Pommier P, Ginestet C, Sunyach M, Zrounba P, Poupart M, Céruse P, Ciupea C, Carrie C, Montbarbon X
Department of Radiation Oncology, Centre Léon Bérard, Lyon, France.
Int J Radiat Oncol Biol Phys. 2000 Sep 1;48(2):485-93. doi: 10.1016/s0360-3016(00)00616-7.
To assess the possibility to deliver a high and homogeneous irradiation with respect to maximal tolerated dose to the visual pathways for paranasal sinus and nasal cavity tumors.
Forty patients with advanced stage malignant tumors were treated with postoperative (30) or primary (10 patients) conformal radiotherapy (CRT). Five patients were previously irradiated. Six to 15 individually shaped isocentric noncoplanar field arrangements, using a multileaf collimator were designed. Dose-volume histograms (DVH) for the planning target volumes (PTV) and the optic pathways were analyzed in 31 cases.
Median and maximal delivered doses to the PTV were 60 (+/-3) and 66 (+/-4) Gy. Dose distributions for critical organs are detailed. Median follow-up was 19 months (3 to 48). Local, nodal, and metastatic recurrences occurred in 8, 2, and 7 cases, respectively. Major prognostic factor for local recurrences was central nervous system (CNS) involvement. One patient died of meningitis. Two patients developed cataract, and 1 patient ipsilateral blindness due to vascular glaucoma.
CRT for locally advanced paranasal sinus and nasal cavity tumors enables the delivery of high homogeneous doses to the PTV with respect to critical organs, with a low toxicity and a high local control.
评估对于鼻旁窦和鼻腔肿瘤，在不超过视觉通路最大耐受剂量的情况下，实现高剂量均匀照射的可能性。
40例晚期恶性肿瘤患者接受了术后（30例）或根治性（10例）适形放疗（CRT）。5例患者曾接受过放疗。设计了6至15个使用多叶准直器的个体化等中心非共面野照射方案。对31例患者的计划靶区（PTV）和视觉通路的剂量体积直方图（DVH）进行了分析。
PTV的中位剂量和最大剂量分别为60（±3）Gy和66（±4）Gy。详细列出了关键器官的剂量分布情况。中位随访时间为19个月（3至48个月）。分别有8例、2例和7例出现局部、区域和远处复发。局部复发的主要预后因素是中枢神经系统（CNS）受累。1例患者死于脑膜炎。2例患者发生白内障，1例患者因血管性青光眼导致同侧失明。
对于局部晚期鼻旁窦和鼻腔肿瘤，适形放疗能够在关键器官耐受的情况下，向PTV提供高剂量均匀照射，且毒性低、局部控制率高。
