Incidence and dosimetric parameters for brainstem necrosis following intensity modulated radiation therapy in nasopharyngeal carcinoma
Incidence and dosimetric parameters for brainstem necrosis following intensity modulated radiation therapy in nasopharyngeal carcinoma
复制标题
鼻咽癌调强放射治疗后脑干坏死的发生率和剂量参数
DOI：
10.1016/j.oraloncology.2017.08.011
复制
发表时间：
2017-10-01
期刊：
影响因子：
4.8
通讯作者：
Sun, Ying
中科院分区：
文献类型：
--
作者：
Li, Yang-Chan;Chen, Fo-Ping;Sun, Ying
目的：对接受调强放疗（IMRT）的鼻咽癌（NPC）患者进行长期随访，明确脑干毒性的发生率，并对脑干进行剂量体积分析。 材料与方法：回顾性分析2009年4月至2012年3月在中山大学肿瘤防治中心接受IMRT治疗的所有鼻咽癌患者。总共纳入了 1544 名随访 > 12 个月的患者以及详细的治疗计划数据。使用同步整合加强技术以每部分 2.0-2.48 Gy/28-33 部分进行放射治疗。脑干坏死定义为T2加权图像上高信号强度和T1加权图像上低信号强度的病变，在随访MRI中增强或不增强增强。结果：中位随访79.7个月（范围12.2-85.6个月）后，2/1544（0.13%）患者在间隔12.3和18.5个月后出现脑干坏死。 1、2、3和5年后脑干坏死的精算发生率分别为0.07%、0.13%、0.13%和0.13%。总体而言，384 名 (24.9%)、153 名 (9.9%)、67 名 (4.3%)、39 名 (2.5%)、78 名 (5.1%) 和 114 名 (7.4%) 患者 D-max >= 64 Gy、D1 cc > 59 Gy、D2 cc > 59 Gy、aV50 > 5.9 cc 剂量过高， aV55 > 2.7 cc和aV60 > 0.9 cc分别为2例，其中仅2例发生脑干坏死。结论：鼻咽癌中脑干坏死较少见。基于常规放疗的明确标准无法准确预测IMRT后脑干坏死的发生，因此需要制定更灵活、限制更严格的明确标准。
Objectives: To clarify the incidence of brainstem toxicity and perform a dose-volume analysis for the brainstem after long-term follow-up of a large cohort of nasopharyngeal carcinoma (NPC) patients who underwent intensity-modulated radiation therapy (IMRT).Materials and methods: All patients with NPC treated with IMRT at Sun Yat-sen University Cancer Center between April 2009 and March 2012 were retrospectively reviewed. A total of 1544 patients with follow-up > 12 months and detailed treatment plan data were included. Radiotherapy was administered using the simultaneous integrated boost technique in 2.0-2.48 Gy per fractions/28-33 fractions. Brainstem necrosis was defined as lesions with high signal intensity on T2-weighted images and low signal intensity on T1-weighted images, with or without enhancement after administration of contrast in follow-up MRI.Results: After median follow-up of 79.7 months (range, 12.2-85.6 months), 2/1544 (0.13%) patients developed brainstem necrosis after intervals of 12.3 and 18.5 months. Actuarial incidence of brainstem necrosis was 0.07%, 0.13%, 0.13% and 0.13% after 1, 2, 3 and 5 years, respectively. Overall, 384 (24.9%), 153 (9.9%), 67 (4.3%), 39 (2.5%), 78 (5.1%), and 114 (7.4%) patients had excessive doses of D-max >= 64 Gy, D1 cc > 59 Gy, D2 cc > 59 Gy, aV50 > 5.9 cc, aV55 > 2.7 cc and aV60 > 0.9 cc respectively, of whom only two developed brainstem necrosis.Conclusions: Brainstem necrosis is rare in NPC. The definitive criteria based on conventional radiotherapy cannot accurately predict the occurrence of brainstem necrosis after IMRT, thus more flexible definitive criteria with strict restrictions need to be defined.