调强放疗技术在鼻咽癌治疗中的应用

Application of intensity modulated radiotherapy in treatment of nasopharyngeal carcinoma

目的 ：探讨调强放疗技术在鼻咽癌治疗中的应用。方法 ：对2010年4月至2012年5月50例经病理确诊的鼻咽癌患者采用头颈肩面膜固定、CT扫描定位,用三维治疗计划系统制定治疗计划,并将治疗计划传输到直线加速器实施调强放疗。鼻咽大体肿瘤体积（gross tumor volume of the nasopharynx,GTVnx）、颈部转移淋巴结（gross tumor volume of the cervical lymph node,GTVnd）、临床靶体积1（clinical target volume,CTV1）、临床靶体积2（CTV2）处方剂量分别为68~70 Gy、64~66 Gy、60~62 Gy、54~56 Gy,1次/d,5次/周,共30次。结果 ：随访6~25（中位时间12）个月,1、2 a生存率为100%和98%,总体局控率为96%。调强放疗口干反应多为1、2级,皮肤反应多为1级,咽部和口腔黏膜反应多为2级。结论：调强放疗能使鼻咽癌各靶区剂量分布均匀,周围正常器官得到很好的保护,提高了鼻咽癌患者的生存率和肿瘤局部控制率,改善了患者的生存质量。

Objective To explore the application of intensity modulated radiotherapy（IMRT） technique to treating nasopharyngeal carcinoma. Methods From April 2010 to May 2012, 50 nasopharyngeal carcinoma patients confirmed pathologically underwent fixation with head neck shoulder mask, and CT scanning and positioning; and then were provided with treatment plans with 3D planning system. The plans were transmitted to the linear accelerator for IMRT. The prescribed doses of gross tumor volume of the nasopharynx（GTVnx）, gross tumor volume of the cervical lymph node（GTVnd） and clinical target volumes（CTV1、CTV2） were 68 to 70 Gy, 64 to 66 Gy, 60 to 62 Gy and 54 to 56 Gy once a day, five times per week for a total of 30 times. Results Six to 25-month follow-up with the median time of 12 months proved that one-year and two-year survival rates were 100% and 98% respectively and the overall local control rate was 96%. The complications included first- or second-stage dry mouth reaction, first-stage skin reaction as well as second-stage pharynx and oral mucosa reaction. Conclusion IMRT may result in evenly distributed doses in target areas and protection for surrounding tissues when applied to the treatment of nasopharyngeal carcinoma, and enhance the survival rate, local tumor control rate and living quality.