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[目的]探讨鼻咽癌调强放疗保护颌下腺的可行性,为鼻咽癌调强放疗靶区的优化提供依据。[方法]95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87例病例测算Ⅰb区和颌下腺的放疗剂量参数,评估Ⅰb区不设靶区但颌下腺设保护区以及Ⅰb区不设靶区同时颌下腺也不设保护区两种情况对颌下腺剂量的影响,并比较不同临床期别、T分期和N分期间颌下腺平均剂量的差异。[结果]对无Ⅰb区照射指征的患者,Ⅰb区不设靶区的同时设立颌下腺保护区并未降低患者的近期疗效,但可显著减少同侧颌下腺的最大放射剂量、最小放射剂量以及平均放射剂量。Ⅰ期以及N0的患者颌下腺平均剂量明显较低(P<0.05)。Ⅰb区无靶区且同时设立颌下腺保护区的患者,其颌下腺平均剂量明显低于N0患者(P<0.05)。[结论]对无Ⅰb区照射指征的患者,Ⅰb区不设靶区并设立颌下腺保护区是安全的。调强放疗可以更好地保护鼻咽癌患者的颌下腺,进一步减少放疗后口干的发生。
[Objective] To investigate the feasibility of intensity modulated radiotherapy for nasopharyngeal carcinoma (NPC) to protect the submandibular gland and provide the basis for optimization of intensity modulated radiotherapy target area for nasopharyngeal carcinoma. [Methods] 95 cases of nasopharyngeal carcinoma with intensity modulated radiotherapy were analyzed by Kaplan-Meier method. A total of 87 cases were stored in the treatment plan to measure the radiation dose parameters of the Ib area and submandibular gland. The assessment was made that the Ib area had no target area but the submandibular gland had a protected area and the Ib area had no target area while the submandibular gland did not have a protected area. The effect of the dose and the difference in mean submandibular gland doses during different clinical stages, T stages, and N points were compared. [Results] In patients with no indication of Ib irradiation, setting the submandibular gland protection zone without a target zone in zone Ib did not reduce the short-term efficacy of the patient, but significantly reduced the maximum radiation dose, minimum radiation dose, and average of the ipsilateral submandibular gland. Radiation dose. The average dose of submandibular gland in patients with stage I and N0 was significantly lower (P<0.05). In patients with no target area in Ib area and submandibular gland protection zone established at the same time, the average dose of submandibular gland was significantly lower than that of N0 patients (P<0.05). [Conclusion] For patients without indication of Ib area irradiation, it is safe to set up target area and establish submandibular gland protection area in Ib area. Intensity-modulated radiotherapy can better protect the submandibular gland in patients with nasopharyngeal carcinoma, further reducing the incidence of dry mouth after radiotherapy.