诱导化疗对局部晚期鼻咽癌IMRT剂量学影响及再计划剂量学特点分析

doi:10.3760/cma.j.issn.1004-4221.2017.11.012

Abstract
Figure/Table
References()
Related Citation (15)
Read Tracking
Download Tracking

Download: PDF (801 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS) Supporting Info

Abstract

Objective To investigate the benefits of replanning after induction chemotherapy (IC) by analyzing the dosimetric impact of IC on intensity-modulated radiotherapy (IMRT) for locally advanced nasopharyngeal carcinoma (NPC) and the dosimetric characteristics of replanning after IC, and to provide data for the rational design of clinical radiotherapy plans. Methods 16 NPC patients underwent contrast-enhanced CT scan once before and after IC. Target volumes were delineated and the chemotherapy plans were created, defined as Plan-1 and Plan-2, respectively. Then the target structure after IC was copied to Plan-1, generating the third plan, defined as Plan-1-2. The paired t-test was used to compare the dosimetric parameters between Plan-1 and Plan-1-2 and between Plan-2 and Plan-1-2. Resutls Plan-1 vs. Plan-1-2:Plan-1-2 showed significantly reduced Dmean of target volume compared with Plan-1(P<0.05). Plan-1-2 significantly increased Dmean and Dmax of the spinal cord (P<0.05), although significantly reduced Dmean of the brain stem and Dmax of the temporal lobes compared with Plan-1. Plan-1-2 also had significantly reduced conformity index (CI) and significantly increased homogeneity index (HI) for the target volume compared with Plan-1(P<0.05). Plan-2 vs. Plan-1-2:Compared with Plan-1-2, Plan-2 significantly increased Dmean and Dmin of gross tumor volume (GTV) and primary GTV (P<0.05) and significantly reduced Dmean of the temporal lobes and Dmax and Dmean of the spinal cord (P<0.05), with Dmax decreased to 430.48 cGy;Plan-2 had significantly increased CI and significantly reduced HI for the target volume compared with Plan-1-2(all P<0.05). Conclutions IMRT plan-1 after IC has worse dosimetric distribution, while replanning after IC has more dosimetric benefits.

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	Wang Jia
	Xiao Feng
	Liu Feng
	Huang Shixiong
	Luo Longjun
	Wang Yu
	Xu Shilei
	Zhou Qiyuan
	Xi Xuping

Key words： Nasopharyngeal neoplasms/induction chemotherapy Nasopharyngeal neoplasms/intensity modulated radiotherapy Target delineation Dosimetry

Received: 17 October 2016

Corresponding Authors: Xi Xuping,Email:xixuping@163.com

Cite this article:

Wang Jia,Xiao Feng,Liu Feng et al. Dosimetric impact of induction chemotherapy on intensity-modulated radiotherapy for locally advanced nasopharyngeal carcinoma and dosimetric characteristics of replanning[J]. Chinese Journal of Radiation Oncology, 2017, 26(11): 1298-1302.

URL:

http://journal12.magtechjournal.com/Jweb_fszlx/EN/10.3760/cma.j.issn.1004-4221.2017.11.012 OR http://journal12.magtechjournal.com/Jweb_fszlx/EN/Y2017/V26/I11/1298

[1] 赵充,肖巍魏,韩非,等.419例鼻咽癌患者IMRT疗效和影响[J].中华放射肿瘤学杂志,2010,19(3):191-196.DOI:10.3760/cma.j.issn.1004-4221.2010.03.005.
Zhao C,Xiao WW,Han F,et al. Long-term outcome and prognostic factors of patients with nasopharyngeal carcinoma treated with intensity-modulated radiation therapy[J].Chin J Radiat Oncol,2010,19(3):191-196.DOI:10.3760/cma.j.issn.1004-4221.2010.03.005.
[2] 易俊林,高黎,黄晓东,等.416例鼻咽癌IMRT远期生存与影响因素分析[J].中华放射肿瘤学杂志,2012,21(3):196-200.DOI:10.3760/cma.j.issn.1004-4221.2012.03.002.
Yi JL,Gao L,Huang XD,et al. Nasopharyngeal carcinoma treated by intensity-modulated radiotherapy:long-term results of 416 patients[J].Chin J Radiat Oncol,2012,21(3):196-200.DOI:10.3760/cma.j.issn.1004-4221.2012.03.002.
[3] 林少俊,潘建基,韩露,等.鼻咽癌小靶区IMRT及化疗的远期疗效分析[J].中华放射肿瘤学杂志,2013,22(5):378-382.DOI:10.3760/cma.j.issn.1004-4221.2013.05.011.
Lin SJ,Pan JJ,Han L,et al. Long-term outcome of nasopharyngeal carcinoma treated with reduced-volume intensity-modulated radiotherapy and chemotherapy[J].Chinese Journal of Radiation Oncology,2013,22(5):378-382.DOI:10.3760/cma.j.issn.1004-4221.2013.05.011.
[4] 张力,管忠震.诱导化疗在鼻咽癌治疗中的作用[J].癌症,1992,11(3):234-238.
Zhang L,Guan ZZ.The role of induction chemotherapy in the treatment on NPC[J].Chin J Cancer,1992,11(3):234-238.
[5] Geara FB,Glisson BS,Sanguineti G,et al. Induction chemotherapy followed by radiotherapy versus radiotherapy alone in patients with advanced nasopharyngeal carcinoma:results of a matched cohort study[J].Cancer,1997,79(7):1279-1286.DOI:10.1002/(SICI)1097-0142(19970401)79:7<1279::AID-CNCR2>3.0.CO;2-C.
[6] Airoldi M,Gabriele P,Gabriele AM,et al. Induction chemotherapy with carboplatin and taxol followed by radiotherapy and concurrent weekly carboplatin+taxol in locally advanced nasopharyngeal carcinoma[J].Cancer Chemother Pharmacol,2011,67(5):1027-1034.DOI:10.1007/s00280-010-1399-5.
[7] Zhong YH,Dai J,Wang XY,et al. Phase Ⅱ trial of neoadjuvant docetaxel and cisplatin followed by intensity-modulated radiotherapy with concurrent cisplatin in locally advanced nasopharyngeal carcinoma[J].Cancer Chemother Pharmacol,2013,71(6):1577-1583.DOI:10.1007/s00280-013-2157-2.
[8] 曹建忠,罗京伟,徐国镇,等.鼻咽癌IMRT中靶区和正常器官变化规律及临床意义探讨[J].中华放射肿瘤学杂志,2007,16(2):81-85.DOI:10.3760/j.issn:1004-4221.2007.02.001.
Cao JZ,Luo JW,Xu GZ,et al. Probe into the clinical significance of target volume and change of the normal organs in image-guided radiotherapy for nasopharyngeal carcinoma[J].Chin J Radiat Oncol,2007,16(2):81-85.DOI:10.3760/j.issn:1004-4221.2007.02.001.
[9] 曹建忠,罗京伟,徐国镇,等.鼻咽癌IMRT中解剖及剂量学改变再次计划必要性研究[J].中华放射肿瘤学杂志,2008,17(3):161-164.DOI:10.3321/j.issn:1004-4221.2008.03.001.
Cao JZ,Luo JW,Xu GZ,et al. Necessity of replanning for the change of anatomy and dosimetry during intensity modulated radiotherapy for nasopharyngeal carcinoma[J].Chin J Radiat Oncol,2008,17(3):161-164.DOI:10.3321/j.issn:1004-4221.2008.03.001.
[10] Radiation Therapy Oncology Group. A phase Ⅱ study 0f concurrent chemoradiotherapy using three-dimensional conformal radiotherapy (3D-CRT) or intensity-modulated radiation therapy (IMRT)+ Bevacizumab (BV) for locally or regionally advanced nasopharyngeal cancer,RTOG0615[2011-03-05].http://208.251.169.72/members/protocols/0615/0615.pdf.
[11] 中国鼻咽癌临床分期工作委员会.2010鼻咽癌IMRT靶区及剂量设计指引专家共识[J].中华放射肿瘤学杂志,2011,20(4):267-269.DOI:10.3760/cma.j.issn.1004-4221.2011.04.001.Chinese nasopharyngeal carcinoma clinical staging Committee.2010 nasopharyngeal carcinoma IMRT target area and dose design guidelines expert consensus[J].Chin J Radiat Oncol,2011,20(4):267-269.DOI:10.3760/cma.j.issn.1004-4221.2011.04.001.
[12] 张瑜,潘建基,陆军,等.中晚期鼻咽癌调强适形放疗分段设计计划的可行性研究[J].实用癌症杂志,2006,21(5):512-515.DOI:10.3969/j.issn.1001-5930.2006.05.021.
Zhang Y,Pan JJ,Lu J,et al. A feasible study of stepwise-plan IMRT for local advanced nasopharyngeal carcinoma[J].Pract J Cancer,2006,21(5):512-515.DOI:10.3969/j.issn.1001-5930.2006.05.021.
[13] Salama JK,Haddad RI,Kies MS,et al. Clinical practice guidance for radiotherapy planning after induction chemotherapy in locoregionally advanced head-and-neck cancer[J].Int J Radiat Oncol Biol Phys,2009,75(3):725-733.DOI:10.1016/j.ijrobp.2008.11.059.
[14] 余湛,罗伟,周琦超,等.诱导化疗后局部晚期鼻咽癌IMRT肿瘤靶区勾画方式改变对剂量分布和临床疗效的影响[J].癌症,2009,28(11):1132-1137.DOI:10.3321/j.issn:1000-467X.2009.11.003.
Yu Z,Luo W,Zhou QC,et al. Impact of changing gross tumor volume delineation of intensity-modulated radiotherapy on the dose distribution and clinical treatment outcome after induction chemotherapy for the primary locoregionally advanced nasopharyngeal carcinoma[J].Chin J Cancer,2009,28(11):1132-1137.DOI:10.3321/j.issn:1000-467X.2009.11.003.