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目的探讨不同鼻咽癌调强放疗剂量分割模式的近期疗效和不良反应。方法选取2011年6月-2013年3月我科收治的98例鼻咽癌患者。应用螺旋断层治疗技术,改变了传统剂量分割模式,具体处方剂量为:鼻咽部原发肿瘤(pGTVnx)及可见的转移淋巴结(pGTVnd)67.5 Gy/30 F,高危临床靶区(CTV1)60 Gy/30 F,低危临床靶区(CTV2)54 Gy/30 F,5次/周。根据RECIST 1.0版实体肿瘤疗效评价标准评价近期疗效,参照RTOG/EORTC标准,在治疗结束时和治疗结束后一个月评价急性反应。根据LQ放射生物模型计算改变剂量分割模式的生物等效剂量(biological effective dose,BED)。结果随访1~22个月,中位随访12个月。鼻咽部原发灶和颈部转移淋巴结消退率分别为90.8%和93.9%。皮肤、黏膜、唾液腺、咽食管1~2级急性反应发生率分别92.8%、89.8%、96.9%、98%,3~4级急性反应发生率分别为4.1%、7.1%、0%、2%。对于肿瘤组织,本组单次2.25 Gy,总剂量67.5 Gy,照射30次/40 d即67.5 Gy(30×2.25 Gy)剂量分割模式的BED为62.9 Gy,等效于单次2 Gy,总剂量72 Gy。对于正常组织晚期反应,等效于单次2 Gy,总剂量70 Gy。结论改变调强放疗剂量分割模式治疗鼻咽癌的近期疗效较好,不良反应较轻,患者可耐受,同时缩短了总治疗时间,相应地减轻了患者的经济负担。远期疗效有待进一步观察。
Objective To investigate the short-term curative effect and adverse reactions of dose-dividing mode of intensity modulated radiotherapy in different nasopharyngeal carcinoma patients. Methods From June 2011 to March 2013, 98 patients with nasopharyngeal carcinoma were enrolled in our department. Spiral tomography was used to change the traditional dose-division model. The specific prescription dose was 67.5 Gy / 30 F for pGTVnx and visible metastatic lymph node (pGTVnd) and 60 Gy for high-risk clinical target (CTV1) / 30 F, low-risk clinical target (CTV2) 54 Gy / 30 F, 5 times / week. The short-term efficacy was evaluated according to RECIST version 1.0 Solid Tumor Efficacy Evaluation Criteria, with an acute response assessed at the end of the treatment and one month after the end of treatment, with reference to the RTOG / EORTC criteria. The biological effective dose (BED) for changing the dosing mode was calculated from the LQ radiobiological model. The results were followed up for 1 to 22 months, with a median follow-up of 12 months. Nasopharyngeal primary tumor and cervical lymph node metastasis regression rates were 90.8% and 93.9%. The acute reaction rates of grade 1, grade 2 and grade 2 in skin, mucosa, salivary gland and esophagus were 92.8%, 89.8%, 96.9% and 98% respectively. The incidences of grade 3 to 4 acute reactions were 4.1%, 7.1%, 0% and 2% . For tumor tissue, this group a single 2.25 Gy, a total dose of 67.5 Gy, 30/40 d irradiation that is 67.5 Gy (30 × 2.25 Gy) dose-divided BED was 62.9 Gy, equivalent to a single 2 Gy, the total dose 72 Gy. For normal tissue late response, equivalent to a single 2 Gy, a total dose of 70 Gy. CONCLUSIONS: The treatment of nasopharyngeal carcinoma by radiation-dose-division-at-a-time mode is better in short-term, with less adverse reactions, tolerable in patients and shortened the total treatment time, which in turn reduces the economic burden on patients. Long-term efficacy needs further observation.