鼻咽癌HT与IMRT急性不良反应比较

doi:10.3760/cma.j.issn.1004-4221.2019.08.005

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摘要

目的比较鼻咽癌螺旋断层放疗(HT)和调强放疗(IMRT)的急性不良反应。方法对2016年收治的100例鼻咽癌放疗患者进行回顾分析,HT组50例,IMRT组50例。全部患者均予以同步放化疗,放疗选用6MV X线照射,剂量为68.2~73.8Gy分30~34次。采用RTOG评分标准分别对皮肤、口腔黏膜、唾液腺及下咽/食管的急性不良反应进行评价。配对t检验两组差异。结果两组靶区剂量PTVnx、PTVnd(左)及PTVnd(右)均相近(P>0.05),HT组危及器官剂量低于IMRT组(P<0.05)。HT组不良反应发生率分别为皮肤0级14%、1级68%、2级18%,口腔黏膜0级10%、1级54%、2级36%;唾液腺1级74%、2级26%,下咽/食管0级10%、1级60%、2级28%、3级2%。IMRT组的分别为皮肤1级52%、2级48%;口腔黏膜1级58%、2级42%,唾液腺1级28%、2级72%,下咽/食管1级40%、2级60%。HT组皮肤、唾液腺和下咽/食管急性不良反应优于IMRT组(P<0.05),口腔黏膜反应相近(P>0.05)。HT组仅皮肤反应发生时间比IMRT组晚(P<0.05),其他相近(P>0.05)。结论 HT和IMRT均能满足鼻咽癌放疗靶区剂量分布要求,但在危及器官保护和急性不良反应程度及出现时间上HT更具优势。

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	刘慧
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关键词 ：鼻咽肿瘤/螺旋断层疗法, 鼻咽肿瘤/调强放射疗法, 急性不良反应

Abstract：

Objective To comparatively analyze the acute adverse reactions of helical tomotherapy (HT) and intensity-modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC). Methods A total of 100 NPC patients treated with radiotherapy were selected and divided into the HT group (n=50) and IMRT group (n=50). All patients were treated with concurrent chemoradiotherapy. The prescription dose of radiotherapy was DT68.2-73.8 Gy/30-34F. The severity of acute adverse reactions of skin, oral mucosa, salivary glands and esophagus was evaluated with the established RTOG criteria. The differences between two groups were evaluated by paired t-test. Results The dose of organs at risk (OARs) in the HT group was significantly lower than that in the IMRT group (P<0.05),whereas the dose of target area of PTVnx, PTVnd (left) and PTVnd (right) did not significantly differ between two groups (all P>0.05). In the HT group, the incidence rate of grade 0-3 acute adverse reactions in the skin, oral mucosa, salivary glands and esophagus were (14%,68%,18%,0%),(10%,54%,36%,0%),(0%,74%,26%,0%) and (10%,60%,28%,2%), respectively. In the IMRT group, the corresponding results were (0%,52%,48%,0%),(0%,58%,42%,0%),(0%,28%,72%,0%) and (0,40%,60%,0%), respectively. The severity of acute adverse reactions of skin, salivary glands and esophagus in the HT group was slighter than those in the IMRT group (all P<0.05), the acute adverse reactions in the oral mucosa were similar between two groups (P>0.05). In the HT group, the onset time of acute adverse reactions in the skin was later than that in the IMRT group (P<0.05), and the onset time of other adverse reactions was similar between two groups (all P>0.05). Conclusions Both HT and IMRT can meet the requirements of the dose distribution in the target area for NPC, whereas HT is superior to IMRT in terms of the protection of OARs protection, the severity and onset time of acute adverse reactions.

Key words： Nasopharyngeal neoplasm/helical tomotherapy Nasopharyngeal neoplasm/intensity-modulated radiation therapy Acute adverse reaction

收稿日期: 2018-08-10

通讯作者: 林承光,Email:linchg@sysucc.org.cn

引用本文:

刘慧,何汇朗,陈炫光等. 鼻咽癌HT与IMRT急性不良反应比较[J]. 中华放射肿瘤学杂志, 2019, 28(8): 580-583.

Liu Hui,He Huilang,Chen Xuanguang et al. Comparison of acute adverse reactions between helical tomotherapy and intensity-modulated radiation therapy for nasopharyngeal carcinoma[J]. Chinese Journal of Radiation Oncology, 2019, 28(8): 580-583.

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http://journal12.magtechjournal.com/Jweb_fszlx/CN/10.3760/cma.j.issn.1004-4221.2019.08.005 或 http://journal12.magtechjournal.com/Jweb_fszlx/CN/Y2019/V28/I8/580

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