头颈部肿瘤ART体积和剂量比较:系统评价与<em>Meta分析</em>

doi:10.33760/cma.j.issn.1004-4221.2016.06.004

摘要
图/表
参考文献()
相关文章 (15)
点击分布统计
下载分布统计

全文: PDF (1571 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS) 背景资料

摘要

目的对头颈部肿瘤放疗ART靶区与OAR体积和剂量变化系统评价与Meta分析,说明ART在治疗中作用。方法文献检索纳入相关研究,分析指标原发肿瘤(GTV-T、GTV-N)与腮腺体积;靶区D₉₅D_mean,同、异侧腮腺(I-PG、C-PG)D_mean,脊髓、脑干D_max。结果 17个研究336病例纳入Meta分析。原发肿瘤与腮腺体积变化明显,GTV-T、GTV-N、I-PG第15—20天及第20天后体积显著减小(P<0.05),C-PG第20天后显著减小(P=0.004)。实际剂量分析,原发肿瘤D_95、D_mean无变化,脊髓D_max第20—25天增加2.26 Gy (P=0.000),脑干D_max第20天前无显著变化(P=0.090),第25天后增加1.78 Gy (P=0.020),I-PG D_mean第20—25天增加2 Gy (P=0.000),C-PG D_mean第20天前增加,第25天后无显著变化(P=0.110)。ART剂量分析,脊髓、脑干D_max均下降(MD=-2.15,95% CI为-3.12~-1.18,P=0.000;MD=-2.20,95% CI为-3.32~-1.09,P=0.000),I-PG D_mean下降约3.5 Gy,敏感性分析显示C-PG D_mean结果不稳定。结论原发肿瘤、腮腺体积显著变化,脊髓、脑干D_max,腮腺D_mean实际剂量显著增加,GTV-T、GTV-N剂量变化不明显,ART能很好保护OAR剂量要求,对同步放化疗局部晚期头颈部肿瘤患者第15—20天及第25天左右实施ART计划可能获得较好剂量增益。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	张彪
	贾鹏飞
	汤乐民

关键词 ：头颈部肿瘤, 自适应放射疗法, 体积剂量比较, Meta分析

Abstract：

Objective To perform a systematic review and Meta-analysis on volumetric and dosimetric changes in target volumes and organs at risk (OARs) in adaptive radiotherapy (ART) for patientswith head and neck cancer (HNC), and to investigate the role of ART in the treatment of HNC. Methods Literature retrieval was performed to include related studies, and the parameters of primary tumor, GTV-T and GTV-N, parotid volume, D₉₅ and D_mean of target volumes, D_mean of ipsilateral and contralateral parotid volume (I-PG and C-PG), and D_max of the spinal cord and brainstem. Results A total of 17 studies involving 336 patients were included in the meta-analysis. Primary tumor and parotid volume changed significantly. The volumes of GTV-T, GTV-N, and I-PG were significantly reduced during the 15-20^th radiotherapy and after the 20^th radiotherapy (P<0.05), and the C-PG was significantly reduced after the 20^th radiotherapy (P=0.004). The analysis of actual dose showed that the D₉₅ and D_mean of primary tumor showed no significant differences, and during the 15-20^th radiotherapy, the D_max of the spinal cord was increased by 2.26 Gy (P=0.000), while the D_max of the brainstem showed no significant changes before the 20^th radiotherapy and was increased by 1.78 Gy after the 25^th radiotherapy (P=0.020). In addition, the D_mean of I-PG was increased by 2 Gy during the 20-25^th radiotherapy (P=0.0001), and the D_mean of C-PG was increased before the 20^th radiotherapy and showed no significant changes after the 25^th radiotherapy (P=0.110). The dosimetric analysis of ART showed that the D_max of the spinal cord and brainstem was reduced significantly (spinal cord:MD=-2.15, 95% CI-3.12 to -1.18,P=0.000;brainstem:MD=-2.20, 95% CI-3.32 to -1.09, P=0.000). The D_mean of I-PG was reduced by about 3.5 Gy, and the sensitivity analysis revealed that the results of D_mean of C-PG were unstable. Conclusions The volumes of primary tumors and parotid glands change significantly, and the actual doses of OARs (D_max of the spinal cord and brainstem and D_mean of the parotid glands) significantly increase, while the doses of GTV-T and GTV-N show no significant changes. ART can effectively protect the OARs, and patients with locally advanced HNC who receive concurrent chemoradiotherapy can obtain good dose gains from ART plan performed during the 15-20^th radiotherapy and at about the 25^th radiotherapy.

Key words： Head and neck cancer Adaptive radiotherapy Volumetric and dosimetric comparison Meta analysis

收稿日期: 2015-01-07

通讯作者: 汤乐民,Email:lemint50@ntu.edu.cn

引用本文:

张彪,贾鹏飞,汤乐民. 头颈部肿瘤ART体积和剂量比较:系统评价与Meta分析[J]. 中华放射肿瘤学杂志, 2016, 25(6): 557-564.

Zhang Biao,Jia Pengfei,Tang Lemin. Volumetric and dosimetric comparison in adaptive radiotherapy for patients with head and neck cancer:a systematic review and Meta-analysis[J]. Chinese Journal of Radiation Oncology, 2016, 25(6): 557-564.

链接本文:

http://journal12.magtechjournal.com/Jweb_fszlx/CN/10.33760/cma.j.issn.1004-4221.2016.06.004 或 http://journal12.magtechjournal.com/Jweb_fszlx/CN/Y2016/V25/I6/557

[1] Rades D,Fehlauer F,Wroblesky J,et al. Prognostic factors in head-and-neck cancer patients treated with surgery followed by intensity-modulated radiotherapy (IMRT),3D-conformal radiotherapy,or conventional radiotherapy[J].Oral Oncol,2007,43(6):535-543.DOI:10.1016/j.oraloncology.2006.05.006.
[2] Nutting C,A’Hern R,Rogers MS,et al. First results of a phase Ⅲ multicenter randomized controlled trial of intensity modulated (IMRT) versus conventional radiotherapy (RT) in head and neck cancer (PARSPORT:ISRCTN48243537;CRUK/03/005)[J].J Clin Oncol,2009,27(18S):LBA6006.
[3] Rusthoven KE,Raben D,Ballonoff A,et al. Effect of radiation techniques in treatment of oropharynx cancer[J].Laryngoscope,2008,118(4):635-639.DOI:10.1097/MLG.0b013e31815fdf0e.
[4] Kam KM,Leung SF,Zee B,et al. Prospective randomized study of intensity-modulated radiotherapy on salivary gland function in early-stage nasopharyngeal carcinoma patients[J].J Clin Oncol,2007,25(31):4873-4879.DOI:10.1200/JCO.2007.11.5501.
[5] Han CH,Chen YJ,Liu A,et al. Actual dose variation of parotid glands and spinal cord for nasopharyngeal cancer patients during radiotherapy[J].Int J Radiat Oncol Biol Phys,2008,70(4):1256-1262.DOI:10.1016/j.ijrobp.2007.10.067.
[6] Hansen EK,Larson DA,Aubin M,et al. Image-guided radiotherapy using megavoltage cone-beam computed tomography for treatment of paraspinous tumors in the presence of orthopedic hardware[J].Int J Radiat Oncol Biol Phys,2006,66(2):323-326.DOI:10.1016/j.ijrobp.2006.05.038.
[7] Ding GX,Duggan DM,Coffey CW,et al. A study on adaptive IMRT treatment planning using KV cone-beam CT[J].Radiother Oncol,2007,85(1):116-125.DOI:10.1016/j.radonc.2007.06.015.
[8] Hansen EK,Bucci MK,Quivey JM,et al. Repeat CT imaging and replanning during the course of IMRT for head-and-neck cancer[J].Int J Radiat Oncol Biol Phys,2006,64(2):355-362.DOI:10.1016/j.ijrobp.2005.07.957.
[9] Wells GA,Shea B,O’Connell D,et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in Metaanalyses[EB/OL].[2015-01-04].http://www.ohri.ca/programs/clinical-epidemiology/oxford.asp.
[10] Wang W,Yang HH,Hu W,et al. Clinical study of the necessity of replanning before the 25^th fraction during the course of intensity-modulated radiotherapy for patients with nasopharyngeal carcinoma[J].Int J Radiat Oncol Biol Phys,2010,77(2):617-621.DOI:10.1016/j.ijrobp.2009.08.036.
[11] Bhide SA,Davies M,Burke K,et al. Weekly volume and dosimetric changes during chemoradiotherapy with intensity-modulated radiation therapy for head and neck cancer:a prospective observational study[J].Int J Radiat Oncol Biol Phys,2010,76(5):1360-1368.DOI:10.1016/j.ijrobp.2009.04.005.
[12] Ahn PH,Chen CC,Ahn AI,et al. Adaptive planning in intensity-modulated radiation therapy for head and neck cancers:single-institution experience and clinical implications[J].Int J Radiat Oncol Biol Phys,2011,80(3):677-685.DOI:10.1016/j.ijrobp.2010.03.014.
[13] Zhao L,Wan QY,Zhou YQ,et al. The role of replanning in fractionated intensity modulated radiotherapy for nasopharyngeal carcinoma[J].Radiother Oncol,2011,98(1):23-27.DOI:10.1016/j.radonc.2010.10.009.
[14] Capelle L,Mackenzie M,Field C,et al. Adaptive radiotherapy using helical tomotherapy for head and neck cancer in definitive and postoperative settings:initial results[J].Clinical Oncology,2012,24(3):208-215.DOI:10.1016/j.clon.2011.11.005.
[15] Cheng HCY,Wu VWC,Ngan RKC,et al. A prospective study on volumetric and dosimetric changes during intensity-modulated radiotherapy for nasopharyngeal carcinoma patients[J].Radiother Oncol,2012,104(3):317-323.DOI:10.1016/j.radonc.2012.03.013.
[16] Fung WWK,Wu VWC,Teo PML.Dosimetric evaluation of a three-phase adaptive radiotherapy for nasopharyngeal carcinoma using helical tomotherapy[J].Med Dosim,2012,37(1):92-97.DOI:10.1016/j.meddos.2011.01.006.
[17] Zhang X,Li M,Cao J,et al. Dosimetric variations of target volumes and organs at risk in nasopharyngeal carcinoma intensity-modulated radiotherapy[J].Br J Radiol,2012,85(1016):e506-e513.DOI:10.1259/bjr/20695672.
[18] Nishi T,Nishimura Y,Shibata T,et al. Volume and dosimetric changes and initial clinical experience of a two-step adaptive intensity modulated radiation therapy (IMRT) scheme for head and neck cancer[J].Radiother Oncol,2013,106(1):85-89.DOI:10.1016/j.radonc.2012.11.005.
[19] Chen CB,Lin X,Pan JJ,et al. Is it necessary to repeat CT imaging and replanning during the course of intensity-modulated radiation therapy for locoregionally advanced nasopharyngeal carcinoma?[J].Japan J Radiol,2013,31(9):593-599.DOI:10.1007/s11604-013-0225-5.
[20] Berwouts D,Olteanu LAM,Duprez F,et al. Three-phase adaptive dose-painting-by-numbers for head-and-neck cancer:initial results of the phase I clinical trial[J].Radiother Oncol,2013,107(3):310-316.DOI:10.1016/j.radonc.2013.04.002.
[21] Lu J,Ma YD,Chen JH,et al. Assessment of anatomical and dosimetric changes by a deformable registration method during the course of intensity-modulated radiotherapy for nasopharyngeal carcinoma[J].J Radiat Res,2014,55(1):97-104.DOI:10.1093/jrr/rrt076.
[22] Bhandari V,Patel P,Gurjar OP,et al. Impact of repeat computerized tomography replans in the radiation therapy of head and neck cancers[J].J Med Phys,2014,39(3):164-168.DOI:10.4103/0971-6203.139005.
[23] Wang RH,Zhang SX, Zhou LH,et al. Volume and dosimetric variations during two-phase adaptive intensity-modulated radiotherapy for locally advanced nasopharyngeal carcinoma[J].Biomed Mater Eng,2014,24(1):1217-1225.DOI:10.3233/BME-130923.
[24] Castelli J,Simon A,Louvel G,et al. Impact of head and neck cancer adaptive radiotherapy to spare the parotid glands and decrease the risk of xerostomia[J].Radiat Oncol,2015,10:6.DOI:10.1186/s13014-014-0318-z.
[25] Wang W,Yang HH,Mi YC,et al. Rules of parotid gland dose variations and shift during intensity modulated radiation therapy for nasopharyngeal carcinoma[J].Radiat Oncol,2015,10:3.DOI:10.1186/s13014-014-0307-2.
[26] Jin XC,Hu WG,Shang HJ,et al. CBCT-based volumetric and dosimetric variation evaluation of volumetric modulated arc radiotherapy in the treatment of nasopharyngeal cancer patients[J].Radiat Oncol,2013,8:279.DOI:10.1186/1748-717X-8-279.
[27] Tan WY,Li YP,Han G,et al. Target volume and position variations during intensity-modulated radiotherapy for patients with nasopharyngeal carcinoma[J].Onco Targets Ther,2013,6:1719-1728.DOI:10.2147/OTT.S53639.
[28] Schwartz DL,Garden AS,Shah SJ,et al. Adaptive radiotherapy for head and neck cancer-Dosimetric results from a prospective clinical trial[J].Radiother Oncol,2013,106(1):80-84.DOI:10.1016/j.radonc.2012.10.010.
[29] McMillan AS,Pow EHN,Leung WK,et al. Oral health-related quality of life in disease-free survivors following radiotherapy for nasopharyngeal carcinoma[J].J Oral Rehabil,2004,31(6):600-608.DOI:10.1111/j.1365-2842.2004.01383.x.
[30] Roesink JM,Schipper M,Busschers W,et al. A comparison of mean parotid gland dose with measures of parotid gland function after radiotherapy for head-and-neck cancer:implications for future trials[J].Int J Radiat Oncol Biol Phys,2005,63(4):1006-1009.DOI:10.1016/j.ijrobp.2005.04.023.
[31] Vergeer MR,Doornaert PAH,Rietveld DHF,et al. Intensity-modulated radiotherapy reduces radiation-induced morbidity and improves health-related quality of life:results of a nonrandomized prospective study using a standardized follow-up program[J].Int J Radiat Oncol Biol Phys,2009,74(1):1-8.DOI:10.1016/j.ijrobp.2008.07.059.
[32] Jabbari S,Kim HM,Feng M,et al. Matched case-control study of quality of life and xerostomia after intensity-modulated radiotherapy or standard radiotherapy for head-and-neck cancer:initial report[J].Int J Radiat Oncol Biol Phys,2005,63(3):725-731.DOI:10.1016/j.ijrobp.2005.02.045.
[33] Lee C,Langen KM,Lu WG,et al. Assessment of parotid gland dose changes during head and neck cancer radiotherapy using daily megavoltage computed tomography and deformable image registration[J].Int J Radiat Oncol Biol Phys,2008,71(5):1563-1571.DOI:10.1016/j.ijrobp.2008.04.013.
[34] Elstrm UV,Wysocka BA,Muren LP,et al. Daily kV cone-beam CT and deformable image registration as a method for studying dosimetric consequences of anatomic changes in adaptive IMRT of head and neck cancer[J].Acta Oncol,2010,49(7):1101-1108.DOI:10.3109/0284186X.2010.500304.
[35] Kierkels RG,Pickup LC,Gooding MJ,et al. Rigid dose transformation as a surrogate for dose recalculation when assessing the need for adaptive re-planning in head and neck cancer patients[J].Int J Radiat Oncol Biol Phys,2014,90(1):S107.DOI:10.1016/j.ijrobp.2014.05.522.