"青"近英语|邱博士和您一起学——鼻咽癌调强放疗篇

发布时间:2018-05-17     信息来源:     字号: T | T

 素芳,主任医师,肿瘤学博士,副教授,硕士科研生导师。专业从事鼻咽癌、舌癌、口咽癌、下咽癌、喉癌、副鼻窦癌等头颈部恶性肿瘤的放化疗。兼任第八届中华医学会放射肿瘤学分会青年委员会副主任委员等。颁发国内外论文30余篇,其中SCI 10多篇。
Nasopharyngeal carcinoma of the undifferentiated subtype is endemic to southern China, and patient prognosis has improved significantly over the past three decades because of advances in disease management, diagnostic imaging, radiotherapy technology, and broader application of systemic therapy. Despite the excellent local control with modern radiotherapy, distant failure remains a key challenge. Advances in molecular technology have helped to decipher the molecular pathogenesis of nasopharyngeal carcinoma as well as its etiologic association with the Epstein-Barr virus. This in turn has led to the discovery of novel biomarkers and drug targets, rendering this cancer site a current focus for new drug development.


Intensity-modulated RT (IMRT) is the current standard of treatment for NPC. With conformity of dose distribution achieved by sculpting the high-dose zone for complete coverage of tumor targets while sparing the critical normal structures, excellent locoregional control can be achieved by most expert centers. Randomized controlled trials comparing IMRT with conventional two dimensional RT have shown a significant reduction in the risk of permanent xerostomia, especially in patients with early disease,as well as improvement in local control with reduction of other treatment complications.One major refinement of the delineation of high-risk regions for elective irradiation is the tailoring of clinical tumor volume for node-negative patients. There is increasing evidence that the lymphatic spread of NPC follows a fairly predictable order, with retropharyngeal nodes and the level II neck nodes being most commonly affected and skip metastases being uncommon. Retrospective and randomized studies have shown that selective neck irradiation confined to levels II, III, and Va is safe and would not jeopardize nodal control or survival.This sparing of the lower neck and level IB is useful, because the latter allows a better sparing of the submandibular gland, thus reducing the risk of xerostomia.


For large primary tumors abutting or infiltrating critical structures, one common practice is to add induction chemotherapy to shrink the tumor bulk for better dose coverage during subsequent RT plus concurrent cisplatin. The current practice is to prescribe a fairly uniform and standardized dose level (approximately 70 Gy) to the whole GTV.Another future perspective is to individualize the radiation dose.With the advent of functional positron emission tomography and magnetic resonance imaging, it may be possible to determine and deliver themost appropriate dose levels to different parts of the target volume with IMRT, optimizing the therapeutic ratio for individual patients.

重点单词

1.radiotherapy  [?re?di???θer?pi]         

n.放射疗法

2.xerostomia [?z??r?'st??mj?]                   

n.口腔干燥

3.perspective[p??spekt?v]

n.透镜,望远镜; 观点,看法; 远景,景色; 洞察力;

adj.(按照) 透视画法的; 透视的;

4.target [?tɑ:g?t]

n.目标;目的;(办事的)对象;(射击的)靶子

vt.瞄准;把…作为攻击目标

5.complications [?k?mpl?'ke???ns] 

n.(新出现的)困难,困难( complication的名词复数 );

<医>并发症;曲折



重点词汇:

1.Nasopharyngeal carcinoma   

鼻咽癌

2.undifferentiated subtype     

未分化亚型

3.systemic therapy           

全身治疗

4.molecular pathogenesis       

分子病因学

5.Intensity-modulated RT (IMRT)   

三维适形调强放疗

6.retropharyngeal nodes           

咽后淋巴结

7.therapeutic ratio               

治疗率

鼻咽癌调强放疗(IMRT)

未分化型鼻咽癌是中国南方一种常见的地方病,由于疾病办理、影像诊断、先进的放射治疗技艺的进步和全身系统性治疗的广泛应用,在昔时三十年中病人的疗效有了显著的提高。尽管现代放射治疗取得了优良的局部控制率,但远处转移仍然是一个重要的挑战。分子生物学技艺的进步有助于说明与EB病毒密切相干的鼻咽癌的分子发病机制及其病因,从而导致了新的生物标记物和药物靶标的发现,成为此刻新药开发的重点。

三维适形调强放射治疗(IMRT,调强放疗)是此刻鼻咽癌的的准则精确放射治疗技艺。其特点是经过调整照射剂量强度使高剂量照射区完全覆盖肿瘤靶区,同时鼻咽周围正常结构尽或许地得到保护,进而达到优良的局部控制率。该先进的放疗技艺此刻在大多数放疗中心得以广泛使用。随机对照试验比较调强放疗和常规的二维放疗发现调强放疗可以显著降低永久性口腔干燥症的后遗症,尤其是早期鼻咽癌患者,调强放疗可以达到很好的局部控制率,大大减少了治疗的并发症。对颈部淋巴结没有转移的患者创议下颈部可以不做预防性照射,并且很少出现复发。越来越多的证据表明,鼻咽癌的淋巴扩散是有规律的,很少出现跳跃性转移,咽后淋巴结和II组淋巴结转移最常见。回顾性和随机科研显示照射II组、III组和Va组淋巴结是安全的,不会影响局部控制率或生存率。不照射IB组和下颈部(IV组)淋巴结,可以更好地保护颌下腺,从而降低口腔干燥的风险。

对于鼻咽周围重要器官受侵犯的体积较大的患者,常常先行诱导化疗,后实行同步放化疗,使得肿瘤体积缩小后更好设计放疗靶区。此刻鼻咽肿瘤靶区创议给予统一的剂量 (大约70Gy)。另一个前瞻性的科研针对照射剂量实行个体化处置。因为随着功能性正电子发射断层成像(PETCT)和磁共振功能成像(MRS)的出现,可以针对不同的危险区域经过调强放疗确定最合适的照射剂量,个体化地设计每个病人的放射治疗方案。

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