中华放射肿瘤学杂志
中華放射腫瘤學雜誌
중화방사종류학잡지
CHINESE JOURNAL OF RADIATION ONCOLOGY
2013年
1期
30-34
,共5页
姬凯%赵路军%杨成文%冯振兴%王平
姬凱%趙路軍%楊成文%馮振興%王平
희개%조로군%양성문%풍진흥%왕평
食管鳞癌/三维适形放射治疗%累及野照射%淋巴引流区%剂量学
食管鱗癌/三維適形放射治療%纍及野照射%淋巴引流區%劑量學
식관린암/삼유괄형방사치료%루급야조사%림파인류구%제량학
Esophageal neoplasms/three-dimensional radiotherapy%Involved-field irradiation%Lymph node stations%Dosimetry
目的 评估T1-4N0M0期胸段食管鳞癌患者行累及野三维适形放疗时淋巴引流区不经意接受的剂量.方法 利用29例患者CT定位图像重新设计放疗靶区及治疗计划,GTV根据钡餐、胃镜及胸部CT确定,CTV在GTV上下外扩3 cm、其余外扩0.5 cm,PTV在CTV上下外扩1 cm、其余外扩0.5 cm,处方剂量为60 Gy分30次.分别勾画颈部、胸部及腹部各淋巴引流区,并评估各淋巴引流区剂量学参数.以淋巴结转移风险5%作为判断区域淋巴结是否为高危区域的临界值.结果 胸段食管鳞癌绝大部分高危淋巴引流区中位平均剂量、等效均匀剂量≥40 Gy,中位V40≥85%、V50≥75%.对中位等效均匀剂量<40 Gy的大部分高危淋巴接引流区,食管癌PTV长度与其等效均匀剂量线性相关(r =0.602、0.892,P=0.046、0.000).结论 对食管鳞癌患者仅行三维适形放疗累及野照射时邻近淋巴引流区也受到了高剂量照射,有可能对控制亚临床转移起到一定作用,但有待于进一步临床研究证实.
目的 評估T1-4N0M0期胸段食管鱗癌患者行纍及野三維適形放療時淋巴引流區不經意接受的劑量.方法 利用29例患者CT定位圖像重新設計放療靶區及治療計劃,GTV根據鋇餐、胃鏡及胸部CT確定,CTV在GTV上下外擴3 cm、其餘外擴0.5 cm,PTV在CTV上下外擴1 cm、其餘外擴0.5 cm,處方劑量為60 Gy分30次.分彆勾畫頸部、胸部及腹部各淋巴引流區,併評估各淋巴引流區劑量學參數.以淋巴結轉移風險5%作為判斷區域淋巴結是否為高危區域的臨界值.結果 胸段食管鱗癌絕大部分高危淋巴引流區中位平均劑量、等效均勻劑量≥40 Gy,中位V40≥85%、V50≥75%.對中位等效均勻劑量<40 Gy的大部分高危淋巴接引流區,食管癌PTV長度與其等效均勻劑量線性相關(r =0.602、0.892,P=0.046、0.000).結論 對食管鱗癌患者僅行三維適形放療纍及野照射時鄰近淋巴引流區也受到瞭高劑量照射,有可能對控製亞臨床轉移起到一定作用,但有待于進一步臨床研究證實.
목적 평고T1-4N0M0기흉단식관린암환자행루급야삼유괄형방료시림파인류구불경의접수적제량.방법 이용29례환자CT정위도상중신설계방료파구급치료계화,GTV근거패찬、위경급흉부CT학정,CTV재GTV상하외확3 cm、기여외확0.5 cm,PTV재CTV상하외확1 cm、기여외확0.5 cm,처방제량위60 Gy분30차.분별구화경부、흉부급복부각림파인류구,병평고각림파인류구제량학삼수.이림파결전이풍험5%작위판단구역림파결시부위고위구역적림계치.결과 흉단식관린암절대부분고위림파인류구중위평균제량、등효균균제량≥40 Gy,중위V40≥85%、V50≥75%.대중위등효균균제량<40 Gy적대부분고위림파접인류구,식관암PTV장도여기등효균균제량선성상관(r =0.602、0.892,P=0.046、0.000).결론 대식관린암환자부행삼유괄형방료루급야조사시린근림파인류구야수도료고제량조사,유가능대공제아림상전이기도일정작용,단유대우진일보림상연구증실.
Objective To quantify the incidental irradiation dose (ⅡD) to lymph node stations of esophagus when treating patients with T1-4N0 M0 thoracic esophageal squamous cell carcinoma (ESCC) with a dose of 60 Gy/30f.Methods Twenty-nine patients with medically inoperable T1-4N0M0 thoracic ESCC were treated with three-dimensional radiotherapy on involved-field.The conformal CTV was re-created using a 3 cm margin in the proximal and distal direction (following the course of the esophagus) beyond the barium esophagogram,endoscopic examination and CT defined GTV and a 0.5 cm margin in the lateral and anteroposterior directions of the CT defined GTV.The PTV encompassed 1 cm proximal and distal margins,0.5 cm radiaI margin on the basis of CTV.Cervical,mediastinal and abdominal lymph nodes were delineated respectively.Equivalent uniform dose (EUD) and other dosimetric paraneters were calculated for each nodal station.Nodal region whose metastasis rate is greater than 5% was considered a high risk lymph node subgroups.Results Under a 60 Gy dose prescription,the median Dmean and EUD,V40 and V50 were ≥40 Gy,≥85% and ≥75% in most of the high risk nodal regions.For the subgroups whose EUD were less than 40 Gy,most of the ⅡD of these regions was significantly associated with the length and location of esophageal tumor (r =0.892,P =0.000).Conclusions Lymph node stations nearby of ESCC received considerable ⅡD with involved-field irradiation which could control subclinical lesions.But more clinical studies should be needed.