A dosimetric study on the feasibility of using the anterior head and neck lymphatic drainage protection area for nasopharyngeal carcinoma intensity-modulated radiotherapy

黄　娟; 陈晓慧; 翟瑞萍

doi:10.19401/j.cnki.1007-3639.2018.09.008

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A dosimetric study on the feasibility of using the anterior head and neck lymphatic drainage protection area for nasopharyngeal carcinoma intensity-modulated radiotherapy

更新时间：2026-01-27

- A dosimetric study on the feasibility of using the anterior head and neck lymphatic drainage protection area for nasopharyngeal carcinoma intensity-modulated radiotherapy
- China Oncology Vol. 28, Issue 9, Pages: 692-697(2018)
- 作者机构：
  
  复旦大学附属肿瘤医院放疗科，复旦大学上海医学院肿瘤学系,上海,200032
- 作者简介：
- 基金信息：
- DOI：10.19401/j.cnki.1007-3639.2018.09.008
  CLC： R739.63;R730.55
- Published Online：26 October 2018，
  
  Published：26 October 2018
- 稿件说明：
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黄　娟,陈晓慧,翟瑞萍,等. 鼻咽癌调强放射治疗设置头颈前部淋巴引流保护区的剂量学可行性研究[J]. 中国癌症杂志, 2018, 28(9): 692-697.

黄　娟, 陈晓慧, 翟瑞萍. A dosimetric study on the feasibility of using the anterior head and neck lymphatic drainage protection area for nasopharyngeal carcinoma intensity-modulated radiotherapy[J]. China Oncology, 2018, 28(9): 692-697.
黄　娟,陈晓慧,翟瑞萍,等. 鼻咽癌调强放射治疗设置头颈前部淋巴引流保护区的剂量学可行性研究[J]. 中国癌症杂志, 2018, 28(9): 692-697. DOI： 10.19401/j.cnki.1007-3639.2018.09.008.

黄　娟, 陈晓慧, 翟瑞萍. A dosimetric study on the feasibility of using the anterior head and neck lymphatic drainage protection area for nasopharyngeal carcinoma intensity-modulated radiotherapy[J]. China Oncology, 2018, 28(9): 692-697. DOI： 10.19401/j.cnki.1007-3639.2018.09.008.

摘要

背景与目的：头颈部淋巴水肿（head and neck lymphedema，HNL）是鼻咽癌（nasopharyngeal carcinoma，NPC）调强放射治疗（intensity-modulated radiotherapy，IMRT）后一种常见的不良反应，但相关的研究和报道则较少。该研究旨在探索一种预防或减轻NPC患者放疗后HNL的计划设计方法，研究其剂量学可行性。方法：对20例NPC患者分别设计两组计划，计划A按常规方法设计简单调强放射治疗（simplified intensitymodulated radiotherapy，sIMRT）计划，计划B在计划A的基础上使用头颈前部淋巴引流保护区设计的sIMRT计划，比较两组计划在靶区剂量分布、危及器官（organ at risk，OAR）受量和机器跳数方面的差异。结果：两组计划靶区剂量分布均满足临床要求，计划靶区1（planning target volume 1，PTV1）的各项指标在两组间的差异均无统计学意义，计划A中PTV2的D

98%

、V

100%

（%）、V

95%

（%）和均匀性指数（homogeneity index，HI）均优于计划B（t=4.134、3.455、2.423和-2.410，P0.05）。计划A中左、右腮腺D

mean

和左侧腮腺V30均低于计划B（t=-2.454、-2.113和-4.651，P0.05）；但计划A的口腔D

mean

和V

高于计划B（t=4.639和2.237，P0.05）；计划A的喉D

mean

和V

也高于计划B（t=10.934和4.624，P0.05）。机器跳数方面，计划B比计划A略有增加，但差异无统计学意义。结论：NPC患者给予头颈前部淋巴引流保护区的计划设计在剂量学上是可行的，在满足临床靶区覆盖的前提下，于头颈前部留出了低剂量（20 Gy）照射的区域以利于淋巴回流，更好地保护了口腔、喉等可导致淋巴水肿的正常组织。

Abstract

Background and purpose: Head and neck lymphedema (HNL) is a common side effect of intensitymodulated (IMRT) radiotherapy for nasopharyngeal carcinoma (NPC)

but few studies have been reported. The purpose of this study was to explore a method to prevent or mitigate HNL after radiotherapy for NPC patients and to study its dosimetric feasibility. Methods: Two groups of plans were designed for 20 NPC patients. Plan A included simplified intensity-modulated radiotherapy (sIMRT) plans by conventional method

and plan B included sIMRT plans using the anterior head and neck lymphatic drainage protection area. Dose distributions of the target

dose-volume parameters of organs at risk (OAR) and the total monitor units (MU) were compared between the two groups. Results: The target dose distributions of the two groups all met the clinical requirements. The indicators of planning target volume 1 (PTV1) had no significant difference between the two groups. In plan A

98%

100%

(%)

95%

(%) and homogeneity index (HI) of PTV2 were superior to those in plan B (t=4.134

3.455

2.423 and -2.410

P0.05). D

mean

of left and right parotid gland and V

of left parotid gland in plan A were lower than those in plan B (t =-2.454

-2.113 and -4.651

P0.05). For oral cavity

mean

and V50 were higher in plan A (t=4.639 and 2.237

P0.05). Similarly

mean

and V

of larynx were also higher in plan A (t=10.934 and 4.624

P0.05). Compared with plan A

the total MU of plan B increased slightly

but the differences were not statistically significant. Conclusion: The plan design of the anterior head and neck lymphatic drainage protection is feasible in dosimetry for NPC patients. Without sacrificing the target coverage

a low-dose (20 Gy) lymphatic drainage area can be reserved to the front of head and neck while oral cavity and larynx are better protected.

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