鼻咽癌IMRT脑干损伤的剂量体积研究

doi:10.3760/cma.j.issn.1004-4221.2017.02.003

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Abstract Objective To investigate the relationship between the incidence of radiation-induced brain stem injury after intensity-modulated radiotherapy (IMRT) and the radiation dose volume in patients with nasopharyngeal carcinoma. Methods A retrospective analysis was performed on the data of 258 patients newly diagnosed with nasopharyngeal carcinoma who received IMRT in our group from 2005 to 2013. The radiation dose per unit volume of brain stem was analyzed. The relationship between the incidence of brain stem injury induced by IMRT and the radiation dose volume was studied. The survival rate was calculated using the Kaplan-Meier method. The factors influencing the radiation-induced brain stem injury were analyzed using the Cox regression model. Results Two patients with stage T₃ disease and three patients with T₄ disease had radiation-induced brain stem injury. The 3-and 5-year injury incidence rates were 1.6% and 2.4%, respectively. The latency ranged between 9 and 58 months, with a median latency of 19 months. The median D_1% and D_max for the brain stem were 54.24 and 59.22 Gy in all patients, 54.31 and 59.45 Gy in patients with stage T₃ disease, and 61.29 and 66.37 Gy in patients with stage T₄ disease, respectively. In the five patients with brain stem injury, the D_1% and D_max were larger than 60 and 63 Gy, respectively. The univariate analysis showed that the incidence of radiation-induced brain stem injury was correlated with D_1%, D_max, D_{0.1 cm³}, D_{0.5 cm³}, and D_{1.0 cm³}(all P=0.01). The incidence of radiation-induced brain stem injury was significantly lower in patients with D_1%, D_max, D_{0.1 cm³}, D_{0.5 cm³}, and D_{1.0 cm³} no larger than 60, 63, 60, 58, and 56 Gy, respectively (all P=0.00). Conclusions The incidence of radiation-induced brain stem injury after IMRT is relatively low in patients with nasopharyngeal carcinoma. Strict control of the dose to the brain stem may help to reduce the incidence of brain stem injury and improve the long-term quality of life.

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	Articles by authors
	Yao Chengyun
	Wang Lijun
	Kong Cheng
	Zhang Lanfang
	He Xia
	Huang Shengfu
	Zhang Yiqin

Key words： Nasopharyngeal neoplasm/radiotherapy Radiotherapy,intensity modulated Brain stem Radiation injuries

Received: 18 May 2016

Corresponding Authors: Huang Shengfu,Email:hsf200902@163.com

Cite this article:

Yao Chengyun,Wang Lijun,Kong Cheng et al. A dose volume analysis of brain stem injury after intensity-modulated radiotherapy in patients with nasopharyngeal carcinoma[J]. Chinese Journal of Radiation Oncology, 2017, 26(2): 128-132.

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http://journal12.magtechjournal.com/Jweb_fszlx/EN/10.3760/cma.j.issn.1004-4221.2017.02.003 OR http://journal12.magtechjournal.com/Jweb_fszlx/EN/Y2017/V26/I2/128

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