摘要
目的 分析容积旋转调强放疗(VMAT)治疗鼻咽癌的效果及对急性口腔黏膜反应的影响.方法 采取前瞻性研究,选择2021 年10 月至2022 年10 月我院收治的 80 例鼻咽癌患者作为研究对象,按随机数字表法分为两组,各40 例.对照组采取静态调强适形放疗(s-IMRT)治疗,观察组采取VMAT治疗.治疗后,比较两组患者临床疗效、治疗效率(加速器跳数、治疗时间)、计划靶区剂量参数[肿瘤靶区(PGTV)、计划靶区(PTV):均匀性指数(HI)、适形性指数(CI)、最小剂量(Dmin)、最大剂量(Dmax)、平均剂量(Dmean)]、危及器官剂量参数(腮腺D mean、颞颌关节V40)、皮肤、口腔黏膜反应分级;采用双变量相关tau-b(K)分析,急性口腔黏膜反应分级与腮腺D mean、颞颌关节V40 剂量的关系.结果 治疗后,观察组总有效率(92.50%)高于对照组(75.00%)(P＜0.05);观察组加速器跳数、治疗时间[(658.04±103.36)MU、(3.14±0.46)min]低于对照组[(1844.25±462.47)MU、(7.84±1.09)min](P＜0.05);观察组PGTV的CI(0.45±0.09)高于对照组(0.37±0.08),PTV的 CI(0.40±0.16)高于对照组(0.29±0.08),Dmean[(64.38±4.43)Gy]低于对照组[(66.49±5.87)Gy](P＜0.05);观察组腮腺 D mean、颞颌关节 V40[(34.14±5.29)Gy、(4.29±0.67)Gy]低于对照组[(37.05±6.33)Gy、(5.11±1.32)Gy](P＜0.05);观察组急性口腔黏膜反应发生率(37.50%)低于对照组(72.50%)(P＜0.05);采用双变量相关tau-b(K)分析,急性口腔黏膜反应分级与腮腺D mean、颞颌关节V40 剂量呈正相关(r＞0,P＜0.05).结论 VMAT治疗鼻咽癌能够有效调节靶区剂量,控制危及器官剂量,降低急性口腔黏膜反应发生率,提升治疗效率.
Abstract
Objective To analyze the efficacy of volume rotation intensity modulated radiotherapy(VMAT)in the treat-ment of nasopharyngeal carcinoma and its impact on acute oral mucosal response.Methods A prospective study was conducted,selecting 80 nasopharyngeal carcinoma patients admitted to our hospital from October 2021 to October 2022 as the study subjects.They were divided into two groups by random number table method,with 40 patients in each group.The control group received static stress adaptive radiotherapy(s-IMRT)treatment,while the observation group received VMAT treatment.After treatment,the clinical efficacy,treatment efficiency(accelerator jumps,treatment time),planned target area dose parameters[tumor target area(PGTV),planned target area(PTV):uniformity index(HI),fitness index(CI),minimum dose(Dmin),maximum dose(Dmax),average dose(D mean)],endangered organ dose parameters(parotid gland D mean,temporomandibular joint V 40),skin and oral mucosal response grading between the two groups of patients were compared;Using bivariate correlation tau-b(K)analysis,the relationship between the grading of acute oral mucosal response and the dose of parotid gland D mean and temporomandibular joint V 40 was studied.Results Af-ter treatment,the total effective rate in the observation group(92.50%)was higher than that in the control group(75.00%)(P＜0.05);The number of accelerator jumps and treatment time in the observation group[(658.04±103.36)MU,(3.14±0.46)min]were lower than those in the control group[(1844.25±462.47)MU,(7.84±1.09)minutes](P＜0.05);The CI of PGTV in the observation group(0.45±0.09)was higher than that of the control group(0.37±0.08),the CI of PTV(0.40±0.16)was higher than that of the control group(0.29±0.08),and the Dmean[(64.38±4.43)Gy]was lower than that of the control group[(66.49±5.87)Gy](P＜0.05);The observation group showed lower levels of parotid gland Dmean and temporomandibular joint V40[(34.14±5.29)Gy,(4.29±0.67)Gy]compared to the control group[(37.05±6.33)Gy,(5.11±1.32)Gy](P＜0.05);The incidence of acute oral mucosal reactions in the observation group(37.50%)was lower than that in the control group(72.50%)(P＜0.05);Using bivariate correlation tau-b(K)analysis,the grading of acute oral mucosal response was positively correlated with the dose of pa-rotid gland D mean and temporomandibular joint V 40(r＞0,P＜0.05).Conclusion Volume rotation intensity modulated radiotherapy for nasopharyngeal carcinoma can effectively regulate the target dose,control the dose to organs at risk,reduce the incidence of acute oral mucosal reactions,and improve treatment efficiency.
维普
万方数据