鼻腔鼻窦癌调强放疗后放射性鼻窦炎与鼻窦黏膜照射剂量-体积关系分析

Dose-volume relationship between sinonasal mucosa and radioactive sinusitis after intensity-modulated radiotherapy for sinonasal carcinoma

目的:分析鼻腔鼻窦癌调强放疗后放射性鼻窦炎的产生与鼻窦黏膜辐射剂量-体积的关系。方法:回顾性分析2013年至2016年我院放射治疗科收治的60例鼻腔鼻窦癌患者资料。放射性鼻窦炎的分级依据毒性反应CTC 3.0标准。在TPS计划系统上勾画正常鼻窦黏膜,通过DVH图读出各种放疗剂量参数,包括V10~60以及平均剂量等。探索放射性鼻窦炎的发生与鼻窦黏膜辐射体积以及剂量之间潜在的量效关系。结果:放射性鼻窦炎总的发生率为86.7%,其中Ⅰ级发生率为26.7%、Ⅱ级发生率为43.3%、Ⅲ级发生率为16.7%。探索到放疗后放射性鼻窦炎的发生与鼻窦黏膜辐射体积以及剂量之间存在关系。寻找到预测放射性鼻窦炎的3个指标:鼻窦黏膜受到的平均剂量、V50以及放疗的靶体积。分层分析得出:鼻窦黏膜平均剂量超过48 Gy、V50超过61.8%、PTV超过223 cm^3时,放疗后放射性鼻窦炎的发生率明显增高。结论:放射性鼻窦炎保护性因素为:鼻窦黏膜平均剂量≤48 Gy、V50≤61.8%、PTV≤223 cm3。

Objective:To analyse the dose-volume relationship between sinonasal mucasa and radioactive sinusitis after intensity-modulated radiotherapy for sinonasal carcinoma.Methods:Retrospective analysis was performed on 60 patients with sinonasal carcinoma followed by the radiotherapy in Department of Radiotherapy Oncology in our hospital from 2013 to 2016,in order to investigate rates of the radioactive sinusitis.According to a standard grading method.Common Toxicity Criteria 3.0(CTC 3.0),radioactive sinusitis was evaluate to show delineation of normal sinus mucosa,mean dose and V10,V20,V30,V40,V50,V60 of sinus mucosa from the dose-volume histogram system,to analyze concentration response relationship between radiation dose and volume.Results:The morbidity of radioactive sinusitis in all patients was 86.7%,including 26.7%gradeⅠ,43.3%gradeⅡ,16.7%gradeⅢ.V50,planning target volume and mean dose were significantly correlated with radioactive sinusitis of≥gradeⅠ.The acute RNS of≥gradeⅠwas significantly increased when V50,mean dose and PTV volume were more than 61.8%,48 Gy,223 cm3,respectively.Conclusion:V50≤61.8%,mean dose of normal sinonasal mucosa≤48 Gy and PTV≤223 cm3 were effective in predicting radioactive sinusitis.