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基于补偿器的头颈部癌调强放射治疗:我们在实现剂量学参数及其临床相关性方面的经验。

Compensator-based intensity-modulated radiotherapy in head and neck cancer: our experience in achieving dosimetric parameters and their clinical correlation.

作者信息

Nangia S, Chufal K S, Arivazhagan V, Srinivas P, Tyagi A, Ghosh D

机构信息

Department of Oncology, Batra Hospital and Medical Research Centre, New Delhi, India.

出版信息

Clin Oncol (R Coll Radiol). 2006 Aug;18(6):485-92. doi: 10.1016/j.clon.2006.03.018.

Abstract

AIMS

To review the Batra Hospital and Medical Research Centre experience of using compensator-based intensity-modulated radiotherapy (IMRT) to treat head and neck cancer.

MATERIALS AND METHODS

Between October 2003 and August 2004, 18 patients underwent IMRT for head and neck cancer at our institution. IMRT was delivered using partial transmission high-resolution compensator blocks.

RESULTS

With a median follow-up of 13.3 months, two patients had residual disease and two failed in the gross tumour volume (GTV). The complete response rate after surgical salvage was 94.5%. Both the locoregional relapse-free and disease-free survival rates were 81.8%. The target coverage in terms of average maximum, mean and minimum dose (in Gy) delivered was 78.6, 73.5 and 58.4 to the GTV-planning target volume, 82.3, 70.9 and 47.3 to clinical target volume 1 (CTV1) and 82.9, 66.2 and 29.6 to CTV2. The dose constraint of 30 Gy to less than 50% of the contralateral parotid volume was achieved in 12 (66.7%) patients. If the dose constraint was revised to 35 Gy, at least 50% of the parotid volume was spared in 17 (94.5%) patients. On average, 75% of the contralateral parotid volume received a dose less than 35 Gy in 13 (72.3%) patients with grade I xerostomia, whereas this was 49.3% in five (27.7%) patients with grade II xerostomia, and the difference was statistically significant (P = 0.001).

CONCLUSIONS

In our initial experience, compensator-based IMRT is feasible with regard to target coverage and parotid volume sparing. The parotid volume dose has significant clinical implications on the grade of xerostomia. Our results invoke rethinking into the issues of the parotid volume dose constraint in our subpopulation.

摘要

目的

回顾巴特拉医院和医学研究中心使用基于补偿器的调强放射治疗(IMRT)治疗头颈癌的经验。

材料与方法

2003年10月至2004年8月期间,18例头颈癌患者在我院接受了IMRT治疗。IMRT采用部分透射高分辨率补偿器挡块进行。

结果

中位随访时间为13.3个月,2例患者有残留病灶,2例患者原发肿瘤体积(GTV)出现复发。手术挽救后的完全缓解率为94.5%。局部区域无复发生存率和无病生存率均为81.8%。给予GTV-计划靶体积的平均最大剂量、平均剂量和最小剂量(单位:Gy)分别为78.6、73.5和58.4,给予临床靶体积1(CTV1)的分别为82.3、70.9和47.3,给予CTV2的分别为82.9、66.2和29.6。12例(66.7%)患者实现了向对侧腮腺体积小于50%给予30 Gy的剂量限制。如果将剂量限制调整为35 Gy,17例(94.5%)患者至少有腮腺体积的50%得到了保留。平均而言,13例(72.3%)I级口干患者中,75%的对侧腮腺体积接受的剂量小于35 Gy,而5例(27.7%)II级口干患者中这一比例为49.3%,差异具有统计学意义(P = 0.001)。

结论

在我们的初步经验中,基于补偿器的IMRT在靶区覆盖和腮腺体积保留方面是可行的。腮腺体积剂量对口干分级具有重要的临床意义。我们的结果促使我们重新思考我们亚组中腮腺体积剂量限制的问题。

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