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目的：探讨鼻咽癌等中心放疗低熔点铅挡块面颈联合野的设野方法。方法：利用鼻咽＋上颈部 CT/MRI扫描，采用等中心体位固定方法模拟定位并拍摄面颈部 X线照片，根据鼻咽病灶侵犯的范围描画照射靶区，制作低熔点铅挡块。结果：（ 1）常规第一段面颈联合野前上界与眼眶缘的距离 15～ 20 mm；前下界与上颌窦底壁的距离 5 mm；上界平筛窦顶壁；后上界与上 1/3斜坡距离 5 mm；后下界与下 1/3斜坡距离 10～ 15 mm。第二段面颈分野的后下界向前移 5～ 10 mm；下界上移至下颌角水平。口咽受累时，两段均用面颈联合野，但后界前移至颈椎体后缘，其颈后三角区用 8～ 12 MeV电子线照射。（ 2）根据鼻咽癌侵犯的范围相应扩展局部照射野。结论：（ 1）等中心面颈联合野设野原则可根据鼻咽癌侵犯的范围做个体化放疗设计。（ 2）通过精确的适形设野，可使照射靶区设计更合理 ,并更有效地遮挡邻近重要器官。
Objective: To investigate the method of setting up the joint field of the neck and the neck of low-melting point lead block in central radiotherapy for nasopharyngeal carcinoma. Methods: The nasopharynx + upper neck CT / MRI scan was used to simulate the location and radiography of face and neck radiographs. The irradiation target area was drawn according to the scope of the nasopharyngeal lesions and the low melting point lead stopper was made. Results: (1) The distance between the upper frontal joint and the orbital rim of the first stage of face-neck joint was 15 ~ 20 mm; the distance between the anterior lower bound and the bottom wall of maxillary sinus was 5 mm; The upper 1/3 slope distance is 5 mm; the lower boundary and the lower 1/3 slope distance is 10-15 mm. The second lower part of face and neck after the lower bound to move forward 5 ~ 10 mm; the lower bound to the mandibular angle level. When the oropharyngeal was involved, both of them were treated by face-neck combined field, but the posterior bound was moved to the posterior edge of the cervical vertebra, and the posterior triangular region of the neck was irradiated with 8-12 MeV electron beam. (2) According to the scope of the invasion of nasopharyngeal carcinoma corresponding expansion of the local irradiation field. Conclusions: (1) The principle of isoplasty combined with face-neck surgery can be used as an individualized radiotherapy design according to the scope of nasopharyngeal carcinoma. (2) Through precise conformal positioning, the design of irradiation target area can be more reasonable and the adjacent vital organs can be blocked more effectively.