鼻咽癌肿瘤靠近视交叉靶区勾画的剂量研究

The Dose Study of Delineation of Target Area for Near Optic Chiasma in Nasopharyngeal Carcinoma Tumor

目的探究鼻咽癌靠近视交叉靶区剂量与肿瘤复发及视力改变的关系,指导临床靶区勾画。方法回顾性分析2016年3月至2020年6月郴州市第四人民医院收治的63例分期为Ⅲ期及Ⅳa期[美国癌症联合委员会(AJCC)第八版]的初治肿瘤靠近视交叉鼻咽癌患者,按照治疗方法不同分组,优先确保肿瘤靶区剂量为A组(43例),优先保证视交叉的剂量相对较低为B组(20例),比较两组放疗疗效、2年生存率及失明率。结果A组平均剂量6462 cGy,2年生存率为86.0%,1例视力下降,无失明者。B组视交叉平均剂量4275 cGy,2年生存率85.0%,无视力下降者。结论鼻咽癌肿瘤靠近视神经应该优先保证靶区剂量,视交叉的耐受性尚可。

Objective The relationship between the dose of target area for near optic chiasma and tumor recurrence and visual acuity change in nasopharyngeal carcinoma was explored to guide the delineation of clinical target area.Methods With retrospective analysis of 63 patients with near optic chiasma in nasopharyngeal carcinoma who were initially treated by the Chenzhou Fourth People's Hospital from March 2016 to June 2020 and whose stage wasⅢandⅣa[the 8th edition of the American Joint Commission on Cancer(AJCC)],according to the different treatment methods,the group A(43 cases)was given priority to ensure the tumor target dose,and the group B(20 cases)was given priority to ensure that the optic chiasm dose was relatively low.The radiotherapy efficacy,two-year survival rate and blindness rate between the two groups were compared.Results The average dose in the group A was 6462 cGy,with a 2-year survival rate of 86.0%,decrease of vision in one case,and no blindness.In group B,the average dose of optic chiasm was 4275 cGy,the 2-year survival rate was 85.0%,and there was no visual loss.Conclusion In nasopharyngeal carcinoma,the target dose should be given priority when the tumor is close to the optic nerve,and the optic chiasma is tolerable.