颈部偏中心肿瘤的三种常规照射模式的对比.docVIP

浅谈??????????????????????????????????? 作者：冉亨勇 罗良智 彭海波 【摘要】? 目的? 通过对颈部偏中心肿瘤的三种常规照射模式进行对比研究，探索一种临床上最为可行的常规放疗照射模式。方法 选择30例颈部偏中心肿瘤（根治性或术后）放疗病例，全部均用面罩固定后做ct扫描定位。利用同一三维放射治疗计划系统（tps）根据病灶情况确定原发灶（gtv）、高危亚临床病灶（ctv1）和低危亚临床病灶（ctv2），术后放疗者直接勾画ctv1和ctv2。对每一病例设计三种照射模式，即：传统照射模式（两对穿野分阶段照射）、野中野照射模式（大野中加小野同步照射）、改进照射模式（两对穿野加一前野小野）。传统照射法采用二次缩野照射，分阶段给予ctv2、ctv1、gtv照射；野中野和改进照射模式照射根治病例是先对ctv2大野照射，再对ctv1照射，缩野前后均同时给予gtv局部推量，gtv 220-240cgy/f，ctv1 180-200cgy/f，术后放疗病例先大野照射ctv2，同时给ctv1局部加量，ctv1 220cgy/f，ctv2 200cgy/f。比较三种照射模式的靶区内剂量学差异。结果 三种照射模式gtv内主要剂量学指数无显著性差异；等剂量曲线对靶区的包绕程度及适形度有显著差异；正常组织的受量在改进照射模式中最低。结论 在颈部偏中心肿瘤的放疗计划中，采用改进照射模式能在较短时间内给予靶区足够的、均匀的照射剂量，并且能减少正常组织的受量，具有临床可行性。 【关键词】? 头颈部肿瘤? 放射治疗? 非常规分割? 剂量学? 剂量体积直方图 【abstract】 objective: to compare the three conventional radiotherapy plannings for patients with eccentric neck carcinoma,and explore the most viable mode of conventional radiotherapy.method:30 patients with eccentric neck carcinoma(radical or postoperative) were located by ct scan after fixed position.three different modes of radiotherapy planning were used for each case,which were traditional radiation,field-in-field radiation and improved radiation.the difference of exposure doses between target area and critical organ was compared by isodose line and dose volume histogram.result:the dose homogeneity and conformity index in improved radiation plan were better than the other two plans′.the doses of normal tissue were the lowest in improved radiation plan.the maximum,minimum and mean doses for gross tumor volume (gtv) in three plans were no significant differences. conclusion:in radiotherapy of eccentric neck carcinoma, the improved radiation mode not only ensures sufficient and uniform dose for gtv in a relatively short period of time, but also limits the dose for the organs at risk as could as possible, so that could reduce the treatment time.the improved radiation mode has the clinical value. 【key words】 head and neck cancer? radiotherapy? non-conventional fractionation? dosimetry? dos