后程调强放疗治疗中晚期鼻咽癌效果分析  

Effect of late course intensity modulated radiation therapy in nasopharyngeal carcinoma

作　　者：雷风[1] 陆小军[1] 李民英[1] 白玉海[1] 刘晓东[1] 古定标[1] 

机构地区：[1]广东省中山市人民医院,广东中山528403

出　　处：《现代中西医结合杂志》2013年第30期3307-3309,3312,共4页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：中山市科技计划项目(K20113A104)

摘　　要：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 It is to observed the feasibility, action, curative effect of late course intensity modulated radiation therapy （IMRT） in treatment of nasopharyngeal carcinoma, and approach the dose constraint for dangerous organ such as brain organ and spinal cord. Methods 60 middle-late patients with local nasopharyngeal carcinoma （ stage III to IV） were treated by 6 to 8 MV accelerator, in which 33 cases by the whole stress, 27 cases by the late course IMRT. The whole stress group was treated with GTVnx 72 to 74 Gy, GTVnd 66 Gy, CTV1 60 Gy, CTV2 54 Gy, 30 times division. The late course IMRT group was treated with 2D at the face, neck, joint put wild ＋ neck MLC conformal radiotherapy, nose pharynx ministry dose DT 30 Gy/15 f, neck DT 24 to 30 Gy/12 to 15 f, The second paragraph conformal stress, of nose pharynx ministry dose 40 to 42 Gy/ 17 f, neck lymph nodes and positive to 38 Gy/17 f. The hot plastic film head and neck shoulder cover was used to fix in all the treatment process. Both groups were treated by GP scheme induction chemotherapy twice before radiotherapy. Results The late course IMRT group had the same result in dose constraint for brainstem, spinal cord as the whole stress group. The whole stress group had more dominance in the protection of parotid gland ; the late course IMRT group guaranteed the target area not miss, the orientation and sketch of the target was more accurate, and at the same time the doses in the brain tissue and cere- bellum were more likely to control. Conclusion If only the dose distribution in future 2D conformal and late course IMRT is appropriate, the late course IMRT is effective and feasible in the treatment of middlelate nasopharyngeal carcinoma, and it has more advantage to position and sketch in a target. At the same time it can reduce the treatment costs, so it worth promoting in clinic.

关 键 词：晚期鼻咽癌 放射治疗 调强放射治疗 后程放射治疗 危险器官 

分 类 号：R739.63[医药卫生—肿瘤]