CAJ | 학술논문

目的：探讨自适应放疗在降低Ⅲ、Ⅳ期鼻咽癌放射性颞叶坏死中的作用。方法收集四川省肿瘤医院2004年1月至2009年1月调强放射治疗初诊、根治的Ⅲ、Ⅳ期鼻咽癌病例共471例。通过随访的增强磁共振成像确定RITLN。分析患者的一般情况、治疗情况和放疗剂量、分次剂量、计划次数等因素对RITLN的影响。统计不同局部分期和不同计划方式下放射性颞叶坏死的发生情况。结果在471例Ⅲ、Ⅳ期鼻咽癌中,发生RITLN 59例,T3期非ART组和ART组的RITLN发生率分别为13．7%和5．8%(P=0．037)。 T4期非ART组和ART组的RITLN发生率分别为21．9%和11．8%(P=0．038)。Ⅲ、Ⅳ期鼻咽癌非ART的颞叶剂量明显高于ART组(P<0．001)。多因素分析结果显示颞叶剂量、T分期、单次剂量是否 D2cc≥2Gy、同步化疗、是否行 ART是 RITLN的独立影响因素(P <0．05),其 OR 值分别为3．463、4．023、3．963、2．976、0．339。非ART组与ART组肿瘤的5年年局控率无统计学差异( P>0．05)。结论Ⅲ、Ⅳ期鼻咽癌可通过ART降低颞叶剂量,减少RITLN的发生；肿瘤 T分期、颞叶的剂量 D2cc≥2Gy、同步化疗是 RITLN的独立危险因素。
목적：탐토자괄응방료재강저Ⅲ、Ⅳ기비인암방사성섭협배사중적작용。방법수집사천성종류의원2004년1월지2009년1월조강방사치료초진、근치적Ⅲ、Ⅳ기비인암병례공471례。통과수방적증강자공진성상학정RITLN。분석환자적일반정황、치료정황화방료제량、분차제량、계화차수등인소대RITLN적영향。통계불동국부분기화불동계화방식하방사성섭협배사적발생정황。결과재471례Ⅲ、Ⅳ기비인암중,발생RITLN 59례,T3기비ART조화ART조적RITLN발생솔분별위13．7%화5．8%(P=0．037)。 T4기비ART조화ART조적RITLN발생솔분별위21．9%화11．8%(P=0．038)。Ⅲ、Ⅳ기비인암비ART적섭협제량명현고우ART조(P<0．001)。다인소분석결과현시섭협제량、T분기、단차제량시부 D2cc≥2Gy、동보화료、시부행 ART시 RITLN적독립영향인소(P <0．05),기 OR 치분별위3．463、4．023、3．963、2．976、0．339。비ART조여ART조종류적5년년국공솔무통계학차이( P>0．05)。결론Ⅲ、Ⅳ기비인암가통과ART강저섭협제량,감소RITLN적발생；종류 T분기、섭협적제량 D2cc≥2Gy、동보화료시 RITLN적독립위험인소。
Objective To explore the clinical effect of adaptive radiation therapy ( ART ) to reduce incidence rate of RITLN in locally advanced nasopharyngeal carcinoma. Methods 471 patients with locally advanced NPC were retrospectively an-alyzed in this study. All the patients were treated with IMRT from January 2004 to January 2009. Patient’s general imformation, dose of temporal lobe, treatment modalities and clinical characteristics were systematically reviewed. RITLN was diagnosed accord-ing to dynamic contrast enhancement magnetic resonance imaging ( DCE-MRI) by two experienced radiologists separately. Inci-dence rate of RITLN under different planning strategy in different T stage were evaluated. Results A total of 59 patients were di-agnosed as RITLN among these 471 locally advanced NPC patients. Incidence rate of RITLN in T3 and T4 stage patients with sin-gle plan and multi-plan were 13. 7%,5. 8% and 21. 9% ,11. 8% respectively (P<0. 05). Dose of patients with multi-plan was significantly higher than that of patients with single plan(P<0. 05). The 5 years local control rates in T3 stage and T4 stage were not significantly different between patients with single plan and multi-plan(P>0. 05). Multivariate analysis showed that T stage, dose of temporal lobe, concurrent chemotherapy, dose of fraction D 2cc≥2Gy and number of plan were the independent risk factors of RITLN(p<0. 05), odds ratio(OR) of those parameter were 3. 463,4. 023,3. 963,2. 976 and 0. 339 respectively. Conclusion Adaptive radiation therapy could reduce the incidence rate of RITLN in Ⅲ-Ⅳ stage nasopharyngeal carcinoma patients. T stage, concurrent chemotherapy, dose of fractiom D2cc≥2Gy were the independent risk factors of RITLN.