个体化低熔点铅挡块技术在鼻咽癌放疗中的应用

Application of technique of face-neck combined individualized low-melting-point lead block in radiotherapy of nasopharyngeal carcinoma

目的:观察个体化低熔点铅挡块在鼻咽癌放疗中的应用价值。方法:2006年3月至2009年3月,经病理确诊的112例鼻咽癌患者,采用头颈同一体位,面罩固定,面颈联合野应用个体化低熔点铅挡块技术,6MV-X线照射鼻咽部总剂量至70～76 Gy,35～38次,49～52d,摄片法制作个体化低熔点铅挡块保护垂体、脑干、小脑、眼睛、口腔等重要脏器,同时拍摄射野验证片,确保放疗的质量及其质量控制,按RTOG标准观察急性期放射损伤。结果:近期疗效CR 61.6%,PR 38.4%,总有效率100%。急性期放射损伤,1、2级口腔黏膜炎发生率为85.7%,3、4级为14.3%;1、2级咽炎发生率为60.7%,3、4级为39.3%;1、2级放射性皮炎发生率为48.2%;口干、中耳炎、视力下降、牙齿酸痛发生率分别为82.1%、11.6%、2.7%、9.8%。结论:对于鼻咽癌放疗患者采用头颈同一体位,面罩固定,面颈联合野应用个体化低熔点铅挡块技术,同时拍摄射野验证片,确保了鼻咽癌放射治疗的质量及其质量控制,能提高放射治疗鼻咽癌的局部控制率,减少放射引起的急性副反应,值得临床推广使用。

OBJECTIVE： To determine the application value of face - neck combined individualized low - melting - point lead block in radiotherapy of nasopharyngeal carcinoma. METHOD ： 112 patients with nasopharyngeal carcinoma received radiotherapy. Important organs such as hypophysis, brain stem, cerebellum, eyes and mouth were protected by lead for radiation injury. The low - melting - point lead was shaped according to individualized needs of arrange of irradiation. The total dosage of irradiation by 6MV - X was 70 -76 Gy with 35 -38 times and a period of 49 ~52 days. Irradiation field picture was taken to ensure irradiation quality. Irradiation injury was observed according to standard of RTOG. RESULTS ： The short - term curative effect was 61.6% for CR and 38.4% for PR with total effective rate 100%. Incidence of acute irradiation injury： 85.7% for grade one and two mouth mucositis; 14. 3% for grade three and four mouth mucositis; Incidence of zerostomia, otitis media, diminution of vision toothache was 82. 1%, 11.6%, 2. 7% and 9. 8% respectively. CONCLUSION： Face - neck combined individualized lead block can effectively control irradiation and reduce acute side effects caused by radiation.