鼻咽癌原发灶临床靶区勾画进展

Progress on delineation of clinical target volume of primary tumour of nasopharyngeal carcinoma

鼻咽癌临床靶区的准确勾画对预防肿瘤的局部复发、提高患者的生存率十分重要。早期调强放疗参照二维放疗经验勾画临床靶区(CTV),肿瘤局部无复发生存率高,但放疗不良反应严重、患者生活质量低下。在不影响疗效的情况下,缩小CTV范围,减轻放疗的急性与晚期不良反应,成为目前的研究热点。尽管有2010中国鼻咽癌调强放疗靶区设计专家共识与鼻咽癌临床靶区勾画国际指南作为参考,CTV理想的个体化、标准化勾画方案仍有争议。本文综述了国内外鼻咽癌原发灶临床靶区勾画优化的变迁与进展,希望为临床医生提供实践参考。

Accurate delineation of clinical target volume(CTV)of nasopharyngeal carcinoma is of significance to prevent local recurrence and improve the survival rate of patients.When intensity-modulated radiotherapy(IMRT)was first introduced,CTV was delineated based on two-dimensional radiotherapy experience.The local recurrence-free survival is high,but the adverse reactions induced by radiotherapy are severe and the patients’quality of life is poor.How to reduce CTV to alleviate acute and late radiotherapy-induced adverse reactions without deteriorating therapeutic effect has currently become a research hotspot.Despite the 2010 Chinese Nasopharyngeal Carcinoma IMRT Target and Dose Design Guideline Expert Consensus and the International Guideline for the Delineation of the CTV for Nasopharyngeal Carcinoma as references,the optimal individualized and standardized delineation of CTV remains controversial.This review summarizes the progress on the delineation of CTV of primary tumour of nasopharyngeal carcinoma,aiming to provide practical reference for clinicians.