早期鼻咽癌调强放疗设置颈前后部限量环减少头颈淋巴水肿的剂量学研究

doi:10.3969/j.issn.1006-5725.2024.12.008

Abstract

Abstract:

Objective To establish an optimal limiting dose for dose limiting rings placed in the anterior and posterior regions of the neck for reducing head and neck lymphedema under intensity-modulated radiation therapy（IMRT） for early nasopharyngeal carcinoma（NPC） from a dosimetric perspective. Method Fifteen newly diagnosed early-stage nasopharyngeal carcinoma patients who underwent CT localization for radiotherapy at the Cancer Hospital of Guangzhou Medical University from January to September 2022 were included in the study. Each case was designed with five sets of radiotherapy plans. Plan A consisted of conventional unlimited-field plans， while Plans B-E consisted of limited-field plans with dose constraints set at 20， 18， 16， and 14 Gy， respectively， with the remaining parameters consistent with Plan A. The impact on target coverage and organ-at-risk constraints was evaluated through variance analysis and pairwise multiple comparisons using a randomized block design to determine the optimal dose limits. Results The gradient of 16Gy was determined as the optimal dose limiting cutoff point for achieving the balance between target coverage and organ limiting dose. Compared with the conventional plan， The plans with the placement of a cervical anterior and posterior dose limiting ring （16Gy） did not change the target dose coverage （P > 0.05）， but only yielded a slight change in the homogeneity index （P < 0.05）. It did not cause any changes of the dosage in the inner ear， mandible， and brainstem （all P > 0.05）， but lead to statistically significant reductions in the oral cavity， throat， and thyroid （all P < 0.05）. It caused a slight increase of the dose in the parotid gland and spinal cord （both P < 0.05）， but the increased dose was anyhow within the tolerance range. Conclusion The dosimetric investigation determines an optimal dose limit cutoff point for the cervical anterior and posterior dose limiting rings. It is expected to provide a design method for IMRT plans to reduce head and neck lymphedema after radiotherapy for early NPC.

Key words: nasopharyngeal carcinoma, IMRT, lymphedema, dosimetry

CLC Number:

R739.63

Kai LIAO,Yunhong TIAN,Ronghui ZHENG,Caixian HE,Jiyong PENG,Huijun LI. Reduction of head and neck lymphedema by placing dose limiting rings in the anterior and posterior regions of the neck for treating early nasopharyngeal carcinoma using intensity-modulated radiotherapy： A dosimetric perspective[J]. The Journal of Practical Medicine, 2024, 40(12): 1659-1664.

Figures/Tables 4

Fig.1

Tab.1

Tab.2

Tab.3

References 21

1	方楠，张俊安，孙俊旗，等. 鼻咽癌原发肿瘤MRI-DWI联合体积预测鼻咽部放化疗近期疗效［J］. 实用医学杂志， 2021，37（8）：1037-1040+1045.
2	ZHENG L， TONG L， DU F，et al. Effect of three-dimensional conformal radiotherapy and intensity-modulated radiotherapy on parotid gland function and quality of life in patients with nasopharyngeal carcinoma［J］. Am J Transl Res， 2021，13（5）：5272-5279.
3	刘慧，何彩娴，彭继勇，等. 鼻咽癌放射治疗致放射性颈动脉损伤的研究进展［J］. 实用医学杂志， 2023，39（10）：1201-1205. doi:10.3969/j.issn.1006-5725.2023.10.002 doi: 10.3969/j.issn.1006-5725.2023.10.002
4	YANG S S， PANG Y J， WANG Z Q，et al. Development and prospective validation of a risk score model in guiding individualized concurrent chemoradiotherapy in stage II nasopharyngeal carcinoma in intensity-modulated radiotherapy era［J］. Cancer Med， 2022，11（4）：1109-1118. doi:10.1002/cam4.4520 doi: 10.1002/cam4.4520
5	LIANG Y J， LIU L T， LI Y，et al. Association of treatment advances with survival rates in pediatric patients with nasopharyngeal carcinoma in China，1989-2020［J］. JAMA Netw Open，2022，5（3）：e220173. doi:10.1001/jamanetworkopen.2022.0173 doi: 10.1001/jamanetworkopen.2022.0173
6	ROSENTHAL D I， CHAMBERS M S， FULLER C D，et al. Beam path toxicities to non-target structures during intensity modulated radiation therapy for head and neck cancer［J］. Int J Radiat Oncol Biol Phys， 2008，72（3）：747-755. doi:10.1016/j.ijrobp.2008.01.012 doi: 10.1016/j.ijrobp.2008.01.012
7	KIM D，NAM J， KIM W，et al. Radiotherapy dose-volume parameters predict facial lymphedema after concurrent chemoradiation for nasopharyngeal carcinoma［J］. Radiat Oncol， 2021，16（1）：172. doi:10.1186/s13014-021-01901-7 doi: 10.1186/s13014-021-01901-7
8	KALEMIKERAKIS I， EVAGGELAKOU A， KAVGA A，et al. Diagnosis，treatment and quality of life in patients with cancer-related lymphedema［J］. J BUON， 2021， 26（5）：1735-1741.
9	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.
10	廖恺，冯建辉，谭锦云，等. 鼻咽癌调强放疗后头颈淋巴水肿的危险因素分析［J］. 实用肿瘤杂志， 2021，36（2）：124-128.
11	LEE A W， NG W T， PAN J J，et al. International guideline for the delineation of the clinical target volumes（CTV） for nasopharyngeal carcinoma［J］. Radiother Oncol， 2018，126（1）：25-36. doi:10.1016/j.radonc.2017.10.032 doi: 10.1016/j.radonc.2017.10.032
12	TANG LL， HUANG C L， ZHANG N，et al. Elective upper-neck versus whole-neck irradiation of the uninvolved neck in patients with nasopharyngeal carcinoma： an open-label， non-inferiority， multicentre， randomised phase 3 trial［J］. Lancet Oncol， 2022，23（4）：479-490. doi:10.1016/s1470-2045(22)00058-4 doi: 10.1016/s1470-2045(22)00058-4
13	中国鼻咽癌临床分期工作委员会. 2010鼻咽癌调强放疗靶区及剂量设计指引专家共识［J］. 中华放射肿瘤学杂志， 2011，20（4）：267-269. doi:10.3760/cma.j.issn.1004-4221.2011.04.001 doi: 10.3760/cma.j.issn.1004-4221.2011.04.001
14	LEE A W， NG W T， PAN J J， et al. International guideline on dose prioritization and acceptancecriteria in radiation therapy planning for nasopharyngeal carcinoma［J］. Int J Radiat Oncol Biol Phys， 2019，105（3）：567-580. doi:10.1016/j.ijrobp.2019.09.030 doi: 10.1016/j.ijrobp.2019.09.030
15	CHEN D， CAI S B， SOON Y Y， et al. Dosimetric comparison between Intensity Modulated Radiation Therapy（IMRT） vs dual arc Volumetric Arc Therapy（VMAT） for nasopharyngeal cancer（NPC）：Systematic review and meta-analysis［J］. J Med Imaging Radiat Sci， 2023，54（1）：167-177. doi:10.1016/j.jmir.2022.10.195 doi: 10.1016/j.jmir.2022.10.195
16	AKBAS U， KOKSAL C， KESEN N D，et al. Nasopharyngeal carcinoma radiotherapy with hybrid technique［J］. Med Dosim， 2019，44（3）：251-257. doi:10.1016/j.meddos.2018.09.003 doi: 10.1016/j.meddos.2018.09.003
17	FADHIL M， SINGH R， HACAS T， et al. Systematic review of head and neck lymphedema assessment ［J］. Head Neck， 2022， 44（10）： 2301-2315. doi:10.1002/hed.27136 doi: 10.1002/hed.27136
18	PIGOTT A， NIXON J， FLEMING J，et al. Head and neck lymphedema management： Evaluation of a therapy program［J］. Head Neck， 2018，40（6）：1131-1137. doi:10.1002/hed.25086 doi: 10.1002/hed.25086
19	SANGUINETI G， ADAPALA P， ENDRES E J，et al. Dosimetric predictors of laryngeal edema［J］. Int J Radiat Oncol Biol Phys，2007，68（3）：741-749. doi:10.1016/j.ijrobp.2007.01.010 doi: 10.1016/j.ijrobp.2007.01.010
20	KINRPAMCK J P， VAN DER KOGEL A J， SEHULTHEISS T E.Radiation dose-volume effects in the spinal cord［J］. Int J Radiat Oncol Biol Phys， 2010，76（）：42-49. doi:10.1016/j.ijrobp.2009.04.095 doi: 10.1016/j.ijrobp.2009.04.095
21	JEANS C， BROWN B， WARD E C，et al. Lymphoedema after head and neck cancer treatment：an overview for clinical practice［J］. Br J Community Nurs， 2021， 26（Sup4）：S24-S29. doi:10.12968/bjcn.2021.26.sup4.s24 doi: 10.12968/bjcn.2021.26.sup4.s24

	A	B	C	D	E	F值	P值
V100%(%)	95.79 ± 0.63	95.97 ± 0.54	95.89 ± 0.69	95.59 ± 0.71	96.01 ± 0.58	0.339	0.797
V93%(%)	99.55 ± 0.28	99.65 ± 0.31	99.52 ± 0.36	99.62 ± 0.31	99.59 ± 0.29	0.429	0.732
HI	0.121 ± 0.012	0.133 ± 0.014	0.134 ± 0.012	0.140 ± 0.014	0.141 ± 0.013	5.588	0.002
CI	0.840 ± 0.015	0.847 ± 0.016	0.846 ± 0.016	0.852 ± 0.015	0.850 ± 0.013	1.512	0.221
跳数（MU）	586.07 ± 7.77	628.58 ± 7.56	625.22 ± 8.11	632.55 ± 8.05	644.65 ± 8.12	151.572	< 0.001

	A&B	A&C	A&D	A&E	B&C	B&D	B&E	C&D	C&E	D&E
HI	0.088	0.051	0.001	< 0.001	1.000	0.882	0.551	1.000	0.834	1.000
双侧腮腺Dmean/Gy	0.038	0.035	0.034	< 0.001	1.000	1.000	< 0.001	1.000	0.044	0.049
口腔Dmean/Gy	0.583	1.000	< 0.001	< 0.001	0.100	< 0.001	< 0.001	< 0.001	< 0.001	0.016
喉Dmean/Gy	< 0.001	< 0.001	< 0.001	< 0.001	0.002	< 0.001	< 0.001	1.000	0.319	0.539
甲状腺Dmean/Gy	< 0.001	< 0.001	< 0.001	< 0.001	1.000	1.000	0.543	1.000	0.605	1.000
脊髓Dmax/Gy	0.303	0.026	0.011	< 0.001	1.000	1.000	< 0.001	1.000	0.013	0.033
跳数（MU）	< 0.001	< 0.001	< 0.001	< 0.001	1.000	1.000	< 0.001	0.091	< 0.001	< 0.001

	A	B	C	D	E	F值	P值
双侧内耳Dmean	41.97 ± 2.34	41.52 ± 2.54	42.30 ± 2.51	41.65 ± 2.63	40.51 ± 2.60	1.456	0.236
双侧腮腺Dmean	33.88 ± 1.01	34.94 ± 1.07	34.95 ± 1.00	34.96 ± 1.02	35.99 ± 1.01	10.639	< 0.001
下颌骨Dmax	57.63 ± 1.96	58.01 ± 1.86	57.44 ± 2.01	57.46 ± 1.81	57.54 ± 1.86	0.286	0.835
口腔Dmean	33.01 ± 1.25	32.46 ± 1.21	33.26 ± 1.28	30.58 ± 1.35	29.11 ± 1.28	28.119	< 0.001
喉Dmean	43.95 ± 1.45	41.20 ± 1.31	39.29 ± 1.42	38.92 ± 1.38	38.67 ± 1.34	41.064	< 0.001
甲状腺Dmean	40.03 ± 2.03	36.30 ± 1.98	36.26 ± 1.91	35.67 ± 2.03	35.03 ± 2.15	15.142	< 0.001
脊髓Dmax	36.73 ± 0.86	37.36 ± 0.80	37.66 ± 0.86	37.76 ± 0.88	38.67 ± 0.91	13.287	< 0.001
脑干 Dmax	56.42 ± 1.89	56.24 ± 1.99	56.87 ± 1.85	56.04 ± 2.02	56.08 ± 1.97	0.501	0.683

[1]	Haixia YANG,Menglu SUN,Xiaosha ZHOU,Yaxuan HAN,Baolong REN,Jianying LI,Yi LI. Application of optical surface monitoring system in intensity⁃modulated radiotherapy for thoracic tumors [J]. The Journal of Practical Medicine, 2025, 41(9): 1345-1351.
[2]	Xiuting HUANG,Jie LIN,Xiaoxin YE,Jiazuo CAI,Yawei. YUAN. Copper regulates the radiosensitivity of nasopharyngeal carcinoma by activating MAPK-ERK signaling pathway [J]. The Journal of Practical Medicine, 2024, 40(9): 1191-1196.
[3]	Fei CHEN,Xiaoqin GONG,Yunpeng YU,Tao YOU,Xu WANG,Chunhua DAI,Jing HU. Feasibility of automatic segmentation of CTV and OARs in postoperative radiotherapy for cervical cancer using AccuLearning [J]. The Journal of Practical Medicine, 2024, 40(2): 153-157.
[4]	Che CHEN,Dehong LUO,Huangfei YU,Qin ZHANG,Xiaochi HU,Shenghua YU,Yajun. LI. Clinical Application of automatic delineation in whole breast radiotherapy with simultaneous integrated boost to the medial tumor beds [J]. The Journal of Practical Medicine, 2024, 40(17): 2406-2411.
[5]	Ying CHEN,Fei CHEN,Xiaoqin GONG,Jian HUANG,Wuyang YANG,Tao YOU,Chunhua DAI,Jing. HU. Application of surface monitoring system for thoracic tumors treated with intensity modulated radiotherapy [J]. The Journal of Practical Medicine, 2024, 40(17): 2435-2439.
[6]	Qian DOU,Yuzhen ZHANG,Yong. ZHOU. EBV infection and influencing factors of nasopharyngeal carcinoma screening population in Guangzhou [J]. The Journal of Practical Medicine, 2024, 40(10): 1440-1444.
[7]	ZHOU Yong, CHEN Hao, DOU Qian, LI Yue, LIU Wofeng.. An applied study on assessing the risk of nasopharyngeal carcinoma in Guangzhou population based on 5 kinds of EBV antibodies [J]. The Journal of Practical Medicine, 2023, 39(5): 602-612.
[8]	LIU Kun, CAI Qiong, XU Lei, ZHOU Ying, LI Jing, NING Renli.. Self ⁃ perceived burden and influencing factors in nasopharyngeal carcinoma patients treated with proton and heavy ion radiotherapy [J]. The Journal of Practical Medicine, 2023, 39(3): 350-354.
[9]	LIAO Zhiwei, ZHU Jianman, ZHOU Tongchong, ZHENG Ronghui.. Effect of LncRNA TUG1 on biological behavior and radiosensitivity of nasopharyngeal carcinoma [J]. The Journal of Practical Medicine, 2023, 39(2): 209-216.
[10]	WU Yingning, HUANG Li′na.. The relationship between MRI diffusion kurtosis imaging and NPC clinical stage [J]. The Journal of Practical Medicine, 2023, 39(13): 1704-1708.
[11]	HAO Kun, SUN Yu⁃ guang, XIN Jianfeng, LIU Xuan, ZHANG Li, LI Bin, WANG Rengui, SHEN Wenbin.. Application of narrow sterile hemostatic ring in upper limb lymphedema aspiration [J]. The Journal of Practical Medicine, 2023, 39(12): 1500-1505.
[12]	LIU Hui, HE Caixian, PENG Jiyong, ZHONG Xi, LIAO Kai, YUAN Yawei, ZHENG Ronghui.. Carotid arterial injuries caused by radiotherapy for nasopharyngeal carcinoma：A review [J]. The Journal of Practical Medicine, 2023, 39(10): 1201-1205.
[13]	JI Guangwei. . Research advances in breast cancer⁃Related lymphedema [J]. The Journal of Practical Medicine, 2022, 38(18): 2247-2252.
[14]	FANG Nan, ZHANG Jun′ an, SUN Junqi, ZHANG Xiangguo, CHEN Dongping, ZHENG Lu, DENG Ying, YANG Zhanxin, DONG Enlai, QI Bin.. Prognostic value of diffusion ⁃weighted MRI combine with tumor volume for the short ⁃ term treatment response ofnasopharynxin nasopharyngeal carcinoma [J]. The Journal of Practical Medicine, 2021, 37(8): 1037-1045.
[15]	CHEN Xi, ZHU Yueying, SHI Dianyu, YAN Shuai, TANG Guodong, ZOU Yu. Influence of LncRNA HOTAIR on invasion and migration of nasopharyngeal carcinoma cells by regulating miR⁃30d [J]. The Journal of Practical Medicine, 2021, 37(3): 314-318.

Reduction of head and neck lymphedema by placing dose limiting rings in the anterior and posterior regions of the neck for treating early nasopharyngeal carcinoma using intensity-modulated radiotherapy： A dosimetric perspective

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 4

References 21

Related Articles 15

Recommended Articles

Metrics

Comments