鼻咽癌N<sub>0</sub>‐N<sub>1</sub>期患者Ⅱb区临床靶区剂量优化策略及可行性分析

doi:10.3760/cma.j.cn113030-20210901-00336

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Abstract Objective To determine the safety of prophylactic irradiation dose CTV_60Gyoptimized to CTV_50Gy for II_b region in patients with stage N₀‐N₁ nasopharyngeal carcinoma (NPC) and the dose advantage and clinical value for parotid gland protection, and to understand the diagnostic value of PET‐CT and diffusion‐weighted imaging (DWI) for suspicious positive lymph nodes in the neck (5 mm≤maximum short diameter<10 mm). Methods Clinical data of 157 patients with primary non‐metastatic NPC (N₀‐N₁) admitted to our hospital from June 2015 to March 2017 were retrospectively analyzed. 104 patients underwent II_b clinical target volume optimization guided by multimodal imaging system. Survival analysis was performed by Kaplan ‐ Meier method. Univariate/multivariate regression analysis was performed to analyze the pattern of cervical lymph node recurrence. Paired t‐test was used to compare the differences in target volume and parotid gland dose parameters before and after dose optimization. Results Sixty patients underwent single‐neck optimization in stage N₁, 25 patients received double‐neck optimization (only those with retropharyngeal lymph node metastasis), and 19 patients underwent double‐neck optimization in stage N₀. Three patients had cervical regional recurrence, all in‐field. The 5‐year overall survival rate was 93.3%. The lymph node recurrence‐free survival rate, local recurrence‐free survival rate, distant metastasis‐free survival rate and disease‐free survival rate were 97.1%, 91.3%, 88.5% and 80.8%, respectively. Cervical lymph node recurrence was associated with local recurrence in the nasopharynx, regardless of retropharyngeal lymph node status. Fourteen patients had suspicious positive cervical lymph nodes in II_b region, with a mean maximum short diameter of 7.1 (5~9) mm on the largest cross‐sectional plane, and 11 of them were positive on PET‐CT, with a mean SUV_max of 2.96 (2.5~3.3). There was no significant difference in GTV after optimization (P>0.05). D_mean, D_max, D_50% and V_26Gy of parotid gland were significantly lower than those of conventional plan (all P<0.01). Conclusions It is safe to optimize CTV_60Gy to CTV_50Gy in II_b region in patients with N₀‐N₁ NPC, and the exposure dose to normal tissues around the parotid gland and neck is significantly reduced. For small lymph nodes that do not meet the diagnostic criteria, it needs to be individualized in combination with multimodality imaging systems, such as PET‐CT and DWI.

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	Articles by authors
	Huang Wenxuan
	Zong Dan
	Zhang Bin
	Wang Lijun
	Zhang Lanfan
	Ma Chengxian
	Yin Li
	Huang Shengfu
	He Xia

Key words： Nasopharyngeal carcinoma Intensity‐modulated radiotherapy Clinical target volume Cervical lymph node Diffusion‐weighed imaging

Received: 01 September 2021

Fund:National Natural Science Foundation of China(81872192); Key Program of the Health Commission of Jiangsu Province, China(K2019028); Key Program of Social Development of Department of Science and Technology, Jiangsu Province, China(BE2019756)

Corresponding Authors: He Xia , Email: hexiabm@163.com

Cite this article:

Huang Wenxuan,Zong Dan,Zhang Bin et al. The strategy and feasibility of dose optimization in clinical target volume Ⅱb in patients with N₀‐N₁ nasopharyngeal carcinoma[J]. Chinese Journal of Radiation Oncology, 2022, 31(9): 778-784.

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http://journal12.magtechjournal.com/Jweb_fszlx/EN/10.3760/cma.j.cn113030-20210901-00336 OR http://journal12.magtechjournal.com/Jweb_fszlx/EN/Y2022/V31/I9/778

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