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目的评估单侧颈淋巴结转移鼻咽癌(NPC)患者调强适形放疗(IMRT)对侧颈部临床靶区(CTV)优化的可行性。方法行IMRT的NPC患者67例分为两组:A组32例,均为单侧颈淋巴结转移患者,对侧颈部ⅠB区、ⅡB区和Ⅳ区CTV优化;B组35例,按照放疗肿瘤学组0225/0615方案设立双侧颈部CTV。比较两组颌下腺、腮腺及甲状腺放射剂量参数,并分析患者生存情况。结果随访6-31个月,67例患者死亡7例,无一例局部复发,2年局部控制率、2年无进展生存率和总生存率分别为100%、86.6%和89.6%。两组2年局部控制率、总生存率、2年无进展生存率及远处转移率相仿(P>0.05)。A组颌下腺、腮腺及甲状腺放射剂量参数优于B组(P<0.05或P<0.01)。结论 IMRT对单侧颈淋巴结转移NPC患者对侧颈部CTV的优化可保护一侧颌下腺、腮腺及甲状腺,提高患者生存质量。
Objective To evaluate the feasibility of optimizing conformal radiotherapy (IMRT) on the clinical target (CTV) of the lateral neck in patients with unilateral cervical lymph node metastasis (NPC). Methods A total of 67 NPC patients with IMRT were divided into two groups: group A (n = 32), all patients with unilateral neck lymph node metastasis, CTVs of contralateral neck region ⅠB, ⅡB and Ⅳ were optimized; in group B, 35 patients were treated with radiotherapy Group 0225/0615 program to establish bilateral neck CTV. Radiographic parameters of submandibular gland, parotid gland and thyroid were compared between the two groups, and the survival of patients was analyzed. Results The patients were followed up for 6-31 months. There were 7 deaths in 67 patients. No local recurrence was found. The 2-year local control rate, 2-year progression-free survival rate and overall survival rate were 100%, 86.6% and 89.6% respectively. The two-year local control rate, overall survival, 2-year progression-free survival and distant metastasis rates were similar (P> 0.05). A group of submandibular gland, parotid and thyroid radiation dose parameters better than the B group (P <0.05 or P <0.01). Conclusion IMRT can optimize the contralateral neck CTV in patients with unilateral cervical lymph node metastasis and protect one side of submandibular gland, parotid gland and thyroid gland, and improve the quality of life of patients.