肿瘤预防与治疗2025，Vol.38Issue(11)：960-969,10.DOI:10.3969/j.issn.1674-0904.2025.11.003
基于重复CT在局部晚期鼻咽癌自适应放疗中的临床研究
Clinical Study on Repeat CT in Adaptive Radiotherapy for Locally Ad-vanced Nasopharyngeal Carcinoma
刘冬梅 1胡洪源 1刘彤 2谢斯宇 2王硕 3周杰 3路顺 3徐鹏3
作者信息
- 1. 637000 四川南充,川北医学院临床医学院
- 2. 610500 成都,成都医学院临床医学院
- 3. 610041 成都,四川省肿瘤医院·研究所,四川省肿瘤临床医学研究中心,四川省癌症防治中心,电子科技大学附属肿瘤医院放疗科
- 折叠
摘要
Abstract
Objective:This study aims to assess the potential dosimetric impact of plan modifications following repeat CT scans in radical volumetric modulated arc therapy for locally advanced nasopharyngeal carcinoma(NPC),and to explore the necessity and clinical value of replanning.Methods:This retrospective study comprised a cohort of 100 patients with locally advanced NPC who received mid-treatment replanning at Sichuan Cancer Hospital between January 2020 and December 2021.This study compared the dose-volume histograms of three treatment plans:the initial plan(Plan-1),the adapted plan(Plan-2)based on the second CT scan(CT2),and a vir-tual plan(Plan-3)generated by rigidly registering Plan-1 to the CT2 anatomy.First,the comparison between Plan-1 and Plan-2 was used to assess volume changes of the planning target volume(PTV)and organs at risk(OARs).Second,a cross-comparison between Plan-1 and Plan-3 delineated the dosimetric discrepancies of the non-adapted plan.Finally,the comparison between Plan-2 and Plan-3 quantified the dosimetric benefit achieved through replanning.Results:A total of 100 NPC patients were included in this study based on the inclusion and exclusion criteria.We observed a significant decrease in target volume in Plan-2 compared to Plan-1,demonstrating notable volumetric changes during treatment.Notably,the mean volumes of the planning gross tumor volume(PGTV),left PGTV of lymph nodes,and right PGTV of lymph nodes were re-duced by 2.33 cm3,10.86 cm3,and 3.67 cm3,respectively(all P＜0.001).Similarly,the left and right parotid glands also exhibited significant volume reductions of 4.88 cm3 and 5.22 cm3,respectively(both P＜0.001).The adapted plan provided superior dosimetric performance compared to Plan-3,demonstrating higher prescription doses in the target area,im-proved dose homogeneity and higher minimum doses(D98％,D99％)across all PTV.Meanwhile,the doses to the surrounding OARs were significantly reduced.The mean dose(Dmean)to the left parotid gland decreased by 2.01 Gy(P＜0.001),while that to the right decreased by 1.50 Gy(P＜0.001).The maximum dose(Dmax)to the spinal cord decreased by 1.89 Gy(P=0.001).For the oropharynx,the Dmean and D5％declined by 0.89 Gy and 1.89 Gy,respectively(both P＜0.001).The D5％for the oral cavity was also significantly reduced by 4.94 Gy(P＜0.001).Conclusion:Replanning dur-ing radiotherapy enhances dose homogeneity to the target and significantly reduces radiation exposure to the parotid glands and other surrounding OARs.关键词
鼻咽癌/重新计划/刚性配准/剂量学变化Key words
Nasopharyngeal carcinoma/Replanning/Rigid registration/Dosimetric changes分类
医药卫生引用本文复制引用
刘冬梅,胡洪源,刘彤,谢斯宇,王硕,周杰,路顺,徐鹏..基于重复CT在局部晚期鼻咽癌自适应放疗中的临床研究[J].肿瘤预防与治疗,2025,38(11):960-969,10.
