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目的局部晚期鼻咽癌按照诱导化疗后肿瘤体积勾画靶区安全性仍存在争议,研究局部晚期鼻咽癌诱导化疗后勾画靶区和危及器官(organs at risk,OAR),分析大体肿瘤靶区(gross tumor volume,GTV)变化对靶区适形性指数(conformity index,CI)、均匀性指数(homogeneity index,HI)和OAR剂量的影响,并观察近期疗效与不良反应,为局部晚期鼻咽癌诱导化疗后勾画靶区安全性进行临床研究。方法收集2012-01-01-2012-12-31钦州市第一人民医院肿瘤科收治的46例局部晚期鼻咽癌患者,采用紫杉醇(paclitaxel,PTX)联合顺铂(DDP)诱导化疗2个周期,按化疗后影像勾画GTV及OAR,逆向5野调强适形(intensity-modulated radiotherapy,IMRT)设野,对2次放疗计划靶体积差值及剂量学差异行配对检验;同期DDP每周方案化疗,观察不良反应与近期疗效。结果诱导化疗前后原发灶鼻咽部GTV(GTVnx)平均体积分别为(83.85±22.64)和(42.87±15.41)cm~3,t=-5.905,P=0.001;颈淋巴结GTV(GTVnd)分别为(85.93±31.20)和(44.96±19.01)cm~3,t=-5.905,P=0.001;化疗后GTVnx靶区CI(t=-2.311,P=0.021)和HI(t=-3.297,P=0.001)均好于化疗前靶区;化疗后GTVnd靶区CI(t=-2.907,P=0.001)和HI(t=-4.643,P=0.001)均好于化疗前靶区。诱导化疗后脑干、脊髓、眼球、颞叶、腮腺所受最大剂量(t=-5.905,P=0.001)和平均剂量(t=-5.834,P=0.001)降低,差异有统计学意义;3年局部控制率(local control rate,LCR)、无远处转移生存率(distant metastasis free survival,DMFS)、无瘤生存率(disease-free survival,DFS)和总生存率(overall survival,OS)分别为91.3%、86.9%、80.4%和89.1%。诱导化疗后同步放化疗白细胞减少发生率为100.0%,Ⅲ~Ⅳ级者54.2%;口腔黏膜炎发生率为100.0%,Ⅲ级者30.4%;皮肤反应发生率为97.9%,Ⅲ级者54.2%;恶心呕吐发生率为93.5%,Ⅲ级者19.6%。结论鼻咽癌TP方案诱导化疗后肿瘤体积缩小,按化疗后病灶勾画GTV的IMRT,CI和HI可接受;OAR最大剂量和平均剂量减小,OAR得到较好保护;诱导化疗后同步放化疗不良反应发生率高、程度略重,可耐受;近期疗效较好,远期疗效需进一步观察。
Objective To investigate the safety of targeted nasopharyngeal carcinoma in locally advanced nasopharyngeal carcinoma (NPC) according to the volume of tumor induced by chemotherapy is still controversial. To study the target atherosclerotic lesions (OR) gross tumor volume (GTV) on the target conformality index (CI), homogeneity index (HI) and OAR dose, and to observe the short-term curative effect and side effects. After the induction of chemotherapy outlined the safety of the target clinical research. METHODS: Forty-six patients with locally advanced nasopharyngeal carcinoma admitted to the First People’s Hospital of Qinzhou from January 2012 to January 2012 were enrolled in this study. Paclitaxel (PTX) plus cisplatin (DDP) , According to the GTV and OAR images after radiotherapy, and reverse-5 intensity-modulated radiotherapy (IMRT) setting up the field. The target volume difference and dose difference of the two radiotherapy programs were matched. Chemotherapy to observe the adverse reactions and the recent curative effect. Results The mean volume of GTVnx in the nasopharynx before and after induction of chemotherapy was (83.85 ± 22.64) and (42.87 ± 15.41) cm ~ 3, respectively, t = -5.905, P = 0.001. The GTVnd of cervical lymph nodes were (85.93 ± 31.20) and (44.96 ± 19.01) cm ~ 3, respectively, t = -5.905, P = 0.001. After treatment, the GTVnx target area CI (t = -2.311, P = 0.021) and HI 0.001) were better than the pre-chemotherapy target area; the GTVnd target area of GTVnd after chemotherapy (t = -2.907, P = 0.001) and HI (t = -4.643, P = 0.001) The maximum dose (t = -5.905, P = 0.001) and mean dose (t = -5.834, P = 0.001) of the brainstem, spinal cord, eyeball, temporal lobe and parotid gland after induction chemotherapy were significantly decreased; 3 The local control rate (LCR), distant metastasis free survival (DMFS), disease-free survival (DFS) and overall survival (OS) 91.3%, 86.9%, 80.4% and 89.1%. The incidence of concurrent chemoradiotherapy leukopenia after induction chemotherapy was 100.0%, 54.2% of grade Ⅲ ~ Ⅳ; oral mucositis incidence was 100.0%, grade Ⅲ 30.4%; skin reaction rate was 97.9%, grade Ⅲ 54.2% The incidence of nausea and vomiting was 93.5% and the grade Ⅲ was 19.6%. CONCLUSIONS: The tumor size of the TP regimen of nasopharyngeal carcinoma is reduced after the induction of chemotherapy. The IMRT, CI and HI of GTV are acceptable after the chemotherapy. The maximal and average doses of OAR are reduced and the OAR is well protected. After concurrent chemoradiotherapy and chemotherapy, The reaction rate is high, the degree of slightly heavier, tolerable; the recent curative effect is better, the long-term efficacy needs further observation.