CAJ | 학술논문

背景与目的:晚期鼻咽癌诱导化疗后大体肿瘤体积(gross tumor volume,GTV)明显缩小.本研究探讨按化疗后肿瘤改变GTV勾画方式对靶区和正常组织剂量以及临床疗效的影响.方法:从2008年1月至2009年4月收治24例局部晚期鼻咽癌初治患者,采用TPF诱导化疗加同期调强放化疗方案进行治疗.调强放疗原发灶GTV分为诱导化疗后可见的肿瘤和诱导化疗后肿瘤消退区域两部分.选取10例患者,比较按诱导化疗前后肿瘤勾画GTV所做计划的剂量分布,同时观察全组患者毒副反应和近期疗效.结果:诱导化疗后和前原发灶GTV平均体积分别为25.5 cm~3和51.1 cm~3(P=0.001);颈淋巴结GTV 9.1 cm~3和31.4 cm~3(P=0.035);原发灶+颈淋巴结GTV 33.2 cm~3和82.6 cm~3(P=0.004),诱导化疗使肿瘤总体积减少了61%,64.6 Gy等剂量线所包括的体积分别为422.9 cm~3和457.9 cm~3(P=0.003);68 Gy等剂量线所包括的体积274.2 cm~3和334.5 cm~3(P=0.041).诱导化疗后鼻咽病灶和颈部淋巴结完全缓解率达38%.同期放化疗结束后3个月鼻咽病灶和颈部淋巴结完全缓解率达100%.该模式同期放化疗毒性反应与单纯调强同期放化疗相似.经中位期9个月的随访,全组患者局部区域控制率为100%.仅1例患者在15个月出现多处远处转移.结论:鼻咽癌TPF方案诱导化疗后肿瘤体积明显缩小,按化疗后肿瘤勾画GTV的调强放疗能使高剂量区体积减少,同期放化疗毒性反应未见加重,并且具有较好的近期治疗效果.
배경여목적:만기비인암유도화료후대체종류체적(gross tumor volume,GTV)명현축소.본연구탐토안화료후종류개변GTV구화방식대파구화정상조직제량이급림상료효적영향.방법:종2008년1월지2009년4월수치24례국부만기비인암초치환자,채용TPF유도화료가동기조강방화료방안진행치료.조강방료원발조GTV분위유도화료후가견적종류화유도화료후종류소퇴구역량부분.선취10례환자,비교안유도화료전후종류구화GTV소주계화적제량분포,동시관찰전조환자독부반응화근기료효.결과:유도화료후화전원발조GTV평균체적분별위25.5 cm~3화51.1 cm~3(P=0.001);경림파결GTV 9.1 cm~3화31.4 cm~3(P=0.035);원발조+경림파결GTV 33.2 cm~3화82.6 cm~3(P=0.004),유도화료사종류총체적감소료61%,64.6 Gy등제량선소포괄적체적분별위422.9 cm~3화457.9 cm~3(P=0.003);68 Gy등제량선소포괄적체적274.2 cm~3화334.5 cm~3(P=0.041).유도화료후비인병조화경부림파결완전완해솔체38%.동기방화료결속후3개월비인병조화경부림파결완전완해솔체100%.해모식동기방화료독성반응여단순조강동기방화료상사.경중위기9개월적수방,전조환자국부구역공제솔위100%.부1례환자재15개월출현다처원처전이.결론:비인암TPF방안유도화료후종류체적명현축소,안화료후종류구화GTV적조강방료능사고제량구체적감소,동기방화료독성반응미견가중,병차구유교호적근기치료효과.
Background and Objective:The gross tumor volume (GTV) obviously reduces after induction chemotherapy (IC) for primary Iocoregionally advanced nasopharyngeal carcinoma (NPC). This study was to investigate the impact of changing gross tumor volume delineation on the dose distribution and clinical treatment outcome after IC. Methods: From January 2008 to April 2009, 24 patients with Stage Ⅲ-Ⅳb primary locoregionally advanced NPC were treated with TPF regimen IC followed by intensitymodulated radiotherapy (IMRT) with concurrent chemotherapy The primary GTVs were delineated into two parts: the post-IC primary GTV (GTVpost-IC-NP),and the region of pre-IC primary GTV minus GTVpost-IC-NP (GTVprepost-IC-NP). The dose distributions of two plans with GTVpost-IC-NP or pre-IC primary GTV were assessed by analyzing ten cases. The clinical treatment outcome and toxicity of all patients were observed. Results:The post-IC GTV was significantly smaller than the pre-IC GTV(primary GTV 25.5 cm~3 vs.51.1 cm~3,P=0.001;lymph nodes GTV 9.1 cm~3 vs. 31.4 cm~3, P=0.035;primary+lymph nodes GTV 33.2 cm~3 vs. 82.6 cm~3, P=0.004), the overall GTV with an average shrinkage of 61%. The high dose region was also smaller after IC(volumes covered by 64.4 Gy were 422.9 cm~3 vs.457.9cm~3, P=0.003; 274.2 cm~3 vs.334.5 cm~3 by 68 Gy, P=0.041). The complete response rate was 38% after IC,and 100% three month after radiotherapy.The toxicity of following IMRT with concurrent chemotherapy was similar to that of IMRT with concurrent chemotherapy alone. With median follow-up of 9 months, the locoregionally control rate was 100% and only one patient presented metastasis 15 months after treatment. Gonclusions: TPF regimen IC could significantly reduce tumor volume. The following IMRT with GTVpost-IC-NP plan reduced the high dose region,which didn't add toxicity while had excellent short-term treatment outcome.