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[目的]探讨局部晚期鼻咽癌诱导化疗后肿瘤体积缩小,按化疗后肿瘤改变勾画大体肿瘤体积(GTV)对靶区体积和正常组织(OAR)剂量、近期疗效的影响及临床应用价值。[方法]46例局部晚期鼻咽癌,采用TP方案诱导化疗2个周期,按化疗后勾画GTV及OAR,逆向5野适形调强(IMRT)设野,对两次放疗计划靶体积差值及剂量学差异行配对t检验;同期DDP化疗,观察近期疗效及治疗失败情况。[结果]诱导化疗前和后原发灶GTV平均体积分别为(53.86±26.54)cm3和(35.01±20.47)cm3(t=4.09,P=0.001);颈淋巴结GTVnd分别为(37.42±16.39)cm3和(22.82±11.05)cm3(t=4.82,P=0.001);诱导化疗使肿瘤总体积减少了35%、39%;诱导化疗后脑干、脊髓、颞叶、眼球、腮腺所受最大剂量区体积、平均剂量减少5%~17%;3年LCR、DMFS、DFS、OS分别为89.1%、82.6%、73.9%、87.0%。GTV边缘复发率为10.9%,远处转移率为17.4%。[结论 ]局部晚期鼻咽癌TP方案诱导化疗后肿瘤体积明显缩小,按化疗后肿瘤勾画GTV的调强放疗能使高剂量区体积减少,OAR最大剂量区体积减小,OAR可得到较好保护;肿瘤局部控制率、近期疗效较好;远处转移、GTV边缘复发是治疗失败主要原因,值得临床继续深入研究。
[Objective] To investigate the effect of GTV on the dose and the effect of target tissue and the short-term effect of GTV after chemotherapy-induced chemotherapy, and to evaluate its clinical value in patients with locally advanced nasopharyngeal carcinoma. [Method] Forty-six patients with locally advanced nasopharyngeal carcinoma were treated with TP regimen for two cycles of chemotherapy. GTV and OAR were outlined after chemotherapy and IMRT was set up in reverse. The target volume difference And dose difference paired t-test; the same period of DDP chemotherapy to observe the short-term efficacy and treatment failure. [Results] The average volume of GTV in the primary tumor before and after induction of chemotherapy were (53.86 ± 26.54) cm3 and (35.01 ± 20.47) cm3 respectively (t = 4.09, P = 0.001). The GTVnd of the cervical lymph node were (37.42 ± 16.39) cm3 And (22.82 ± 11.05) cm3 (t = 4.82, P = 0.001). The induction of chemotherapy reduced the total volume of tumor by 35% and 39%, respectively. After induction of chemotherapy, the maximal dose area of brain stem, spinal cord, temporal lobe, eyeball and parotid gland Volume and mean dose decreased by 5% -17%. The 3-year LCR, DMFS, DFS and OS were 89.1%, 82.6%, 73.9% and 87.0% respectively. GTV edge recurrence rate was 10.9%, distant metastasis rate was 17.4%. [Conclusion] Tumor volume of TP regimen in locally advanced nasopharyngeal carcinoma is significantly reduced after chemotherapy, and the intensity of radiotherapy of GTV after chemotherapy can reduce the volume of high-dose area and the volume of OAR maximum dose area, and OAR can be well protected ; Tumor local control rate, the recent curative effect is good; distant metastasis, GTV edge recurrence is the main reason for treatment failure, it is worth further study in clinical.