2012-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/645591摘要：15-58%的鼻咽癌病患即使接受完整的放射治療後，在之後的追蹤仍會發現有局部 的復發，對於這些復發病患，再次接受放射治療（re-irradiation）仍是目前主要的治療 方式之一。但根據過去統計，再次放射治療會造成5-36%嚴重之治療副作用。動態弧形 強度調控放射治療（Volumetric modulated arc therapy, VMAT）是一種新穎的治療技術， 藉由射束旋轉速度、劑量率、及多葉片準直儀之葉片變化，提供較佳之治療品質並進一 步減少正常組織傷害。本次研究的主要目的為評估動態弧形強度調控放射治療（VMAT）相較於一般強度 調控放射治療（Intensity-modulated radiation therapy, IMRT）在劑量學之優勢，並找出最 佳化之參數設定。同時也收錄鼻咽癌復發病患進行前瞻性研究，評估病患在接受動態弧 形強度調控放射治療（VMAT）之療效、急/慢性副作用、生活品質影響、以及重要之預 後因子。劑量學之比較主要是以劑量體積組織圖（dose-volume histograms, DVH）來比較腫 瘤及正常組織的之劑量、均一性（Homogeneity）及順形度（Conformity），急性及慢性 副作用之評估是利用RTOG及EORTC之相關量表來評估，生活品質評量則是用EORTC QLQ C-30和EORTC QLQ-H&N35中文問卷來追踪，同時也利用單變數及多變數統計分析影響疾 病控制及存活率之重要預後因子。根據此研究分析的結果，可以提供未來臨床治療上重要之參考依據，以造福鼻咽 癌復發之患者，期能提昇治療的效果，同時也減少治療副作用發生的機會，使病患能維 持更佳的生活品質。<br> Abstract: Local failures after primary radiotherapy still occur in 15-58% of cases. Reirradiation still remains the effective modality for salvaging recurrent nasopharyngeal carcinoma (NPC). The incidence of severe late complications after reirradiation has ranged from 5-35%. Volumetric modulated arc therapy (VMAT), another novel technique, employs a linear accelerator to conduct dynamic modulation rotation therapy. VMAT operates by adjusting the gantry rotation speed, dose rate, and shapes of multileaf collimator (MLC), with an aim to generate better planning quality and thereby reduce the damage of normal tissue.This study aimed to elucidate the dosimetric quality and effectiveness of VMAT for recurrent NPC, compared to intensity-modulated radiation therapy (IMRT). Another aim is to look for the optimal setting of planning parameters for VMAT. Based on the optimal setting, we will conduct a prospective to assess treatment outcome, acute/late toxicities, impact of quality of life, and significantly prognostic factors in patients with recurrent NPC treating by VMATTreatment plans will be compared using dose volume histograms (DVH) to evaluate doses to tumor/normal tissue, conformity index (CI), and homogeneity index (HI). , Adverse effects will be accessed and scored according to the radiation morbidity scoring criteria of the RTOG and EORTC. We will use the Taiwan Chinese version of the EORTC QLQ C-30 and EORTC QLQ-H&N35 questionnaire as a tool to assess the quality of life. Univariate and multivariate analyses will be used to identify the important prognostic factors.The results of this study will offer useful information in clinical practice and thereby provide increased benefit to the patient with recurrent NPC. With this comprehensive study of VMAT, we hope to improve treatment efficacy, radiation-related toxicity, and quality of life for cancer patients.動態弧形強度調控放射治療強度調控放射治療鼻咽癌復發Volumetric modulated arc therapyIntensity-modulated radiation therapyNasopharyngeal carcinomaRecurrence