野茎突后区剂量分析.肿瘤防治研究,2005,32(3):168-170
[18]HuntMA,ZelefskyMJ,Wolden S,et al.Treatment planning anddelivery of intensity-modulated radiation therapy for p rimary nasopharynx cancer.Int Radiat Oncol Biol Phys,2001,49(3):623-632
[19]Kam MK,Chau RM,Suen J,et al.Intensity-modulated radiotherapy in nasopharyngeal carcinoma:dosimetric advantage over conventional p lans and feasibility of dose escalation.Int J RadiatOncol Biol Phys,2003,56(1):145-157
[20]Kwong DL,Sham JS,Leung LH,et al.Preliminary results of radiation dose escalation for locally advanced nasopharyngeal carcinoma.Int J Radiat Oncol Biol Phys,2006,64(2):374-381
[21]赵充,等.调强适形放射治疗对局部晚期鼻咽癌的临床疗效.癌症,2004,23(11):1532-1537
[22]殷蔚伯,余子豪.肿瘤放射治疗学.第4版.北京:中国协和医科大学出版社,2008,281-282
[23]张书旭,王兆武,沈国辉,等.鼻咽癌调强放疗受照剂量分布特性研究.肿瘤基础与临床,2006,19(3):203-205
[24]孙全富,陶祖范,等.阳江天然放射性高本底辐射慢性照射与实体癌超额危险.中华放射医学与防护杂志,2002,22(1):512-514
[1]朱苏雨.鼻咽癌调强放疗靶区描绘和设定及剂量分配的现状.中国肿瘤临床,2008,35(3):173-177
[2]Wolden SL,Chen WC,Pfister DG,et al.Intensity-modulated radiationtherapy (IMRT)for nasopharynx cancer:update of the Memorial Sloan-Kettering experience.Int J Radiat Oncol BiolPhys,2006,64(1):57-62
[3]Kwong DL,Sham JS,Leung LH,et al.Preliminary results of radiation dose escalation for locally advanced nasopharyngeal carcinoma.Int J Radiat Oncol Biol Phys,2006,64(2):374-381
[4]赵充,卢丽霞,韩非,等.122例鼻咽癌单纯根治性调强放疗疗效分析.中华放射肿瘤学杂志,2006,15(5):364-368
[5]Kam MK,Teo PM,Chau RM,et al.Treatment of nasopharyngeal carcinoma with intensity-modulated radiotherapy:the Hong Kong experience.Int J Radiat Oncol Biol Phys,2004,60(5):1440-1450
[6]Eisbruch A,Foote RL,O'Sullivan B,et al.Intensity-modulatedradiation therapy for head and neck cancer:emphasis on the selection and delineation of the targets.Semin Radiat Oncol,2002,12(3):238-249
[7]袁智勇,高黎,徐国镇,等.初治鼻咽癌调强放疗的初步结果.中华放射肿瘤学杂志,2006,15(4):237-243
[8]Hunt MA,Zelefsky MJ,Wolden S,et al.Treatment planning and delivery of intensity-modulated radiation therapy for primary nasopharynx cancer.Int J Radiat Oncol Biol Phys,2001,49(3):623-632
[9]Chao KS,Wippold FJ,Ozyigit G,et al.Determination and delineation of nodal target volumes for head-and-neck cancer based on patterns of failure in patients receiving definitive and post operativelMRT.Int J Radiat Oncol Biol Phys,2002,53(5):1174-1184
[10]Eisbruch A,Ten Haken RK,Kim HM,et al.Dose,volume,and function relationships in parotid salivary glands following conformaland intensity-modulated irradiation of head and neck cancer.Int J Radiat Oncol Biol Phys,1999,45(3):577-587
[11]Lee N,Xia P,Quivey JM,et al.Intensity-modulated radiotherapy in the treatment of nasopharyngeal carcinoma:an update of the UCSF experience.Int J Radiat Oncol Biol Phys,2002,53(1):12-22
[12]张金涛,李平.生物靶区在肿瘤调强放射治疗中应用的研究进展.华西医学2007,22(1):217-219
[13]Kesster ML.Integration of multimodality image data for three dimensional treatment planning.In:Jaced P,Syllabus A.Categorical course in physics.Threedimensional Radiation Therapy Treatment planning.1994:31-39
[14]Frank Ciernik,Elena Dizendorf,Brigitta G,et al.Radiation treatment planning with anintegrated position emission and computer to2mography(PET/CT):a feasibility study.Int J Radiat Phys,2003,51(3):853-863
[15]Nishioka T,Shiga T,Shirato H,et al.Image fusion between 18FDG-PET andMRI/CTfor radiotherapy planning of oropha2ryngeal and nasopharyngeal carcinomas.Int J Radiat Oncol Biol Phys,2002,53(4):1051-1057
[16]Ling CC,Humm J,Larson S,et al.Towards multidimensional radiotherapy (MD-CRT):biological imaging and biological conformality.Int J Radiat Oncol BiolPhys,2000,47(3):551
[17]曹建忠,罗京伟,徐国镇,等.鼻咽癌调强放疗中靶区和正常器官变化规律及临床意义探讨.中华放射肿瘤学杂志,2007,16(2):81-85
[18]Barker JL J r,Garden AS,Ang KK,et al.Quantification of volumetric and geometric changes occurring during fractionated radiotherapy for head-andneck cancer using an integrated CT/linear accelerator system.Int J Radiat Oncol Biol Phys,2004,59(4):960-970
[19]柏森.IGRT技术与应用.2007第六届放射肿瘤学学术年会,457-459
[2]肖光莉,徐国镇,高黎,等.鼻咽癌咽旁间隙受侵对预后的影响.中华肿瘤杂志,2001,23(3):244-246
[3]Sham J S,Cheung Y K,Choy D,et al.Nasopharyngeal carcinoma;CT evaluation of pattern of tumor spread.Am J Neuroradial,1991,12(2):265-270
[4]Teo P,Lee W Y,Yu P.The prognostic significance of parapharyngealtumor involvement in nasopharyngeal carcinoma.Radiother Onco1,1996,39(3):209-221
[5]孙折玉,麦海强,谢传森,等.鼻咽癌咽旁间隙侵犯对预后的影响.中华肿瘤防治杂志,2006,13(10):756-759
[6]Parliament MB,Scrimger RA,Anderson SG,et al Preservation of oralhealth2related quality of life and salivary flow rates after inverse planned IMRT for head and neck cancer.Int J Radiat Oncol Biol Phys,2004,58(3):663-673
[7]Chao KS,Ozyigit G,Thorsdad WL.Toxicity profile of IMRT for head and neck carcinoma and potential role of amifostine.Semin Oncol,2003,30(1):101-108
[8]Lin A,Kim HM,Terrell JE,et al.Quality of life after parotid sparing IMRT for head and neck cancer:a prospective longitudinal study.IntJ Radiat Oncol Biol Phys,2003,57(1):61-70
[9]ICRU.Prescribing,recording and repirting photon beam therapy.ICRU Report 50,1993
[10]ICRU.Prescribing,recording and repirting photon beam therapy.ICRU Report 62,1999
[11]Hunt MA,Zelefsky MJ,Wolden S,et al.Treatment planning and delivery of intensity-modulated radiation therapy for primary nasopharynx cancer.Int J Radiat Oncol Biol Phys,2001,49(3):623-632
[12]胡自省,胡炳强,廖遇平,等.肿瘤放射治疗手册.湖南科学技术出版社,1999,107-116
[13]Andrea pirzkam,Markcarol,Frank lohr,et al.Comparison of intensity-modulated radiotherapy with conventional conformal radiotherapy for complex-shaped tumors.Int.J.Radiation Oncology Biol.Phys,2000,48(5):1371-1380
[14]魏宝清.从鼻咽癌放疗后颅神经损伤探讨当前放疗技术的问题.中华放射肿瘤学杂志,1994,3(3):209-221
[15]张恩罴,罗伟,钱剑扬.改进鼻咽癌放射治疗技术的研究一(1)靶区剂量分布.癌症,1996,15(2):136
[16]Teo P,YuLP.The prognostic significance of parapharyngeal tumor involvetment in nasopharygeal carcinoma.Radiother Onco1,1996,39(3):209-221
[17]彭逊,林志雄.鼻咽癌常规外照射放疗不同设野茎突后区剂量分析.肿瘤防治研究,2005,32(3):168-170
[18]HuntMA,ZelefskyMJ,Wolden S,et al.Treatment planning anddelivery of intensity-modulated radiation therapy for p rimary nasopharynx cancer.Int Radiat Oncol Biol Phys,2001,49(3):623-632
[19]Kam MK,Chau RM,Suen J,et al.Intensity-modulated radiotherapy in nasopharyngeal carcinoma:dosimetric advantage over conventional p lans and feasibility of dose escalation.Int J RadiatOncol Biol Phys,2003,56(1):145-157
[20]Kwong DL,Sham JS,Leung LH,et al.Preliminary results of radiation dose escalation for locally advanced nasopharyngeal carcinoma.Int J Radiat Oncol Biol Phys,2006,64(2):374-381
[21]赵充,等.调强适形放射治疗对局部晚期鼻咽癌的临床疗效.癌症,2004,23(11):1532-1537
[22]殷蔚伯,余子豪.肿瘤放射治疗学.第4版.北京:中国协和医科大学出版社,2008,281-282
[23]张书旭,王兆武,沈国辉,等.鼻咽癌调强放疗受照剂量分布特性研究.肿瘤基础与临床,2006,19(3):203-205
[24]孙全富,陶祖范,等.阳江天然放射性高本底辐射慢性照射与实体癌超额危险.中华放射医学与防护杂志,2002,22(1):512-514
[1]朱苏雨.鼻咽癌调强放疗靶区描绘和设定及剂量分配的现状.中国肿瘤临床,2008,35(3):173-177
[2]Wolden SL,Chen WC,Pfister DG,et al.Intensity-modulated radiationtherapy (IMRT)for nasopharynx cancer:update of the Memorial Sloan-Kettering experience.Int J Radiat Oncol BiolPhys,2006,64(1):57-62
[3]Kwong DL,Sham JS,Leung LH,et al.Preliminary results of radiation dose escalation for locally advanced nasopharyngeal carcinoma.Int J Radiat Oncol Biol Phys,2006,64(2):374-381
[4]赵充,卢丽霞,韩非,等.122例鼻咽癌单纯根治性调强放疗疗效分析.中华放射肿瘤学杂志,2006,15(5):364-368
[5]Kam MK,Teo PM,Chau RM,et al.Treatment of nasopharyngeal carcinoma with intensity-modulated radiotherapy:the Hong Kong experience.Int J Radiat Oncol Biol Phys,2004,60(5):1440-1450
[6]Eisbruch A,Foote RL,O'Sullivan B,et al.Intensity-modulatedradiation therapy for head and neck cancer:emphasis on the selection and delineation of the targets.Semin Radiat Oncol,2002,12(3):238-249
[7]袁智勇,高黎,徐国镇,等.初治鼻咽癌调强放疗的初步结果.中华放射肿瘤学杂志,2006,15(4):237-243
[8]Hunt MA,Zelefsky MJ,Wolden S,et al.Treatment planning and delivery of intensity-modulated radiation therapy for primary nasopharynx cancer.Int J Radiat Oncol Biol Phys,2001,49(3):623-632
[9]Chao KS,Wippold FJ,Ozyigit G,et al.Determination and delineation of nodal target volumes for head-and-neck cancer based on patterns of failure in patients receiving definitive and post operativelMRT.Int J Radiat Oncol Biol Phys,2002,53(5):1174-1184
[10]Eisbruch A,Ten Haken RK,Kim HM,et al.Dose,volume,and function relationships in parotid salivary glands following conformaland intensity-modulated irradiation of head and neck cancer.Int J Radiat Oncol Biol Phys,1999,45(3):577-587
[11]Lee N,Xia P,Quivey JM,et al.Intensity-modulated radiotherapy in the treatment of nasopharyngeal carcinoma:an update of the UCSF experience.Int J Radiat Oncol Biol Phys,2002,53(1):12-22
[12]张金涛,李平.生物靶区在肿瘤调强放射治疗中应用的研究进展.华西医学2007,22(1):217-219
[13]Kesster ML.Integration of multimodality image data for three dimensional treatment planning.In:Jaced P,Syllabus A.Categorical course in physics.Threedimensional Radiation Therapy Treatment planning.1994:31-39
[14]Frank Ciernik,Elena Dizendorf,Brigitta G,et al.Radiation treatment planning with anintegrated position emission and computer to2mography(PET/CT):a feasibility study.Int J Radiat Phys,2003,51(3):853-863
[15]Nishioka T,Shiga T,Shirato H,et al.Image fusion between 18FDG-PET andMRI/CTfor radiotherapy planning of oropha2ryngeal and nasopharyngeal carcinomas.Int J Radiat Oncol Biol Phys,2002,53(4):1051-1057
[16]Ling CC,Humm J,Larson S,et al.Towards multidimensional radiotherapy (MD-CRT):biological imaging and biological conformality.Int J Radiat Oncol BiolPhys,2000,47(3):551
[17]曹建忠,罗京伟,徐国镇,等.鼻咽癌调强放疗中靶区和正常器官变化规律及临床意义探讨.中华放射肿瘤学杂志,2007,16(2):81-85
[18]Barker JL J r,Garden AS,Ang KK,et al.Quantification of volumetric and geometric changes occurring during fractionated radiotherapy for head-andneck cancer using an integrated CT/linear accelerator system.Int J Radiat Oncol Biol Phys,2004,59(4):960-970
[19]柏森.IGRT技术与应用.2007第六届放射肿瘤学学术年会,457-459