影像引导调强放射治疗鼻咽癌

目的：探讨调强放疗技术（ＩＭＲＴ）治疗鼻咽癌的近期疗效、毒副反应及技术特点。方法：采用影像引导的ｓｌｉｄｉｎｇｗｉｎｄｏｗｓ动态调强技术对３１例鼻咽癌初治患者进行根治性放疗，分３０～３３次照射。靶区处方剂量ＧＴＶｎｘ、ＧＴＶｎｄ、ＣＴＶ１、ＴＶ２分别为７０～７６Ｇｙ、６８～７０Ｇｙ、６０～６６Ｇｙ和５４Ｇｙ，同时对脑干、腮腺等重要器官给予剂量限制保护。结果：随访３～１８个月，中位随访时间１０个月，患者１年局部区域无进展生存率、无远处转移生存率和总生存率分别为９３.５％、８７.１％和９３.５％。急性放射反应多为Ⅰ度和Ⅱ度，以口干和放射性口腔炎为主，未观察到Ⅳ度急性反应。ＤＶＨ分析显示ＩＭＲＴ提高了靶体积照射总剂量和分次剂量，减少了危及器官受照总剂量和分次剂量。结论：调强放射治疗鼻咽癌能够取得良好的近期疗效，明显减轻了急性放射反应，患者生活质量得到改善，值得推广应用和深入研究。

Image guided intensity-modulated radiotherapy for the treatment of nasopharyngeal carcinoma

To explore the efficacy of image guided intensity-modulated radiotherapy（IMRT） in the treatment of na- sopharyngeal carcinoma. Methods ： Thirty-one patients with pathologically confirmed squamous cell carcinoma of nasopharynx were treated with image guided IMRT. The prescribed doses of GTVnx, GTVnd, CTV1 and CTV2 were 70-76Gy, 68-70Gy, 60-66Gy and 54Gy respectively. The overall survival and local control rates were calculated with kaplan-meier method. Acute side effects were also evaluated. Results：The median follow-up time was 10 months （range 3-18 months）. The 1-year estimated local-regional progression-free survival rates, distant metastases-free survival rates and overall survival rates were 93.5%, 87. 1% and 93.5% respectively. Most acute radiation toxicity was grade I to grade II and was presented as xerostomia and mucositis, no grade Ⅳ acute radiation toxicity occured. The anaysis of dose volume histogram shows that IMRT provided satisfied dose distribution to the target volume and sparing of normal structures significantly. Conclusion：The image guided IMRT technique can provided satisfied dose distribution with high dose to the target volume and sparing of organ at risk. The excellent local control rate was achieved with significant decrease of acute toxicity.