- 期刊
鼻咽癌二次定位計劃中腫瘤及腮腺體積變化的臨床動態研究
Changes of Tumor and Salivary Gland Volumes in Two-Phase IMRT Plans for Nasopharyngeal Carcinoma
摘要
Objective: To investigate the changes of the tumor and salivary gland volumes in intensity modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC) through 2nd phase of computed tomography (CT) treatment planning.Materials and Methods: Thirty-eight patients with nasopharyngeal carcinoma were enrolled in this study, the primary tumor and neck lymph nodes were treated by IMRT; and formed the plan1 (DVH1), re-planning CT with same position after twenty-two radiation treatments formed the plan2 (DVH2). All target volumes and organs at risk were outlined by the same physician. The physical objective and dose constraints were optimized with same criteria. The data obtained from CT treatment planning and DVH were analyzed. The volumes, weights, and outline changes in the transverse diameter of CT images varied between before and after treatments.Results: Patient weight, volumes of tumors and salivary glands decreased remarkably during radiotherapy. The average weight decreased by 2.97% (2.33 kg, range 1.5~3.7 kg). Compared Plan 1 with Plan 2, the parotid glands was significantly reduced by 15.67% (10.83 cc, 95% CI: range 7.45~14.21 cc), submandibular glands 15.83% (3.39 cc, 95% CI: range 2.14~4.65 cc), GTV decreased 15.49% (3.83 cc, 95% CI: range 2.36~5.30 cc), and GTV-LN decreased 41.81% (15.12 cc, 95% CI: range 8.66~21.57 cc). The transverse diameter of head and neck CT images reduced by average of 0.32 ~ 0.89 cm (1.93%~6.04%), especially at the transverse diameter in the level of 3 cm above the set-up center (0.89 cm). The GTV volume on average shrank 2.23 cc and 6.91 cc as comparing T1-3 with T4 disease (p = 0.0013); The GTV-LN volume shrank on average 8.59 cc, 38.93 cc (P＜ 0.0001) as comparing N1-2 with N3 disease. The transverse diameter changes of head and neck contours were correlated significantly with N stage and body weight loss.Conclusion: For NPC patients treated with IMRT, weight loss, volume reduction of salivary gland, and body contour change are common. The salivary glands on average reduced volume by 15% and GTV-LN by 40% after one-month treatment. The transverse diameter of head and neck regions could decrease up to 0.89 cm. We recommend repeat simulation after one-month of radiotherapy in order to reduce the dose to the normal organs and avoid missing treatment targets.
並列摘要
Objective: To investigate the changes of the tumor and salivary gland volumes in intensity modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC) through 2nd phase of computed tomography (CT) treatment planning.Materials and Methods: Thirty-eight patients with nasopharyngeal carcinoma were enrolled in this study, the primary tumor and neck lymph nodes were treated by IMRT; and formed the plan1 (DVH1), re-planning CT with same position after twenty-two radiation treatments formed the plan2 (DVH2). All target volumes and organs at risk were outlined by the same physician. The physical objective and dose constraints were optimized with same criteria. The data obtained from CT treatment planning and DVH were analyzed. The volumes, weights, and outline changes in the transverse diameter of CT images varied between before and after treatments.Results: Patient weight, volumes of tumors and salivary glands decreased remarkably during radiotherapy. The average weight decreased by 2.97% (2.33 kg, range 1.5~3.7 kg). Compared Plan 1 with Plan 2, the parotid glands was significantly reduced by 15.67% (10.83 cc, 95% CI: range 7.45~14.21 cc), submandibular glands 15.83% (3.39 cc, 95% CI: range 2.14~4.65 cc), GTV decreased 15.49% (3.83 cc, 95% CI: range 2.36~5.30 cc), and GTV-LN decreased 41.81% (15.12 cc, 95% CI: range 8.66~21.57 cc). The transverse diameter of head and neck CT images reduced by average of 0.32 ~ 0.89 cm (1.93%~6.04%), especially at the transverse diameter in the level of 3 cm above the set-up center (0.89 cm). The GTV volume on average shrank 2.23 cc and 6.91 cc as comparing T1-3 with T4 disease (p = 0.0013); The GTV-LN volume shrank on average 8.59 cc, 38.93 cc (P＜ 0.0001) as comparing N1-2 with N3 disease. The transverse diameter changes of head and neck contours were correlated significantly with N stage and body weight loss.Conclusion: For NPC patients treated with IMRT, weight loss, volume reduction of salivary gland, and body contour change are common. The salivary glands on average reduced volume by 15% and GTV-LN by 40% after one-month treatment. The transverse diameter of head and neck regions could decrease up to 0.89 cm. We recommend repeat simulation after one-month of radiotherapy in order to reduce the dose to the normal organs and avoid missing treatment targets.
延伸閱讀
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