苏亚, 王俪臻, 巩贯忠, 卢洁, 谷玉萍, 尹勇. 基于MR超长期延迟强化量化分析鼻咽癌放疗GTV退缩规律的研究[J]. 中国肿瘤临床, 2021, 48(22): 1158-1163. DOI: 10.12354/j.issn.1000-8179.2021.20210716
引用本文: 苏亚, 王俪臻, 巩贯忠, 卢洁, 谷玉萍, 尹勇. 基于MR超长期延迟强化量化分析鼻咽癌放疗GTV退缩规律的研究[J]. 中国肿瘤临床, 2021, 48(22): 1158-1163. DOI: 10.12354/j.issn.1000-8179.2021.20210716
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Ya Su, Lizhen Wang, Guanzhong Gong, Jie Lu, Yuping Gu, Yong Yin. Quantitative analysis of GTV regression in radiotherapy of nasopharyngeal carcinoma based on enhanced ultra-long-term-delayed enhanced MR scan[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2021, 48(22): 1158-1163. DOI: 10.12354/j.issn.1000-8179.2021.20210716
Citation: Ya Su, Lizhen Wang, Guanzhong Gong, Jie Lu, Yuping Gu, Yong Yin. Quantitative analysis of GTV regression in radiotherapy of nasopharyngeal carcinoma based on enhanced ultra-long-term-delayed enhanced MR scan[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2021, 48(22): 1158-1163. DOI: 10.12354/j.issn.1000-8179.2021.20210716
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基于MR超长期延迟强化量化分析鼻咽癌放疗GTV退缩规律的研究

Quantitative analysis of GTV regression in radiotherapy of nasopharyngeal carcinoma based on enhanced ultra-long-term-delayed enhanced MR scan

    摘要
  • 摘要:
      目的  探讨基于MR超长期延迟强化扫描对鼻咽癌（nasopharyngeal carcinoma，NPC）肿瘤靶区及淋巴结不同区域差异性退缩规律的研究。
      方法  选取2019年12月至2020年8月山东省肿瘤医院53例接受放疗的NPC患者，获得放疗前、中及后MR（T2WI、15s强化及>10 min超长期延迟强化的T1WI像）。在T2WI上确定大体肿瘤靶区（GTVp）和淋巴结（GTVn）。根据15 s强化与>10 min强化T1WI的剪影图像确定造影剂清除比较快的区域（GTVp快、GTVn快），清除慢的区域（GTVp慢、GTVn慢），分析不同亚靶区放疗后的退缩差异性。
      结果  1）GTVp在接受50 Gy及放疗结束的退缩率分别为57.37%、18.61%，低于GTVp快的64.52%、29.66%，而显著高于GTVp慢的25.21%、7.55%（P<0.05），GTVn、GTVn快、GTVn慢的退缩也具有相似变化趋势；2）放疗前、后GTVp快与GTVp、GTVn快与GTVn体积变化均具有相关性（r=0.872、0.998，P<0.05）。而GTVp慢与GTVp、GTVn慢与GTVn体积变化差异无统计学意义（P<0.05）；3）放疗后GTVp慢与接受50 Gy放疗时相比体积增加了7.55%，而GTVp与GTVp快、GTVp慢的退缩均小于淋巴结。
      结论  MR超长期延迟强化扫描可以将NPC及阳性淋巴结分为造影剂清除快、慢的亚区域，不同亚区域及整体靶区退缩显著不同步；在以体积为标准进行NPC放疗疗效评估时，不同亚区域应行个体化分析。

     

    Abstract:
      Objective  To assess the differential withdrawal rules of tumor target and lymph nodes in nasopharyngeal carcinoma (NPC) based on ultra-long-term-delayed enhanced MR scanning.
      Methods  Fifty-three patients with NPC who received radiotherapy at Shandong Cancer Hospital from December 2019 to August 2020 were prospectively observed. MR simulation positioning images, including T2-weighted images (T2WIs), 15-s enhanced T1-weighted images (T1WIs), and 10-min enhanced T1WIs, were obtained before, during, and after radiotherapy. Gross tumor target (GTVp) and positive lymph nodes (GTVn) were delineated on T2WIs. Based on silhouette images of 15-s enhanced T1WI and >10-min enhanced T1WI, areas with fast contrast medium clearance (GTVp fast and GTVn fast) and slow contrast medium clearance (GTVp slow and GTVn slow) were determined, and the effects of withdrawal after radiotherapy in different sub-target areas were analyzed.
      Results  1) The withdrawal rates of GTVp after receiving 50Gy radiotherapy and at the end of radiotherapy were 57.37% and 18.61%, respectively, which were lower than 64.52% and 29.66%, respectively, for GTVp fast and significantly higher than 25.21% and 7.55%, respectively, for GTVp low (P<0.05). The withdrawal rates of GTVn, GTVn fast, and GTVn slow also had a similar trend. 2) Before and after radiotherapy, GTVp fast and GTVp and GTVn fast and GTVn volumes were correlated (r=0.872, 0.998; P<0.05). There was no correlation between GTVp slow and GTVp and GTVn slow and GTVn volume change (P<0.05). 3) The GTVp slow volume after radiotherapy increased by 7.55% compared with that after 50 Gy radiotherapy, while the with drawal of GTV, GTVp fast, and GTVp slow was lower than that of lymph nodes.
      Conclusions  NPC and positive lymph nodes can be divided into sub-regions with fast and slow clearance of contrast media based on ultra-long-term delayed enhanced MR scanning. The withdrawal of different sub-regions and overall target region is significantly asynchronous. When the efficacy of radiotherapy for NPC is evaluated based on volume, different sub-regions should be individually analyzed.

     

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