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目的:采用适形放疗提高鼻咽癌局部复发的治疗效果,探讨最佳剂量分割方法。方法:1997年9月至2000年2月对41例鼻咽癌局部复发病人行适形放疗。27例常规外照射39Gy,在3周内分30次完成后进行低分割适形放疗,80%等剂量线4～7Gy/次,总量20～24Gy,分4次在2周内完成;14例全程超分割适形放疗,90%等剂量线59.8Gy4.6周内分46次完成。结果:适形放疗的等剂量线分布在三维方向上与靶区适形。急性放射性粘膜炎、后组颅神经损伤、张口困难两组相似,低分割组22%鼻咽粘膜坏死,3.7%视神经损伤。超分割组无鼻咽粘膜坏死、视神经损伤。两组治疗有效率均达93%。结论:鼻咽癌局部复发病人采用超分割适形放疗取得满意的近期效果,低分割适形放疗不宜采用。
Objective: To improve the therapeutic effect of local recurrence of nasopharyngeal carcinoma by conformal radiotherapy and to explore the optimal dose division method. Methods: From September 1997 to February 2000, 41 patients with local recurrence of nasopharyngeal carcinoma underwent conformal radiotherapy. 27 cases of conventional external beam irradiation 39Gy, after 30 times within 3 weeks of completion of low-cut conformal radiotherapy, 80% isodose line 4 ~ 7Gy / times, the total 20 ~ 24Gy, 4 times in 2 weeks to complete; Cases of full cross-over conformal radiotherapy, 90% isodose line 59.8Gy 46.6 weeks completed 46 times. Results: The isodose line of conformal radiotherapy conformed to the target in three dimensions. Acute radiation mucositis, the latter group of cranial nerve injury, mouth opening difficulties similar to the two groups, low-cut group 22% nasopharyngeal mucosal necrosis, 3.7% optic nerve injury. There were no nasopharyngeal mucosal necrosis and optic nerve injury in the hyperfractionation group. The effective rate of both groups reached 93%. Conclusion: Local recurrence of nasopharyngeal carcinoma using hyperfractionated conformal radiotherapy to obtain satisfactory short-term results, low-cut conformal radiotherapy should not be used.