改进头颈部恶性肿瘤外照射放疗技术的临床观察

A Clinical Trial in Improving External Irradiation Technique for Head-neck Neoplasms

目的 探讨改进头颈部恶性肿瘤外照射放疗技术的疗效及副反应。方法 经病理确诊头颈部恶性肿瘤 95例 ,头颈部用头枕面罩固定 ,低熔点铅挡块技术 ,等中心照射 ,一般肿瘤根治剂量 72 ( 70～ 80 )Gy ,非霍奇金淋巴瘤 5 0～ 5 5Gy ;预防剂量 5 6( 5 0～ 60 )Gy ,非霍奇金淋巴瘤 45～ 5 0Gy。结果 放疗后 1～ 2个月CT复查可评价的肿瘤完全消退率 5 8 5 7% ,明显消退率 3 2 86% ,正常组织急性放射相关性粘膜炎发生率 0级 5 6 84% ,1级 42 10 % ,2级 1 0 5 % ,随访 1～ 2年脊髓脑干晚期放射反应为 0。结论 改进的外照射放疗技术对头颈部恶性肿瘤照射更准确 ,局部控制率高 。

Objective To improve the external irradiation technique for Head-neck neoplasms.Methods 95 patients with Head-neck neoplasms confirmed by pathology,were fixed with head pillow mask , isocenter irradiation,technique utilizing cerrobend block.Radical therapy dose was 72 (70～80)Gy/35～40 fractions in 7～8 weeks for general carcinoma and 50～55Gy/28～31 fractions in 5 6～6 2 weeks for NHL .Preventive dose was 56 (50～60)Gy/25～30 fractions in 5～6 weeks for general carcinoma and 45～50Gy/25～28 fractions in 5～5 6 weeks for NHL.A short and a long-term clinical outcome, acute and late radiation reactions were observed.Results After 1～2 months following radiation therapy,CT scans revealed that the primary lesion complete remission rate was 58 57% , and obvious remission rate was 32 86%.The normal mucous membrane acute radiation reaction rates were G0 56 84% , GⅠ 42 10% , GⅡ 1 05%,respectively.After 1～2 years following radiation therapy,the spinal cord and brain stem radiation injury rate was zoro.Conclusions The improving external irradiation technique may elevate local control rate better,and reduce radiation reactions of patients with head-neck neoplasms.