局部晚期鼻咽癌新辅助化疗后调强放疗肿瘤靶区勾画方式改变对剂量分布和临床疗效的影响-肿瘤学专业论文.docxVIP

Ab Abstract PAGE PAGE IV ABSTRACT Background and Objective： The gross tumor volume(GTV) was obviously decreased after neoadjuvant chemotherapy for locally advanced nasopharyngeal carcinoma .This study was to investigate the impact on the target and normal tissue dose distribution and clinical efficacy by changing GTV delineation after neoadjuvant chemotherapy. Methods: Retrospective analysis of 60 primary locoregionally advanced nasopharyngeal carcinoma patients clinical data from Jiangxi Provincial Tumor Hospital Department of Radiation Oncology from February 2010 to October 2012.All the patients were treated with two cycles induction chemotherapy(IC) of TP or PF regimen followed by intensity- modulated radiotherapy(IMRT) with conrurrent chemotherapy.The primary GTV was delineated into two parts: the post-IC primary GTV (GTVpost-IC) and the region of pre-IC primary GTV minus GTVpost-IC (GTVpre-post-IC).The tumor target was delineated according to GTVpost-IC,and GTV-pre-IC was overlaid by CTV60. There was Twelve types of TNM pattern according to the 2008 nasopharyngeal carcinoma stage of III ～ IVa. To delineate the GTV of twenty-four cases that each type with two cases selected from sixty patients in accordance with above patterns according to GTVpre-IC.Comparing the difference of the dose distribution of two plans based on GTVpost-IC and GTVpre-IC.The clinical treatment outcome and treatment-related toxicity of all patients were observed. Dosimetric analysis was performed on the patients with locoregional relapse. Compareing of the relationship between rGTV and V95 can distinguish which is the type of locoregional recurrence. Results: The post-IC GTV was significantly decreased comparing with the pre-IC GTV(primary GTV 30.42 cc vs. 17.43cc, P=0.000; lymph nodes GTV 20.14cc vs.11.51cc, P=0.04; the GTVnx and GTVnd with an average shrinkage of 32.1%. PAGE PAGE V and 50.21%,respectively . The high dose region was also decreased( Volumes c