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鼻咽癌常规外照射放疗不同设野茎突后区剂量分析

Dosimetric Impact of Different Portals on Post-styloid-process Region in Def inite Radio-therapy for NPC

  • 摘要: 目的 探讨鼻咽癌(NPC)常规外照射不同设野时茎突后区的剂量学特点。方法 在1例NPC增强CT-SIM扫描后数字重建矢状位图像上,按目前常用的几种照射方法设野,I段采用面颈联合野,剂量.36Gy;Ⅱ段剂量34Gy,方法A、B、C均采用面颈分野,耳前野后缘分别位于外耳道后缘后0.5cm、1.0cm和1.5cm,方法D采用面颈联合缩野(后界避开脊髓)+颈后12MeV电子线野,方法E在方法A完成Ⅰ、Ⅱ段放疗后补充咽旁野16Gy。通过积分剂量体积直方图(DVH)及截面剂量分布图比较不同设野对茎突后区剂量的影响。结果 方法A、B部分茎突后区在Ⅱ段治疗中漏出照射野外,方法C有较多脊髓超过耐受量照射,方法D可满足临床剂量要求,方法E则靶区存在剂量热点。结论 NPC茎突后间隙肿瘤侵犯时应提倡使用方法D照射技术。

     

    Abstract: Objective  To study the rationality of portal designation by evaluating dose dist ribution on post-styloid-process parapharyngeal space ( PSPS) in different t reatment planning for NPC. Methods  Irradiated portals were designed base on DRR image from cont rast CT scan of an adult male NPC patient . All plans included section I and section II in which 36 Gy and 34 Gy would be delivered to the target respectively. Section I of each plan was the same with opposite lateral facial-cervical fields. For section II, posterior border was set beyond external auditory canal at 0. 5 cm for plan A, 1. 0 cm for plan B, 1. 5 cm for plan C, 0. 5 cm plus 16Gy of parapharyngeal space boost for plan E. In plan D, the posterior border of the lateral field was displaced anteriorly to shield the spinal cord, making a conedown facial-cervical field, while the posterior neck was supplemented with 12-MeV elect rons through small lateral fields. AcQPlan 4. 1. 1 was applied for dose calculation, DVH and section dose dist ribution evaluation. Results  In plan A and B, some part of the PSPS was out side the irradiated fields. PSPS was included in plan C but the spinal cord received dose beyond limitation. Only plan D was safe and satisfied the clinical requirement . Parapharyngeal space boost as designed in plan E produced hot spot . Conclusion  When PSPS was infilt rated, conedown facial-cervical field plus electron posterior neck boost should be taking into consideration.

     

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