Debelleix C, Pointreau Y, Lafond C, Denis F, Calais G, Bourhis J-H
Service de Radiothérapie, Centre Hospitalier Dax-Côte d'Argent, Boulevard Yves-du-Manoir, 40100 Dax, France.
Cancer Radiother. 2010 Jul;14(4-5):301-6. doi: 10.1016/j.canrad.2010.05.002. Epub 2010 Jul 2.
For head and neck cancers, the radiation dose usually needed to sterilize a macroscopic tumour is at least 70 Gy in conventional fractionation. In the larynx, this dose level enables optimal tumour control while exposing the patient to a limited risk of severe complications. For oropharynx and nasopharynx tumors, it is sometimes possible to limit the dose received by the larynx according to the extent of the primary lesion. Thus, if the tumour constraints permit, the maximum dose to the larynx must be less than 63 to 66 Gy. To reduce the risk of laryngeal edema, it is recommended if possible to limit the mean non-involved larynx dose to 40 to 45 Gy. In the pharynx, literature's data suggested to minimize the volume of the pharyngeal constrictor muscles receiving a dose greater than or equal to 60 Gy. Limiting the volume receiving a dose greater than or equal to 50 Gy reduces the risk of dysphagia. These dose constraints should be tailored to each patient taking into account the extent of the initial primary lesion, the possible addition of chemotherapy or a modified fractionation radiotherapy.
对于头颈部癌症，采用常规分割时，使肉眼可见肿瘤失活通常所需的放射剂量至少为70 Gy。在喉部，这个剂量水平能够实现最佳的肿瘤控制，同时使患者面临的严重并发症风险有限。对于口咽和鼻咽肿瘤，有时可根据原发病变的范围限制喉部所接受的剂量。因此，如果肿瘤条件允许，喉部的最大剂量必须小于63至66 Gy。为降低喉水肿风险，建议尽可能将未受累喉部的平均剂量限制在40至45 Gy。在咽部，文献数据表明应尽量减少接受剂量大于或等于60 Gy的咽缩肌体积。限制接受剂量大于或等于50 Gy的体积可降低吞咽困难的风险。这些剂量限制应根据每位患者的情况进行调整，同时考虑初始原发病变的范围、可能添加的化疗或调强分割放疗。
