现代肿瘤医学
現代腫瘤醫學
현대종류의학
JOURNAL OF MODERN ONCOLOGY
2015年
11期
1517-1521
,共5页
孙宜%李兆斌%章青%张丽华%熊霏%黄国峰%傅深
孫宜%李兆斌%章青%張麗華%熊霏%黃國峰%傅深
손의%리조빈%장청%장려화%웅비%황국봉%부심
放射治疗%鼻咽癌%放射治疗剂量
放射治療%鼻嚥癌%放射治療劑量
방사치료%비인암%방사치료제량
radiotherapy%nasopharyngeal carcinoma%radiotherapy dose
目的:研究鼻咽癌在调强放射治疗过程中,肿瘤和正常组织的体积、形态变化对各自剂量受量的影响。方法:2009年1月-2010年6月间初诊经病理明确诊断的鼻咽癌患者42例,所有患者经头颈肩膜固定行模拟CT,在CT图像上逐层勾画治疗靶区和正常组织,采用6MV X线9野共面调强放射治疗计划( IMRT)。鼻咽原发灶及颈部转移淋巴结照射剂量66Gy/30f/6w,鼻咽部和颈部淋巴引流区亚临床病灶照射剂量60Gy/30f/6w。治疗设备为西门子ONCOR直线加速器。治疗期间每日采集患者治疗体位0度和90度正交二维摄片图像,同原始计划DRR图像对比,在三维方向对患者进行摆位误差校正,然后实施放射治疗。每周采集一次患者治疗体位头颈部CT图像,把治疗计划按照标记点移植到每周CT上,重新进行计量计算,分析患者在治疗期间靶区及正常组织剂量分布变化。同步化疗采用多西他赛加顺铂方案,每三周一次,在放疗开始前1周内开始同步治疗。结果:所有患者放疗前GTV1平均体积39.19cc,GTV2平均体积16.59cc,放疗第4周及第6周GTV1平均退缩分别为26.41%、62.68%,GTV2平均退缩分别为28.43%、53.93%。治疗前双侧腮腺体积平均为24.16cc,放射治疗第4周,平均腮腺体积为19.04cc,第6周平均腮腺体积为17.54cc。正常组织计量受量方面,脊髓(D1%)、脑干(D1%)、颞叶(D1%)、内耳( Dmean )、腮腺( V30),原计划计量分别为:(41.2±0.98)Gy、(51.26±1.57)Gy、(59.95±2.11)Gy、(45.02±1.98)Gy、(47.87±18.05)%。照射第4周分别为:(44.09±1.88)Gy、(52.81±2.47)Gy、(62.04±2.43)Gy、(47.24±3.68)Gy、(49.03±15.68)%。第六周(44.44±2.7)Gy、(54.14±2.51)Gy、(62.34±2.86)Gy、(48.37±5.37)Gy、(52.19±15.51)%。结论:随着鼻咽癌调强放射治疗的进行,照射肿瘤靶区同原始计划剂量分布会有一定差异,除1例淋巴结退缩及病人消瘦等原因而造成外轮廓内收较大的患者以外,其余CTV实际照射剂量为处方剂量95%以上。正常组织在整个治疗过程所受照射剂量同原始计划比较有所增加。
目的:研究鼻嚥癌在調彊放射治療過程中,腫瘤和正常組織的體積、形態變化對各自劑量受量的影響。方法:2009年1月-2010年6月間初診經病理明確診斷的鼻嚥癌患者42例,所有患者經頭頸肩膜固定行模擬CT,在CT圖像上逐層勾畫治療靶區和正常組織,採用6MV X線9野共麵調彊放射治療計劃( IMRT)。鼻嚥原髮竈及頸部轉移淋巴結照射劑量66Gy/30f/6w,鼻嚥部和頸部淋巴引流區亞臨床病竈照射劑量60Gy/30f/6w。治療設備為西門子ONCOR直線加速器。治療期間每日採集患者治療體位0度和90度正交二維攝片圖像,同原始計劃DRR圖像對比,在三維方嚮對患者進行襬位誤差校正,然後實施放射治療。每週採集一次患者治療體位頭頸部CT圖像,把治療計劃按照標記點移植到每週CT上,重新進行計量計算,分析患者在治療期間靶區及正常組織劑量分佈變化。同步化療採用多西他賽加順鉑方案,每三週一次,在放療開始前1週內開始同步治療。結果:所有患者放療前GTV1平均體積39.19cc,GTV2平均體積16.59cc,放療第4週及第6週GTV1平均退縮分彆為26.41%、62.68%,GTV2平均退縮分彆為28.43%、53.93%。治療前雙側腮腺體積平均為24.16cc,放射治療第4週,平均腮腺體積為19.04cc,第6週平均腮腺體積為17.54cc。正常組織計量受量方麵,脊髓(D1%)、腦榦(D1%)、顳葉(D1%)、內耳( Dmean )、腮腺( V30),原計劃計量分彆為:(41.2±0.98)Gy、(51.26±1.57)Gy、(59.95±2.11)Gy、(45.02±1.98)Gy、(47.87±18.05)%。照射第4週分彆為:(44.09±1.88)Gy、(52.81±2.47)Gy、(62.04±2.43)Gy、(47.24±3.68)Gy、(49.03±15.68)%。第六週(44.44±2.7)Gy、(54.14±2.51)Gy、(62.34±2.86)Gy、(48.37±5.37)Gy、(52.19±15.51)%。結論:隨著鼻嚥癌調彊放射治療的進行,照射腫瘤靶區同原始計劃劑量分佈會有一定差異,除1例淋巴結退縮及病人消瘦等原因而造成外輪廓內收較大的患者以外,其餘CTV實際照射劑量為處方劑量95%以上。正常組織在整箇治療過程所受照射劑量同原始計劃比較有所增加。
목적:연구비인암재조강방사치료과정중,종류화정상조직적체적、형태변화대각자제량수량적영향。방법:2009년1월-2010년6월간초진경병리명학진단적비인암환자42례,소유환자경두경견막고정행모의CT,재CT도상상축층구화치료파구화정상조직,채용6MV X선9야공면조강방사치료계화( IMRT)。비인원발조급경부전이림파결조사제량66Gy/30f/6w,비인부화경부림파인류구아림상병조조사제량60Gy/30f/6w。치료설비위서문자ONCOR직선가속기。치료기간매일채집환자치료체위0도화90도정교이유섭편도상,동원시계화DRR도상대비,재삼유방향대환자진행파위오차교정,연후실시방사치료。매주채집일차환자치료체위두경부CT도상,파치료계화안조표기점이식도매주CT상,중신진행계량계산,분석환자재치료기간파구급정상조직제량분포변화。동보화료채용다서타새가순박방안,매삼주일차,재방료개시전1주내개시동보치료。결과:소유환자방료전GTV1평균체적39.19cc,GTV2평균체적16.59cc,방료제4주급제6주GTV1평균퇴축분별위26.41%、62.68%,GTV2평균퇴축분별위28.43%、53.93%。치료전쌍측시선체적평균위24.16cc,방사치료제4주,평균시선체적위19.04cc,제6주평균시선체적위17.54cc。정상조직계량수량방면,척수(D1%)、뇌간(D1%)、섭협(D1%)、내이( Dmean )、시선( V30),원계화계량분별위:(41.2±0.98)Gy、(51.26±1.57)Gy、(59.95±2.11)Gy、(45.02±1.98)Gy、(47.87±18.05)%。조사제4주분별위:(44.09±1.88)Gy、(52.81±2.47)Gy、(62.04±2.43)Gy、(47.24±3.68)Gy、(49.03±15.68)%。제륙주(44.44±2.7)Gy、(54.14±2.51)Gy、(62.34±2.86)Gy、(48.37±5.37)Gy、(52.19±15.51)%。결론:수착비인암조강방사치료적진행,조사종류파구동원시계화제량분포회유일정차이,제1례림파결퇴축급병인소수등원인이조성외륜곽내수교대적환자이외,기여CTV실제조사제량위처방제량95%이상。정상조직재정개치료과정소수조사제량동원시계화비교유소증가。
Objective:To study the change of dose distribution by the change of the volume and morphology of the tumor and the normal tissues through the process of the nasopharyngeal carcinoma IMRT. Methods:All 42 patients who were pathologically diagnosed as nasopharyngeal carcinoma from January 2009 to June 2010 were admitted. All patients underwent a simulation CT before the treastment,and the images were uploaded to the Xio treatment therapy system( TPS). The target volume and normal tissues were contoured on the CT image and then the treatment IMRT plan was developed using 6MVX,9 coplanar fields. The dose to the nasopharyngeal tumor and lymph node was 66Gy/30f/6w,dose to the nasopharynx subclinical lesions and neck lymphatic drainage area was 60Gy/30f/6w. Daily or-thogonal images were acquired in the patient treatment position to compare with the DRR of the original treatment planning image,and the patient positionning error was corrected in three dimensions,then the radiation therapy was implemented. Each patient underwent a simulation CT scan weekly to analyse the dose distribution changes of the tar-get and the normal tissues. Concurrent chemotherapy regimen was cisplatin plus docetaxel every 3 weeks,the chemo-therapy was started before the beginning of the radiaotherapy. Results:The average volume of GTV1 was 39. 19cc be-fore radiotherapy,GTV2 was 16. 59cc,at 4th and 6th week of the radiotherapy course the average reduction of GTV1 were 26. 41%,62. 68%,for GTV2 were 28. 43%and 53. 93%respectively. Before treatment,the average volume of bi-lateral parotid was 24. 16cc,at 4th week of radiation therapy,the average volume of parotid was 19. 04cc,at 6th week the average volume of the parotid gland was 17. 54cc. For the does distribution to the normal tissues,in the original plan,spinal cord(D1%),brainstem(D1%),temporal lobe(D1%),the inner ear(Dmean),parotid gland(V30)are(41. 2 ± 0. 98)Gy,(51. 26 ± 1. 57)Gy,(59. 95 ± 2. 11)Gy,(45. 02 ± 1. 98)Gy,(47. 87 ± 18. 05)% respectively,at 4th week of radiotherapy,they are(44. 09 ± 1. 88)Gy,(52. 81 ± 2. 47)Gy,(62. 04 ± 2. 43)Gy,(47. 24 ± 3. 68)Gy, (49. 03 ± 15. 68)%,and at 6th week,(44. 44 ± 2. 7)Gy,(54. 14 ± 2. 51)Gy,(62. 34 ± 2. 86)Gy,(48. 37 ± 5. 37) Gy,(52. 19 ± 15. 51)%. Conclusion:In the nasopharyngeal IMRT process,the actual dose distribution of the tumor will be some difference to the original plan,except one case whose outline contour changes relatively sever because of the shrinkage of the lymph node and the weight loss,the CTV actual dose is above 95%of the prescribed dose,al-though after a few weeks of treatment the tumor target volume and shape changes,the difference was not significant. The dose to the normal tissues in the whole course of treatment will be increased compared with the original plan.