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1
題名:探討頭頸部癌合併頸部淋巴結腫大的病患使用二次IMRT治療計劃之必要性     (22點)
IS DUAL-PHASE IMRT REQUIRED FOR THE PATIENT OF HEAD AND NECK CANCER WITH ENLARGED CERVICAL LYMPH NODES?
著者:郭于誠(Yu-Cheng Kuo) ;吳東和(Tung-Ho Wu) ;黃光偉(Kuang-Wei Huang) ;王雅玲(Ya-Ling Wang) ;鍾道生(Tao-Sang Chung) ;蘇文川(Wen-Chuan Su) ;陳東河(Tung-Ho Chen) ;邱仲峰(Jeng-Fong Chiou)
出版地區:台灣
出版城市:台北市
學科:醫學綜合
關鍵字:二次電腦斷層定位IMRT治療計劃 ; 頭頸部癌 ; 頸部淋巴結腫大 ; 影像融合 ; 腮腺 ; 包覆順形度 ; Dual-phase IMRT ; Head and neck cancer ; Cervical lymph nodes ; Image fusion ; The conformal index ; Parotid gland
刊名:放射治療與腫瘤學
頁碼:113-123
語言:繁體中文
摘要: 中文摘要PDF ; 英文摘要PDF

目的:探討頭頸部癌合併頸部淋巴結腫大的患者在強度調控放射治療(intensity-modulated radiotherapy,IMRT)計劃使用二階段與單一階段電腦斷層影像(CT)的差別。 材料與方法:從2003 年4 月至2004 年6 月,共收集6 位罹患頭頸部癌合併頸部淋巴結腫大的患者。我們對這6 位病患安排第一次電腦斷層與核磁共振定位並進行影像融合。接著再由醫師定義出腫瘤(GTV, CTV)與重要器官。最後再由物理師應用電腦治療計劃系統以反算法設計出第一次IMRT 計劃來進行治療。我們採用的治療方式是同步化學放射治療(CCRT):化學治療部份是以Cisplatin 30 mg/wk 靜脈輸注;放射治療部份採用SIB(simultaneous intensity boost)IMRT 。當患者接受到4500 cGy 時(計劃A)我們立即安排第二次電腦斷層與核磁共振定位,並根據第二次獲得的影像進行第二階段治療計劃的安排(計劃B)。此外我們將計劃A 的調強圖譜(fluencemap)套用到第二次的CT 影像上形成模擬的計劃C ,最後分析計劃B 和C 在劑量分布之差異。 結果:比較二次CT 影像,我們發現病患的頸部淋巴結因接受4500 cGy 而縮小甚至消失。若是未進行第二階段的IMRT 計劃則會使患者的皮膚與腮腺落入高劑量區內。接著,在劑量分布上,我們發現:對CTV 而言,其劑量包覆順形度上(conformity index)都是計劃B 比計劃C 好。對於腦幹而言,用t 檢定來分析計劃B 與計劃C 發現沒有明顯差別(p = 0.9943),顯示計劃B 與計劃C對於腦幹的保護相當。對於腮腺的淺葉與深葉而言,用t 檢定來分析計劃B 與C 可以發現計劃B比較低(p < 0.001),顯示使用二階段電腦斷層定位IMRT 治療計劃可以明顯地再降低腮腺所接受的劑量。 結論:本研究顯示在執行IMRT 治療時若患者體廓改變則必須調整治療計劃。若IMRT 計劃未隨之調整,則其腮腺及皮膚劑量可能增加,腫瘤劑量曲線的順形度可能下降,影響治療的成效。
Purpose : To discuss the differences of dose distribution between the dual-phase IMRT and one-phase IMRT in the patients of head-and-neck (H&N) cancers with enlarged cervical lymph nodes . Materials and Methods : From April 2003 to June 2004, we collected 6 patients of H&N cancers with enlarged cervical lymph nodes. Initially, we arranged first simulation by CT-MRI fusion for one-phase IMRT and prescribed 4500 cGy on GTV including enlarged lymph nodes (Plan A). Five weeks later, we arranged the second simulation by the same method to design dual-phase IMRT and prescribed 2700 cGy on GTV (Plan B). All 6 patients received concurrent chemoradiotherapy (CCRT) with cisplatin 30 mg/wk intravenously. The IMRT technique was simultaneous intensity boost (SIB). Furthermore, we combined two CT images and superimposed the fluence map of Plan A onto the second CT images to get the Plan C. Finally, we compared Plan B with Plan C. Result : When we compared two CT images, we found that those enlarged lymph nodes already regressed or disappeared after plan A treatment, which made the skin and parotid gland fall into the high dose area. From the comparison of both plans, B had a much better conformal index than C for CTV. Using t test to analyze the D50%, D30% and Dmean of Plan B and C for the sparing of parotid glands, B had better results than C (p < 0.001). Therefore, the dual-phase IMRT treatment planning can provide another way to significantly decrease the irradiation doses to parotid glands. Conclusion : This study indicate that if the patient’s contour changes without modifying the prior IMRT treatment planning, the doses of parotid glands and the skin will increase and the conformity of dose distribution will decrease, which affect the result of IMRT.


    

本卷期目次
放射治療與腫瘤學
Gingival Metastasis from Rectal Cancer: A Case Report/ Ming-Yii HuangHung-Hong ShyrShi-Long LianKun-Bow TsaiChih-Jen HuangYu-Hue Ho
XV與EDR2底片之劑量表現與可能的影響參數/ 林佑娟許文林陳逸偉廖明雄陳拓榮
Paraganglioma of Head and Neck Treated with Surgery and Local Radiotherapy: Case Report and Reviews of Literature/ Chia-Chun HuangMu-Tai LiuChu-Ping PiTung-Hao Chang
探討頭頸部癌合併頸部淋巴結腫大的病患使用二次IMRT治療計劃之必要性/ 郭于誠吳東和黃光偉王雅玲鍾道生蘇文川陳東河邱仲峰
Evaluation of Two Types of Digitizers for Film Dosimetry/ Chung-Hung TsaiKeh-Shih ChuangShu-Hui HsuChung-Hsien HsuHung-Chi TaiKwan-Hwa Chi
Outcome of Salvage Irradiation for Breast Cancer Patients with Locoregional Recurrence/ Ta-Wei YuJi-An LiangShang-Wen ChenShih-Neng YangFang-Jen Lin
Localized Three Dimensional Conformal Hyperfractionated Radiotherapy in Glioblastoma Multiforme Patients-CGH Experience/ Ching-Jung WuJing-Shan HuangPei-Chieh YuSu-Zun Shaw
The Effect and Safety of Transdermal Fentanyl for Concurrent Chemoradiation Therapy-Induced Mucositis Pain in Head and Neck Cancer Patients/ Shih-Hua LiuYu-Jen ChenKou-Hua ChangYi-Shing LeuJehn-Chuan LeeMing-Jer HuangHong-Wen ChenYuen-Liang Lai
Experiences of Radiotherapy on Extrapulmonary Small Cell Carcinoma/ Wei-Ting HsuehWu-Chou SuFen-Fen ChenHelen H. W. Chen
THE EFFECT AND SAFETY OF TRANSDERMAL FENTANYL FOR CONCURRENT CHEMORADIATION THERAPY-INDUCED MUCOSITIS PAIN IN HEAD AND NECK CANCER PATIENTS/ Shih-Hua LiuYu-Jen ChenKou-Hua ChangYi-Shing LeuJehn-Chuan LeeMing-Jer HuangHong-Wen ChenYuen-Liang Lai
探討頭頸部癌合併頸部淋巴結腫大的病患使用二次IMRT治療計劃之必要性/ 郭于誠吳東和黃光偉王雅玲鍾道生蘇文川陳東河邱仲峰
LOCALIZED THREE DIMENSIONAL CONFORMAL HYPERFRACTIONATED RADIOTHERAPY IN GLIOBLASTOMA MULTIFORME PATIENTS-CGH EXPERIENCE/ Ching-Jung WuJing-Shan HuangPei-Chieh YuSu-Zun Shaw
XV與EDR2底片之劑量表現與可能的影響參數/ 林佑娟許文林陳逸偉廖明雄陳拓榮
EVALUATION OF TWO TYPES OF DIGITIZERS FOR FILM DOSIMETRY/ Chung-Hung TsaiKeh-Shih ChuangShu-Hui HsuChung-Hsien HsuHung-Chi TaiKwan-Hwa Chi
PARAGANGLIOMA OF HEAD AND NECK TREATED WITH SURGERY AND LOCAL RADIOTHERAPY: CASE REPORT AND REVIEWS OF LITERATURE/ Chia-Chun HuangMu-Tai LiuChu-Ping PiTung-Hao Chang
GINGIVAL METASTASIS FROM RECTAL CANCER: A CASE REPORT/ Ming-Yii HuangHung-Hong ShyrShi-Long LianKun-Bow TsaiChih-Jen HuangYu-Hue Ho
OUTCOME OF SALVAGE IRRADIATION FOR BREAST CANCER PATIENTS WITH LOCOREGIONAL RECURRENCE/ Ta-Wei YuJi-An LiangShang-Wen ChenShih-Neng YangFang-Jen Lin
EXPERIENCES OF RADIOTHERAPY ON EXTRAPULMONARY SMALL CELL CARCINOMA/ Wei-Ting HsuehWu-Chou SuFen-Fen ChenHelen H. W. Chen
 
   
 
   

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