面罩固定整体挡铅技术在鼻咽癌放射治疗中的应用及疗效分析  

The application of designed methods for block shielding facio-cervical portal at radiotherapy of nasopharyngeal carcinoma

作　　者：蔡晶[1] 郭金涛[1] 曹飞[1] 

机构地区：[1]南通肿瘤医院放疗科,江苏南通226361

出　　处：《临床和实验医学杂志》2010年第5期324-326,共3页Journal of Clinical and Experimental Medicine

基　　金：南通市卫生局课题;编号W0513

摘　　要：目的探讨面罩固定整体挡铅技术在鼻咽癌治疗中的应用及疗效分析。方法利用鼻咽+颈部CT/MR,采用面罩固定同中心照射,模拟定位摄颈部X线照片,根据鼻咽病灶侵犯的范围勾画照射靶区,制作低溶点挡铅,并在治疗机或模拟机上验证挡块。从2005～2006年收治的62例鼻咽癌病人利用整体挡铅治疗并分析疗效。结果①第一步计划常规面颈联合野及下颈部切线野。第二步计划面颈分野+颈部切线野,口咽侵及时,采用小面颈联合野,后界前移到颈椎椎体前缘,避开脊髓,其颈部后三角区采用电子束补偿照射。②根据鼻咽CT/MR侵及范围相应扩大局部照射野。③整体挡铅治疗的病人一、二年生存率分别为100%和98.4%。结论①面罩固定同中心整体挡铅技术可根据鼻咽癌侵及范围勾画个体化照射野计划。②通过精确适形设野,使鼻咽、口咽、颅底、颈部包在一个照射野内,靶区设计更合理,剂量分布更均匀,并能有效遮挡附近重要器官。Objective To evaluate the application of designed methods for block shielding facio - cervical portal at radiotherapy of naso- pharyngeal carcinoma. Methods The delineation of portal boundary was based on nasopharynx and upper neck CT/MRI scanning in all patients. Patients were taken facio - cervical X - ray radiographs on simulator. The portal volume boundary was delineated on radiograph according to range of involvement of tumor. The portal volume boundary was checked by therapeutic machine or analog machine. The overall 1 - ,2 - year survival rates were observed during 2005 - 2006. Results ①A general rule of facio - cervical portal was designed in the first course, but the posterior boundary of portals was shifted to posterior margin of cervical vertebrae body and the posterecervical triangular regions were irradiated with electric beam. ②On the base of general rule of facio - cervical portal, portal was correspondingly extended according to CT/MRI scanning showing the range to be involved. The overall 1,2 - year survival rates were 100% and 98.4% respectively. Conclusion ① By using designed method of block shielding facio - cervical portal at isocentre, the individual portal can be designed according to malignant invading range. ②Through accurately designed conformal portal, nasopharynx, orepharynx, base of skull and cervical part could be included in one exposure field, the irradiation target volume would be designed more rational, and the neighboring important organs can be effectively shielded.

关 键 词：鼻咽癌 放射治疗 面颈联合野 CT/MR 铅挡块遮挡 

分 类 号：R739.63[医药卫生—肿瘤] R739.91[医药卫生—临床医学]