论文部分内容阅读
目的探讨后程调强放疗(IMRT)对晚期鼻咽癌治疗的可行性、作用和疗效以及危险器官特别是脑、脊髓的剂量约束。方法应用6～8 MV直线加速器治疗局部中晚期(Ⅲ～Ⅳ期)鼻咽癌60例,33例采用全程调强,27例采用后程适形调强放疗方式。全调强组GTVnx 72～74 Gy,GTVnd 66 Gy,CTV160 Gy,CTV254 Gy,30次分割;后调强组前程采用二维普放的面颈联合野+下颈部MLC适形放疗,鼻咽部剂量DT 30 Gy/15f,颈部DT 24～30 Gy/12～15 f,后程采用适形调强,鼻咽部剂量40～42 Gy/17 f,颈阳性淋巴结34～38 Gy/17 f。整个治疗过程均采用热塑膜头颈肩罩固定。2组放疗前均采用GP方案诱导化疗2个疗程。结果后调强组脑干、脊髓均可在约束范围内,取得与全调强组一样的近期效果。全调强组在腮腺的保护上更有优势;后调强组保证了靶区的不遗漏,靶区的定位、勾画更为精确,同时在脑组织、小脑、口腔的剂量控制上更易。结论只要前程二维适形与后程调强的剂量分配适当,后程调强治疗中晚鼻咽癌是可行的,且在靶区的定位及勾画上更有优势。同时降低了治疗费用,临床值得推广。
Objective To investigate the feasibility, efficacy and efficacy of late-course IMRT for the treatment of advanced nasopharyngeal carcinoma and the dose-limiting of dangerous organs, especially the brain and spinal cord. Methods 60 cases of locally advanced (Ⅲ ~ Ⅳ stage) nasopharyngeal carcinoma were treated with 6 ~ 8 MV linear accelerator. 33 cases were treated with whole-body intensity modulation and 27 cases were treated with posterior-conformal IMRT. GTVnx was 72-74 Gy, GTVnd 66 Gy, CTV160 Gy and CTV254 Gy in full-intensity group, respectively. The posterior tone group had two-dimensional generalized MLC conformal radiotherapy of facial and neck joint + lower neck and nasopharynx DT 30 Gy / 15f, and DT DT of 24-30 Gy / 12-15 f at the neck. The intensity of conformal adjustment was used in the later course. The dose of nasopharyngeal was 40-42 Gy / 17 f, 34-38 Gy / 17 f . The entire process of treatment using a thermoplastic film head and neck shoulder fixed. 2 groups before radiotherapy using GP regimen induction chemotherapy 2 courses. Results After adjusting the brainstem, the spinal cord can be within the scope of the constraints, and the whole group to achieve the same effect of the recent strength. The TKA group has more advantages in parotid gland protection. The TKA group ensures that the target area is not missed, the targeting of the target area is more accurate, and the dosage is easier to control in the brain tissue, cerebellum and oral cavity. Conclusions As long as the appropriate two-dimensional conformal and subsequent dose intensity adjustment dose distribution, late strength tonometry for the treatment of late-phase nasopharyngeal carcinoma is feasible, and in the target area positioning and mapping more advantages. At the same time reduce the cost of treatment, clinical worth promoting.