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[目的]评估优化鼻咽癌调强放疗临床靶区中ⅡB区后对腮腺剂量的影响,为鼻咽癌调强放疗靶区的优化提供依据。[方法]81例鼻咽癌调强放疗患者,以Kaplan-Meier法进行生存分析。对治疗计划保存完整的76例病例测算腮腺的放疗剂量参数,评估优化ⅡB区后对腮腺剂量的影响,并比较不同临床期别、T分期和N分期间腮腺放疗剂量参数。[结果]缩减临床靶区中C1横突或C2椎体以上水平ⅡB区可显著降低同侧腮腺的平均剂量及体积百分剂量V26(P<0.05);将该区处方剂量降为50Gy亦可显著降低同侧腮腺的平均剂量及V26(P<0.05)。Ⅳ期和T4期患者的腮腺平均剂量与V26显著高于相应的其它各期别,而N0期患者的腮腺平均剂量与V26则显著低于淋巴结阳性者。[结论]对早期患者尤其是N0患者可以更合理地设计靶区,优化临床靶区中C1横突或C2椎体以上水平ⅡB区,更好地保护腮腺。
[Objective] To evaluate the effect of optimizing the dose of parotid gland in the clinical target area of nasopharyngeal carcinoma intensity-modulated radiotherapy and provide the basis for optimization of intensity-modulated radiotherapy target area of nasopharyngeal carcinoma. [Methods] Eighty-one patients with intensity-modulated radiotherapy for nasopharyngeal carcinoma were analyzed by Kaplan-Meier method. The radiotherapy dose parameters of the parotid gland were calculated for the complete 76 cases of the treatment plan, and the effects of optimizing IIB zone on the parotid gland dose were evaluated. The radiation dose parameters of parotid gland during different clinical stages, T stages and N stages were compared. [Results] Reduction of the C1 transverse process or horizontal IIB zone above the C2 vertebral body in the clinical target area can significantly reduce the mean dose and the volume percentage of the parotid gland dose V26 (P<0.05); the prescription dose in this area can also be reduced to 50 Gy. Significantly reduce the average dose of ipsilateral parotid gland and V26 (P<0.05). The average parotid gland dose and V26 in patients with stage IV and T4 were significantly higher than those in other stages, while the average parotid gland dose and V26 in stage N0 patients were significantly lower than those in lymph nodes. [Conclusion] For early patients, especially N0 patients, the target area can be designed more rationally, and C1 transverse process or level IIB above C2 vertebral body in the clinical target area can be optimized to better protect the parotid gland.