龚修云;金风;甘家应;吴伟莉;李媛媛;龙金华;陈潇潇;王立敏;贺前勇;毕婷;李卓玲;
GONG Xiuyun;JIN Feng;GAN Jiaying;WU Weili;LI Yuanyuan;LONG Jinhua;CHEN Xiaoxiao;WANG Limin;HE Qianyong;BI Ting;LI Zhuoling;Department of Head and Neck Oncology,Cancer Hospital Affiliated to Guizhou Medical Unuversity;Department of Science and Education,The First People's Hospital of Guiyang;

• 1:贵州医科大学附属肿瘤医院头颈肿瘤科
• 2:贵阳市第一人民医院科教科

摘要(Abstract)：

目的:探讨MRI/CT融合图像勾画局部晚期鼻咽癌诱导化疗后靶区对放疗计划的影响。方法 :选取52例经局部晚期鼻咽癌患者,经诱导化疗2或3周期后分别在相同体位下同期采集鼻咽部CT定位图像及鼻咽部MRI T1W1图像,并通过Pinnacle38.0放疗计划系统进行MRI/CT图像融合,分别对CT定位图像及MRI/CT融合图像资料进行GTVnx勾画,对转移淋巴结、CTV1、CTV2及正常组织均在CT图像进行勾画,形成两套靶区;两套靶区均由同一物理师分别进行调强放疗计划设计后给予相同处方剂量及正常组织限量,在勾画诱导化疗后分别比较两套放疗计划靶区适形指数(CI)及均匀指数(HI),统计靶区照射体积、剂量及正常组织受量。结果:与CT图像靶区放疗计划比较,局部晚期鼻咽癌诱导化疗后MRI/CT融合勾画靶区放疗计划CIPTVnx和GTVnx照射体积更大(P<0.05);2套放疗计划的HI、PTV照射体积、PTV靶区适形CI、剂量均匀性HI、靶区剂量及正常组织受量比较,差异无统计学意义(P>0.05)。结论:MRI/CT融合图像方案可一定程度增加局部晚期鼻咽癌时辰诱导化疗后勾画靶区的照射体积,有较好的靶区适形度,可能会减少诱导化疗后放射治疗漏靶的发生。
Objective: To explore the effect of MRI and CT image fusion technology in target delineation of induction chrono-chemotherapy and the influence of radiotherapy plan for locally advanced nasopharyngeal carcinoma. Methods: 52 patients with locally advanced nasopharyngeal carcinoma( NPC)in the Department of Head and Neck Oncology of Cancer Hospital of Guizhou China from Jan 2012 to Dec 2013 were enrolled in this study. All patients received two-three cycles of induction chrono-chemotherapy and then the images of CT and T1 W1 sequence of MRI were collected in the same treatment position. The CT and MRI images were integrated with Pinnacle38. 0 chemotherapy plan system. The Gross target volume( GTVnx) was performed by delineating the CT and MRI/CT fusion image. Meanwhile,metastatic lymph nodes,CTV1,CTV2 and organs at risk were delineated through CT images alone. And finally the two sets of planning target volume were given the same prescription dose and normal tissue dose after the planning design of intensity modulation radiation therapy( IMRT) under the director of the common physiotherapists. The radiation doses calculated from the two sets of planning target volume were compared with regard to the conformal index( CI) and Homogeneity index( HI),and the irradiation target volume,dose and the normal tissue dose were analyzed. Results: Compared with the chemotherapy plan of target delineation by CT images,the CI of MRI/CT fusion images was better after induction chemotherapy,and the difference was statistically significant( P < 0. 01); Compared with the target volume of MRI/CT fusion image increased morer than the GTVnx irradiation volume by CT images,and the difference was statistically significant( P < 0. 05); There was no significant difference in the volume of PTV irradiation,PTV target CI,dose uniformity HI,target volume dose and dose coverage of normal organs between the two images( P > 0. 05). Conclusion: The application of MRI/CT image fusion technology in target delineation can increase the target volume in the local advanced NPC after induced chemotherapy compared with the target delineation of single CT image and effectively reduces the incidence rate of the leakage of target. The plan has a good effect for conformal radiotherapy and it could provide some guidance for the treatment in locally advanced NPC.

关键词(KeyWords)： MRI/CT图像融合;靶区勾画;调强放射放疗;局部晚期鼻咽癌;时辰诱导化疗;应用
MRI/CT fusion images;target delineation;intensity modulated radiation;locally advanced nasopharyngeal carcinoma;induction chrono-chemotherapy;Application

Abstract:

Keywords:

基金项目(Foundation): 贵州省科技厅社发联合攻关项目[黔科合LG字(2012)044号]

作者(Author): 龚修云;金风;甘家应;吴伟莉;李媛媛;龙金华;陈潇潇;王立敏;贺前勇;毕婷;李卓玲;
GONG Xiuyun;JIN Feng;GAN Jiaying;WU Weili;LI Yuanyuan;LONG Jinhua;CHEN Xiaoxiao;WANG Limin;HE Qianyong;BI Ting;LI Zhuoling;Department of Head and Neck Oncology,Cancer Hospital Affiliated to Guizhou Medical Unuversity;Department of Science and Education,The First People's Hospital of Guiyang;

Email:

DOI: 10.19367/j.cnki.1000-2707.2018.03.014

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