| 邵明海,柯文婷,贾海健.腮腺分区勾画对伴有双侧颈部Ⅱ区淋巴结转移鼻咽癌调强放射治疗计划优化的影响[J].肿瘤学杂志,2014,20(1):40-46. |
| 腮腺分区勾画对伴有双侧颈部Ⅱ区淋巴结转移鼻咽癌调强放射治疗计划优化的影响 |
| A Split-parotid Delineation Approach for Dose Optimisation in Intensity-modulated Radiotherapy for Nasopharyngeal Carcinoma with Bilateral Neck Lymph Node Metastasis in Level Ⅱ |
| 投稿时间：2013-09-21 |
| DOI：10.11735/j.issn.1671-170X.2014.01.B009 |
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| 中文关键词: 鼻咽肿瘤 调强放射治疗 剂量限制 腮腺 干细胞 |
| 英文关键词:nasopharyngeal neoplasms intensity-modulated radiotherapy dose constraints parotid gland stem cell |
| 基金项目:台州市科技项目（131KY13） |
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| 中文摘要: |
| 摘 要:［目的］ 探讨腮腺分区勾画对伴有双颈部Ⅱ区淋巴结转移鼻咽癌调强放射治疗计划优化的影响。［方法］ 选择接受调强放疗的双颈部Ⅱ区淋巴结转移的鼻咽癌患者20例，利用Corvus 6.3调强治疗计划系统设计3种治疗计划：既未进行腮腺分区勾画的常规计划(Plan0)；将腮腺沿下颌后静脉前外缘作与腮腺后界的平行线，将腮腺分成前外与后内两部分，分别予剂量限制，重新计划优化，得到将腮腺分区勾画的计划（Plan1）；将腮腺分区勾画的CT序列定义为模体，由常规计划（Plan0）进行正向运算得到计划2(Plan2)。比较Plan1与Plan2在靶区和正常组织的剂量分布。［结果］ 两套计划均符合RTOG0615靶区及正常组织剂量限制要求。采用该腮腺分区勾画方法能够降低整个腺体的平均辐射剂量、V15以及<20Gy体积，这主要归功于降低了腮腺前外侧区约20%的平均辐射剂量、30%~40%的V15。［结论］ 在伴有双颈部Ⅱ区淋巴结转移鼻咽癌IMRT中，腮腺分区勾画在理论上和剂量学上具有可行性，尤其降低了干细胞集中部位（腮腺前外侧区）的辐射剂量，具有一定推广应用价值，对腮腺分泌功能的影响有待前瞻性随机试验证实。 |
| 英文摘要: |
| Abstract：［Purpose］ To assess the dosimetric effect of split-parotid delineation in intensity-modulated radiotherapy (IMRT) treatment planning for nasopharyngeal carcinoma (NPC) with bilateral neck lymph node metastasis in level Ⅱ. ［Methods］ Twenty NPC patients with bilateral neck lymph node metastasis in level Ⅱwere treated by IMRT. Target volumes and several organs at risk were delineated with Corvus 6.3 treatment planning system. A reference IMRT plan(Plan0) was generated based on a standard treatment planning protocol，with a set of user-de?覱ned dose constraints for optimization. An investigative IMRT plan(Plan1) was then generated based on the same protocol，but treating parotid glands as split organs consisting of anterolateral and posteromedial sub-segments. A straight line through the anterolateral margin of retromandibular vein divided parotid glands into two sub-segments，which was nearly parallel to the posteromedial edge of the parotid gland. These subsegments were assigned independent dose constraints. A phantom plan (Plan2) was generated for each patient using the same beam configurations of Plan0 with split-parotid delineation. Plan1 and Plan2 were compared with respect to target coverage and OAR sparing. Target coverages and the sparing of OARs were evaluated by the commonly used dose end points according to RTOG 0615 protocol.［Results］ Two plans both meeted request of dose coverage of target and constrains on normal tissue. Regarding the sparing of OARs，there were signi?覱cant reduction in the mean dose，V15，and <20Gy volume of the whole parotid. It was attributed to an decrease of dose to the anterolateral sub-segments，with reduction of mean dose by approximately 20% and of V15 by 30%～40% to this part of the gland.［Conclusion］ A split-parotid delineation approach in IMRT treatment planning for NPC with bilateral neck lymph node metastasis in level Ⅱ is feasible and has advantage to decrease the dose to the anterolateral part of the parotid.Its effects on secretion of parotid gland deserves to be further studied. |
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