应用手动多叶光栏进行鼻咽癌放射治疗78例临床观察_医学论文.docVIP

应用手动多叶光栏进行鼻咽癌放射治疗78例临床观察_医学论文 应用手动多叶光栏进行鼻咽癌放射治疗78例临床观察_医学论文 【关键词】 鼻咽癌 关键词: 鼻咽癌放射治疗手动多叶光栏固定装置 摘 要:目的 应用手动多叶光栏（MLC）对鼻咽癌患者进行不规则野等中心放射治疗.探讨改进后的技术方法的优势和特点. 方法 应用头颈固定装置和手动多叶光栏，采用不规则野等中心照射技术对78例鼻咽癌患者进行治疗.先用面颈联合野和颈前切线野照射，然后缩野改为耳前小野和颈部垂直野照射. 结果 治疗取得了较满意的近期疗效，鼻咽部原发灶CR和PR分别达44%和56%.但急性皮肤和粘膜反应均较重，对其原因进行了分析. 结论 采用的不规则野等中心放射治疗方法，将鼻咽、咽旁及上颈淋巴结作为一个连续靶区处理，保证了靶区照射剂量分布的均匀性，并避免了在靶区上分野的问题.同时，不规则野照射也使垂体、脑干、牙齿等受到很好屏蔽和保护.面罩固定的方法，使患者体位良好固定，保证了摆位的重复性，近期疗效满意.早期放射反应可得到控制或经过对症处理后绝大多数患者是能够耐受的. 　　Keywords:nasopharyngeal carcinomaradiotherapymulti-leaf collimator（MLC）immobilization device 　　Abstract:AIM To study the advantages and characteristics of improved multileaf collimator（MLC）and immobilization devices in the treatment of nasopharyngeal carcinoma（NPC）.METHODS 78NPC patients were treated with im-proved radiation technique.They were treated first with face-neck joint portal and anterior neck portal，then treated with　shrinkaged face portal and neck portal to curative or prophy-lactic doses.RESULTS The local control rate of nasopha-ryngeal lesion was satisfactory，CR and PR was44%and56%respectively.The acute skin and mucous radiation reac-tions were more freguent and severe comparatively.The causes were analyzed.CONCLUSION The design of radia-tion portals of the improved technique is reasonable.It en-compasses the nasopharynx，paranasophrynx and lymph node of high neck as a single target.It makes the dose distribution of target area more homogenous and shields pituitary，brain stem and teeth more effectively.The improved technique can be applied easily and conveniently with MLC.The good im-mobilization and high reproducibility of setup were ensured by the using of mask.The local control rate immediately af-ter the treatment was satisfactory.The accurate radiation re-actions of skin and mucous can be controlled and can be en-durable through medication. 　　0 引言 　　鼻咽癌是我国常见的恶性肿瘤，耳前野加颈前切线野的面颈分野技术已沿用多年，其5a生存率一直徘徊于40%左右［1，2］ ，且局部复发率和晚期放射损伤并发症发生率较高，目前已证明上述旧的常规放疗技术存在许多缺陷.第三军医大学西南医院放疗中心于1998-04/