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目的研究鼻咽癌病人调强放射治疗过程中腮腺变化规律及影响因素。方法24例初程治疗的鼻咽癌病人接受全程调强放射治疗。所有病人疗前接受1次螺旋CT定位扫描进行治疗计划设计,然后放疗过程中每周1次螺旋CT扫描,直至放疗结束。24例病人共计CT扫描192次。将每次获得的螺旋CT图像与疗前CT图像进行融合,在每层图像上勾画出腮腺外轮廓,进行统计分析,观察放疗过程中腮腺体积的变化,并分析其影响因素,为调强放射治疗计划的二次实施提供依据。结果放疗过程中腮腺体积存在着明显的变化,随着放疗的进行腮腺体积逐渐缩小,放疗结束时腮腺体积缩小17%～59%(中位值38%);腮腺体积的变化在放疗的第5周达到最大值,其与疗前腮腺体积的大小、放疗剂量直接相关,而与治疗过程中体重变化因素无关。结论放疗过程中腮腺体积存在着明显变化,与疗前腮腺体积、放疗剂量直接相关,在放疗第5周时变化达到最大值,此刻进行二次调强计划的实施有临床应用价值。
Objective To study the changes and influencing factors of parotid gland in patients with nasopharyngeal carcinoma during intensity modulated radiation therapy. Methods Twenty-four patients with nasopharyngeal carcinoma undergoing initial treatment received full-intensity IMRT. All patients underwent a 1-slice spiral CT scan prior to treatment planning and then a weekly spiral CT scan during radiotherapy until end of radiotherapy. A total of 24 patients scored 192 CT scans. The spiral CT images obtained each time and pre-treatment CT images were fused on each layer of the image outline of the parotid glands, statistical analysis of the parotid gland during radiotherapy to observe the changes in volume, and analyze the impact of factors for the intensity of radiation The second implementation of treatment plan to provide the basis. Results There was a significant change in parotid gland volume during radiotherapy. With the progress of radiotherapy, the volume of the parotid gland narrowed gradually and the volume of the parotid gland narrowed by 17% -59% (median 38%) at the end of radiotherapy. The parotid gland volume changed in the fifth Week to reach its maximum value, which is directly related to the size of the parotid gland before treatment and the dosage of radiotherapy, but has nothing to do with the change of body weight in the course of treatment. Conclusion The volume of parotid gland changes significantly during radiotherapy, which is directly related to the parotid gland volume and radiotherapy dose before radiotherapy. The radiotherapy dose reaches the maximum value at the fifth week of radiotherapy. At the moment, the implementation of the second intensity boost program has clinical value.