食管癌调强技术根治性放疗后局部区域失败与靶区剂量体积关系研究

Effect of Dose-volume Relationship between Local Regional Failure and Target Volume after Radical Radiotherapy in Patients with Esophageal Cancer

目的研究食管癌调强技术根治性放疗后局部区域失败与靶区剂量体积关系影响。方法随机选取70例食管癌患者,按照照射范围不同分为两种:累及野照射(IFI)和选择性淋巴引流区预防照射(ENI),根据术后随访数据与复查资料确认是否为局部区域失败。将其分为A、B两组。其中A组为局部区域失败共38例,B组为非局部区域失败共32例。通过对比两组患者基本资料、靶剂量、体积参数;分析全组生存率、不同照射范围时靶体积剂量、体积参数;并分别对A、B两组不同照射范围时靶体积剂量、体积参数进行了对比分析。结果通过对比两组患者的靶区剂量参数、体积参数,发现A、B两组在GTV、CTV、PTV的剂量参数与体积参数方面差异无统计学意义(P>0.05)。全组进行了不同照射范围时ENI者与IFI者GTV、CTV、PTV的剂量参数对比,发现差异显著均有统计学意义(P<0.05);体积参数对比CTV的V55、V50和PTV的V60、V55、V50差异显著均有统计学意义(P<0.05)。其中A组ENI者与IFI者的CTV的剂量参数D98%、D95%、PTV的剂量参数D98%、D95%、D50%差异显著,均有统计学意义(P<0.05);体积参数值对比可见两组CTV的V55和PTV的V60、V55、V50比较差异显著,均有统计学意义(P<0.05);B组中ENI者与IFI者的GTV、CTV、PTV的剂量参数D98%、D95%、D50%、D2%差异显著,均有统计学意义(P<0.05);体积参数值对比可见两组PTV的V60、V55、V50比较差异显著,均有统计学意义(P<0.05)。结论食管癌调强技术根治性治疗中,建议处方剂量所包含的靶体积不低于95%,使用淋巴引流区的预防照射(ENI)在一定程度上可提高靶区剂量体积,可能有效减少局部区域失败,提升食管癌放疗的局部控制率。

Objective To study the influence of local dose on volume and volume of target area after radiotherapy in patients with esophageal carcinoma.Methods Randomly selected 70 cases of patients with esophageal cancer,according to the different irradiation range were divided into 2 types：the involved field irradiation（IFI） and elective nodal irradiation（ENI）,according to the follow-up data and review data to confirm whether the failure of local area.They were divided into 2 groups：group A and group B.Among them,group A was local area failure,38 cases,group B was non local area failure,32 cases.By comparing basic information of the 2 groups of patients,the target dose and volume parameters were analyzed;analysis of the whole group survival rate and different irradiation range when the target volume dose and volume parameters;and respectively analyze the 2 groups of different irradiation range when the target volume dose and volume parameters.Results By comparing the target dose parameters and volume parameters of the 2 groups,it was found that there was no significant difference in the dose parameters and volume parameters between the 2 groups,CTV and PTV（P 0.05） in GTV group and group B.The whole group of different irradiation dose parameters range ENI and IFI GTV,CTV,PTV,the differences were statistically significant（P 0.05）;CTV V55,the volume parameters of V50 and PTV V60,V55 V50,the differences were statistically significant（P 0.05）.The parameters of D98%,D95%,PTV dose group A ENI and IFI CTV of the D98%,D95%,D50% dose differences were statistically significant（P 0.05）;volume parameter value comparison of the 2 groups of CTV and V55 were PTV V60,V55,V50 differences were statistically significant（P 0.05） in the group B;ENI group and IFI group of GTV,CTV,PTV,D95%,D98% dose parameters D50%,D2% differences were statistically significant（P 0.05）;volume parameter value comparison of 2 groups of PTV V60,visible V55,V50 differences were statistically significant（P 0.05）.Conclusion Esophageal cancer IMRT radical treatment,the target volume recommended prescription dose contains no less than 95%,the use of the lymphatic drainage area to prevent irradiation（ENI） in a certain extent can improve target dose volume,may effectively reduce the local regional failure,enhance the control rate of esophageal cancer radiotherapy.