局部晚期鼻咽癌螺旋断层放疗与常规调强放疗的剂量学比较及近期疗效分析

崔珍; 刘佳; 孙巧玉; 汪朝歌; 樊筱玓; 方美芳; 段诗苗; 李多杰; 江浩

doi:10.13898/j.cnki.issn.1000-2200.2021.07.012

局部晚期鼻咽癌螺旋断层放疗与常规调强放疗的剂量学比较及近期疗效分析

Dosimetric comparison and short-term efficacy analysis of helical tomotherapy and intensity-modulated radiation therapy for locally advanced nasopharyngeal carcinoma

摘要

摘要:
目的通过比较局部晚期鼻咽癌在螺旋断层放疗(HT)和普通调强放疗(IMRT)两种放疗设备治疗系统下的剂量学、急性不良反应及近期疗效等方面的差异，观察HT在局部晚期鼻咽癌治疗中的剂量学优势、近期疗效及不良反应。
方法回顾性分析2017年2月至2019年10月局部晚期鼻咽癌140例，其中HT组70例，IMRT组70例。依据病人头颈部磁共振成像进行肿瘤的靶区勾画。鼻咽癌原发病灶处方剂量为69.96 Gy/33F，转移淋巴结的处方剂量为66~70 Gy/33F，高危区处方剂量为60 Gy/33F，低危区处方剂量为50~54 Gy/33F。2组在放疗同时均给予以顺铂为基础的同步化疗，顺铂剂量为80 mg/m²，3周为一个周期。根据RTOG/EORTC标准评价放疗的急性不良反应。根据RECTST 1.1标准进行实体瘤的疗效评价。统计分析2组治疗计划的放射物理剂量学差异、自放疗开始至放疗结束后1个月病人的近期疗效以及放化疗相关的急性不良反应。
结果在处方剂量中，HT组在靶区均匀性指数上与IMRT组差异无统计学意义(P>0.05)，其余变量中HT组在靶区适形度及均匀性指数上均优于IMRT组(P < 0.05~P < 0.01)。2组病人的近期疗效相似(P>0.05)。HT组在耳鸣及急性腮腺损伤等放疗不良反应方面较IMRT组轻(P < 0.05)。
结论相比普通IMRT，HT在局部晚期鼻咽癌的放疗上具有更好的放射物理相关的剂量学优势。尽管2组近期疗效相似，但HT在急性腮腺损伤及听力损伤等方面具更低的不良反应。

Abstract:
ObjectiveTo compare the dosimetry, acute adverse reactions and short-term therapeutic effects of helical tomotherapy(HT) and intensity-modulated radiation therapy(IMRT) for locally advanced nasopharyngeal carcinoma, and observe the dosimetric advantage, short-term efficacy and adverse reactions of HT in the treatment of locally advanced nasopharyngeal carcinoma.
MethodsThe clinical data of 140 patients with locally advanced nasopharyngeal carcinoma from February 2017 to October 2019 were retrospectively analyzed, which included 70 patients treatment with HT and 70 patients treatment with IMRT.The target area of tumor was delineated according to the magnetic resonance imaging(MRI) of head and neck.The prescription doses of the primary nasopharyngeal carcinoma, metastatic lymph node, high-risk area and low-risk area were 69.96 Gy/33F, 66-70 Gy/33F, 60 Gy/33F and 50-54 Gy/33F, respectively.Two groups were treated with cisplatin based on concurrent chemotherapy at the same time of radiotherapy, with cisplatin dose of 80 mg/m² for a 3-week cycle.The acute adverse reactions of radiotherapy were evaluated according to RTOG/EORTC criteria.The efficacy of solid tumors was evaluated according to RECTST 1.1 criteria.The differences of radiophysical dosimetry, short-term efficacy of patients from the beginning of radiotherapy to 1 month after the end of radiotherapy, and acute adverse reactions related to radiotherapy and chemotherapy were statistically analyzed between two groups.
ResultsIn the prescribed dose, there was no statistical significance in the homogeneity index of target area between the HT group and IMRT group(P>0.05).Among other variables, the conformation number and homogeneity index of target area in HT group were better than that in IMRT group(P < 0.05 to P < 0.01).The short-term efficacy in two groups was similar(P>0.05).The tinnitus and acute parotid gland injury in HT group were less severe than that in IMRT group(P < 0.05).
ConclusionsCompared with IMRT, HT has a better dosimetry advantage in radiotherapy of locally advanced nasopharyngeal carcinoma.Although the short-term efficacy is similar in both groups, HT has less adverse reactions on acute parotid injury and hearing loss.

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