目的 研究核磁共振（MR）引导的海马保护技术应用于小细胞肺癌全脑放射治疗（放疗）的效果。方法 对确定行全脑放疗的30例小细胞肺癌脑转移患者,行常规放疗CT定位后以定位体位行全头颅MR平扫,将计算机断层扫描（CT）和MR的T1加权像在Monaco 5.1计划系统上进行精准融合,勾画全脑放疗及海马区域,在海马区域三维方向上分别外扩5、15 mm作为海马与计划靶区之间的剂量跌落,每一例患者在Monaco 5.1计划系统上按照不保护海马组织以及外扩5、15 mm进行保护设计3个容积旋转调强技术（VMAT）放疗计划,观察海马组织的平均及最大放疗剂量。结果 增加保护海马组织之后,3个放疗计划的D100均≥95%,每例的3个放疗计划间D100比较差异无统计学意义（P>0.05）;设置外扩5、15 mm的剂量跌落区后,左、右海马的平均剂量、最大剂量均明显降低,而且3个放疗计划的海马平均剂量、最大剂量之间对比差异有统计学意义。结论 小细胞肺癌脑转移患者进行全脑放疗时,利用MR引导的海马保护技术并设置外扩15 mm的剂量跌落区,能够显著降低海马的剂量,达到保护目的。

Objective To explore the application of MR guided hippocampal avoidant whole brain radiotherapy（WBRT）for small cell lung cancer（SCLC）．Methods Thirty SCLC patients with brain metastases who underwent WBRT were enrdled．After routine CT localization was performed,and a head MR was performed in a the same position．T1 weighted images of MR and CT images were accurately fused on the Monaco 5.1 planning system．The entire brain tissue and hippocampus region were delineated． The dose drop areas between the hippocampus and the planned target area were expanded 5mm and 15mm in the three-dimensional direction of the hippocampus,respectively．Three volumetric modulated arc therapy（VMAT）radiotherapy plans were designed for each patient on the Monaco 5.1 planning system based on whether the hippocampal tissue was avoid．The average and maximum doses of hippocampal tissue were observed．Results After the avoidance of hippocampal tissue,the D100 of the three radiotherapy plans reached ≥95%,and there was no significant difference in D100 between the three radiotherapy plans in each case．After setting dose drop areas of 5mm and 15mm for external expansion,the average and maximum doses of the left and right hippocampus were significantly reduced,and there was a significant difference in the comparison between the average and maximum doses in the hippocampus of the three radiotherapy plans．Conclusions MR guided hippocampal avoidant technology and the setting of a 15 mm dose drop area can significantly reduce the dose to the hippocampus in patients with SCLC undergo whole brain radiotherapy．

目的 探讨80例局部宫颈癌根治性同步放化疗的临床疗效及预后影响因素。方法 选取鹤壁市妇幼保健院2018年1月—2021年1月收治的80例宫颈癌患者进行回顾性分析,患者依照其病变程度均采取积极的手术与同步放化疗,其中40例患者采取单纯化疗,将其分为化疗组,40例患者采取同步放化疗,将其分为同步放化疗组,分析其近远期临床疗效与不良反应发生率。对所有患者进行3年随访,将患者分为两个亚组,即预后不良组（n=20）和预后良好组（n=60）,对比两组患者一般临床特征,应用Logistic回归模型分析局部宫颈癌根治性同步放化疗的预后影响因素。结果 同步放化疗组ORR、DCR高与化疗组（P<0.05）,对照组中位无进展生存期为5.4（2.38~14.52）个月。观察组中位无进展生存期为6.66（2~20.1）个月,观察组高于对照组（χ²=4.536,P=0.041）;同步放化疗组盆腔积液、阴道炎症、泌尿生殖道反应、直肠反应、骨髓抑制、胃肠道反应发生率略高于化疗组,但两组对比差异无统计学意义（P>0.05）;预后良好组与预后不良组患者年龄、是否绝经、病理类型、肿瘤大小对比差异无统计学意义（P>0.05）,预后良好组与预后不良组患者临床分期、组织分化程度、淋巴结转移、是否同步放化疗、治疗前血红蛋白水平对比差异有统计学意义（P<0.05）;组织分化程度低、未同步放化疗、治疗前血红蛋白水平低为局部宫颈癌的预后不良影响因素（P<0.05）。结论 对局部宫颈癌患者采取根治性同步放化疗与单一化疗相比可提升其临床疗效与远期生存率,同时安全性较高。组织分化程度低、未同步放化疗、治疗前血红蛋白水平低为宫颈癌预后不良影响因素。

Objective To explore the clinical efficacy and prognostic factors of 80 cases of local cervical cancer treated with radical synchronous radiotherapy and chemotherapy．Methods A retrospective analysis was conducted on 80 cervical cancer patients admitted to Hebi Maternal and Child Health Hospital from January 2018 to January 2021．Patients underwent surgery and synchronous radiotherapy and chemotherapy according to their degree of lesion．Among them,40 patients received simple chemotherapy and were divided into a chemotherapy group,while 40 patients received synchronous radiotherapy and chemotherapy and were divided into a synchronous radiotherapy and chemotherapy group．The short-term and long-term clinical efficacy and incidence of adverse reactions were analyzed．A 3-year follow-up was conducted on all patients,and patients were divided into two subgroups,namely the poor prognosis group（n=20）and the good prognosis group（n=60）．The general clinical characteristics of the two groups of patients were compared,and a Logistic regression model was used to analyze the prognostic factors of local cervical cancer radical synchronous radiotherapy and chemotherapy．Results The objective relief rate and disease control rate of the synchronous radiotherapy and chemotherapy group were significantly higher than those of the chemotherapy group（P<0.05）,and the median progression free survival of the control group was 5.4（2.38-14.52）months．The median progression free survival of the observation group was 6.66（2-20.1）months,which was higher than that of the control group（χ²=4.536,P=0.041）．The incidence of pelvic fluid accumulation,vaginitis,urogenital reactions,rectal reactions,bone marrow suppression,and gastrointestinal reactions in the synchronous radiotherapy and chemotherapy group was slightly higher than that in the chemotherapy group,but there was no statistically significant difference between the two groups（P>0.05）．There was no statistically significant difference in age,menopause,pathological type,and tumor size between the patients with good prognosis and those with poor prognosis（P>0.05）．However,there was a statistically significant difference in clinical stage,tissue differentiation,lymph node metastasis,synchronous radiotherapy and chemotherapy,and pre-treatment hemoglobin levels between the patients with good prognosis and those with poor prognosis（P<0.05）．Low degree of tissue differentiation,lack of synchronous radiotherapy and chemotherapy,and low hemoglobin levels before treatment were adverse prognostic factors for local cervical cancer（P<0.05）．Conclusion sCompared with single radiotherapy,radical synchronous radiotherapy and chemotherapy can improve the clinical efficacy and long-term survival rate of patients with local cervical cancer,with higher safety．The severe tissue differentiation,unsynchronized chemoradiotherapy and hemoglobin before treatment were the adverse prognostic factors of cervical cancer．

目的 探讨容积调强（VMAT）在全脊柱骨多发转移瘤放疗中的运用,观察疗效及安全性。方法 选取 2018年1月—2021年1月本科室收治的50例全脊柱骨多发转移瘤姑息止痛放疗的临床资料,分别对全脊柱靶区设计适形放疗（CRT）和VMAT多中心计划,运用剂量体积直方图及所对应的统计表评估靶区及危及器官剂量覆盖情况,放疗结束后通过1-8周视觉模拟评分法评价近期疗效,每3个月复查全脊柱MRI观察放疗不良反应。结果 采用VMAT技术放疗靶区剂量覆盖度、靶区适形指数和剂量均匀指数均优于CRT技术（P<0.01）,照射野重叠区未见明显剂量热点和冷点。采用VMAT技术危及器官V5 Gy受照体积高于CRT（P<0.01）,除了胃、胰腺和小肠,危及器官V10 Gy受照体积高于CRT（P<0.01或P<0.05）,危及器官V20 Gy受照体积则低于CRT（P<0.01）,除了肾,危及器官V30 Gy受照体积也低于CRT（P<0.01）。采用VMAT技术时危及器官的最大受照量低于CRT（P<0.01或P<0.05）,但除了心脏、胰腺和小肠,VMAT技术的危及器官平均受照量高于CRT（P<0.01或P<0.05）。采用VMAT技术较CRT出束时间增加（P<0.01）,采用CRT时技师摆位时间较VMAT增加（P<0.05）,对于总治疗时间VMAT较CRT增加（P<0.01）。8周后评估疼痛完全缓解16例,部分缓解 22例,轻度缓解8例,无效4例,总有效率为76%。随访日期截至2021年 12月,所有配合随诊的患者3、6、9、12个月全脊柱MRI复查结果显示,VMAT技术照射野内重叠处均未见脊髓及其他组织急慢性损伤情况。结论 VMAT技术对长靶区多中心放疗剂量分布均匀,近期疗效显著,安全性良好。

Objective To investigate the application of volumetric modulated arc therapy（VMAT） in the radiotherapy for multiple bone metastases in the whole spine,and observe of efficacy and evaluation of safety．Methods The clinical data were selected from 50 patients who were treated in our department between January 2018 and January 2021 with palliative analgesic radiotherapy for multiple metastases of the whole spine．Conformal radiotherapy（CRT）and multicenter VMAT plans were respectively applied to target areas of whole spine,and dose volume histogram was used to evaluate the dose coverage of target area and organ at risk（OAR）. After radiotherapy,the short-term efficacy was evaluated by visual analog scale in between 1-8 weeks,and the whole spine MRI was reviewed every 3 months to observe the adverse reactions of radiotherapy．Results The dose coverage,target conformality index and homogeneity index of VMAT treatment were significantly better than those of CRT treatment（P<0.01）,and no obvious dose hotspots and cold spots were observed in the overlapping area of irradiation field. When VMAT treatment was applied,the exposure volume of V5 Gy in OAR was significantly higher when compared with CRT treatment（P<0.01）．Except for stomach,pancreas and small intestine,the exposure volume of V10 Gy in OAR was significantly higher for VMAT treatment when compared with CRT treatment （P<0.01 or P<0.05）．When VMAT treatment was applied,the exposure volume of V20 Gy in OAR was significantly lower when compared with CRT treatment（P<0.01）,and except for kidney,the exposure volume of V30 Gy in OAR was significantly lower when compared with CRT treatment（P<0.01）．When VMAT treatment was applied,the maximum exposure of OAR was significantly lower than that of CRT（P<0.01 or P<0.05）,however,except for the heart,pancreas and small intestine,the average exposure of VMAT treatment to OAR was higher than that of CRT （P<0.01 or P<0.05）．Compared with CRT,VMAT treatment had significantly increased beam-out time（P<0.01）,the therapist setting time of CRT was increased when compared with that of VMAT（P<0.05）,and the total treatment time of VMAT was increased when compared with that of CRT（P<0.01）. In the assessment 8 weeks after the treatments,16 patients had complete pain relief,22 had partial relief,8 had mild relief,and 4 had no effect,which total effective rate was 76%．The follow-up was ended in December 2021．There was no acute or chronic injury to the spinal cord and other tissues in the overlapping areas of the irradiation fields observed for all follow-up patients in the 3rd,6th,9th and 12th month whole-spine MRI re-examination．Conclusions VMAT has uniform dose distribution in multi-center radiotherapy for long target areas,with significant short-term efficacy and safety.

目的 探析化疗联合调强放疗（IMRT）治疗老年（≥65岁）局部晚期鼻咽癌的临床效果。方法 选取2018年1月—2019年1月我院诊治的90例老年局部晚期鼻咽癌患者为研究对象,使用随机数表法将此90例患者分为观察组及对照组,各45例。观察组行IMRT,对照组行化疗联合IMRT,对比2组的效果。结果 2组的治疗总有效率均为100%,组间差异不显著（P<0.05）。观察组的生活质量改善率（93.33%）高于对照组（77.78%）（P<0.05）。对照组出现3~4级白细胞减少、呕吐、黏膜炎人数明显高于观察组（P<0.05）,两者其他毒副反应比较无显著差异（P>0.05）。观察组的1年总体生存率（91.11%）及3年总体生存率（75.56%）均高于对照组（86.67%、68.89%）（P<0.05）。结论 对于老年局部晚期鼻咽癌,化疗联合IMRT相比单纯IMRT降低了远期生存率,增加了毒副反应并影响疗后生活质量的改善,不宜常规应用,单纯IMRT可能是更合适的治疗选择。

Objective To explore the clinical effect of chemotherapy combined with intensity modulated radiation therapy（IMRT）in the treatment of elderly（≥65 years old）locally advanced nasopharyngeal carcinoma．Methods The study was carried out from January 2018 to January 2019．During this period,90 elderly patients with locally advanced nasopharyngeal carcinoma who were diagnosed and treated in our hospital were selected as the research objects．The random number table method was used to divide the 90 patients into observation groups,and the control group,each with 45 cases．The observation group was treated with IMRT,and the control group was treated with chemotherapy combined with IMRT．The effects of the two groups were compared．Results The total effective rate of the two groups was 100%,and there was no significant difference between the two groups（P<0.05）．The improvement rate of quality of life in the observation group（93.33%）was higher than that in the control group（77.78%,P<0.05）．The number of grade 3-4 leukopenia,vomiting and mucositis in the control group was significantly higher than that in the observation group（P<0.05）,and there was no significant difference in other side effects between the two groups（P>0.05）．The 1-year overall survival rate（91.11%）and 3-year overall survival rate（75.56%）of the observation group were higher than those of the control group（86.67%,68.89%,P<0.05）．Conclusions For locally advanced nasopharyngeal carcinoma in the elderly,chemotherapy combined with IMRT reduces the long-term survival rate,increases the toxic and side effects and affects the improvement of the quality of life after treatment．It is not suitable for routine application,and IMRT alone may be a more appropriate treatment choice.

目的 应用锥形束CT比较改良颈肩体热塑膜和传统颈肩体热塑膜体位固定装置在颈胸段食管癌患者放射治疗中的摆位差异,分析两种固定方式对锁骨上下区摆位误差的影响。方法 分析2021年6月—2022年10月在南京医科大学第一附属医院行放射治疗的29例食管癌患者的临床资料。将患者分为改良颈肩体热塑膜组（改良组）和光板颈肩体热塑膜组（对照组）,对比分析2组病例不同配准区域的摆位误差。结果 改良组在X（左右）方向的平移误差及Rz（冠状面）方向的旋转误差小于对照组,差异有统计学意义（P<0.05）。改良组锁骨上下区在X（左右）方向的平移误差以及Rx（矢状面）方向的旋转误差小于对照组,差异有统计学意义（P<0.05）。改良组的整体靶区外放范围在X、Y方向上均小于颈肩体组,改良组在锁骨上下区的X方向靶区外放范围也更小。结论 对于颈胸段食管癌需行锁骨上下区放疗的患者,应用改良颈肩体热塑膜可减少平移误差,控制旋转角度,减少靶区外放范围。

Objective To compare the set-up errors between the modified neck-shoulder body thermoplastic film and the traditional neck-shoulder body thermoplastic film fixation device in the radiotherapy of patients with cervical and thoracic esophageal cancer by cone beam CT,and to analyze the influence of the two fixation methods on the positioning error of the upper and lower clavicular region．Methods The clinical data of 29 patients with esophageal cancer who underwent radiotherapy in the First Affiliated Hospital of Nanjing Medical University from June 2021 to October 2022 were analyzed．The patients were divided into two groups：the modified neck-shoulder body thermoplastic film group（the modified group）and the smooth neck-shoulder body thermoplastic film group（the control group）,the positioning errors in different regions of the two groups were compared and analyzed．Results The translation error in the X（left and right）direction and the rotation error in the Rz（coronal plane）direction of the modified group were smaller than those of the control group,and the differences were statistically significant（P<0.05）．The translation error in the X（left and right）direction and the rotation error in the Rx（sagittal plane）direction of the superior and inferior clavicular region in the modified group were smaller than those in the control group,and the differencs were statistically significant（P<0.05）．The overall target area of the modified group was smaller in X and Y directions than that of the neck-shoulder body group,and the target area of the improved group in X direction was also smaller in the upper and lower clavicle area．Conclusions For patients with cervical and thoracic esophageal cancer who need radiotherapy in the upper and lower clavicular region,the application of modified neck shoulder body thermoplastic film can reduce the translation error,control the rotation angle and reduce the external radiation range of the target region．

目的 评估基于NRS2002系统的多学科营养支持对直肠癌放化疗患者的作用。方法 选取2017年2月—2020年2月我院收治的96例直肠癌放化疗患者作为研究对象,根据入院建档顺序不同分2组,每组48例,对照组接受常规护理,观察组接受基于NRS2002系统的多学科营养支持。比较2组干预前后主观全面评定法(PG-SGA)评分、营养指标[前白蛋白(prealbumin, PA)、血清白蛋白(serum albumin, SA)、转铁蛋白(transferrin, TF)]、癌因性疲乏、生存质量(FLIC评分)。结果 干预后观察组营养状况优于对照组(P＜0.05);干预后观察组SA、PA、TF高于对照组(P＜0.05);干预后观察组癌因性疲乏低于对照组(P＜0.05);干预后观察组生存质量FLIC各维度评分高于对照组(P＜0.05)。结论 基于NRS2002系统的多学科营养支持有助于改善直肠癌放化疗患者营养状态,减轻癌因性疲乏,提升生存质量水平。

Objective To evaluate the efficacy of multidisciplinary nutritional support through NRS2002 system on patients undergoing radiotherapy and chemotherapy with rectal cancer. Methods From February 2017 to February 2020, 96 cases of rectal cancer patients undergoing radiotherapy and chemotherapy in our hospital were selected as the research objects, which were divided into two groups according to the order of filing, 48 cases in each group. The control group received routine nursing, and the observation group received multidisciplinary nutritional support through NRS2002 system. The PG-SGA score, nutritional indexes [prealbumin (PA), serum albumin (SA), transferrin (TF)], cancer-related fatigue and quality of life (FLIC score) were compared between two groups before and after intervention. Results After the intervention, the nutritional status of the observation group was better than that of the control group (P<0.05). The SA, PA, TF of the observation group were higher than those of the control group (P<0.05). The cancer-related fatigue of the observation group was lower than that of the control group (P<0.05), and the FLIC score of the observation group was higher than that of the control group (P<0.05). Conclusion Multidisciplinary nutritional support through NRS2002 system was helpful to improve nutritional status of patients, reduce cancer-related fatigue and improve quality of life of patients with rectal cancer undergoing radiotherapy and chemotherapy.

目的 探究老年食管鳞癌患者单纯放疗、同步放化疗临床治疗效果。方法 选我院2018年1月—2020年12月期间90例老年食管鳞癌患者为研究对象,依据不同治疗方式将其分为对照组、观察组,各45例,分别接受单纯放疗、同步放化疗治疗,比较2组治疗效果及治疗安全性。结果 观察组治疗总有效率为75.56%,与对照组60.00%相近(P＞0.05);观察组疾病控制率为97.78%,较对照组84.44%高(P＜0.05);观察组放射性肺炎、骨髓抑制发生率为24.44%、77.78%,较对照组6.67%、48.89%高;且观察组放射性肺炎、骨髓抑制、放射性食管炎2级占比分别为17.78%、35.56%、57.78%,均较对照组2.22%、8.89%、24.44%高(P＜0.05)。结论 在老年食管鳞癌患者治疗中,与单纯放疗相比,同步放化疗可提升疾病控制能力,但会增加治疗不良反应,增加不良反应严重程度,因此在临床治疗中,需慎重选择。

Objective To explore the clinical effect of radiotherapy only and concurrent chemoradiotherapy in elderly patients with esophageal squamous cell carcinoma. Methods Ninety cases of elderly patients with esophageal squamous cell carcinoma in our hospital from January 2018 to December 2020 were selected as research objects.According to different treatment methods, they were divided into control group and observation group, 45 cases in each group.They were treated with radiotherapy and concurrent chemoradiotherapy respectively.The treatment effect and safety of the two groups were compared. Results The total effective rate of the observation group was 75.56%, which was close to the control group (60.00%, P>0.05). The disease control rate of the observation group was 97.78%, which was higher than control group (84.44%, P<0.05). The incidence of radiation pneumonia and bone marrow suppression of the observation group were 24.44% and 77.78%, which were higher than that of the control group (6.67%, 48.89%). The proportion of radiation pneumonia, bone marrow suppression, radiation esophagitis grade 2 of the observation group were 17.78%, 35.78% and 57.78% respectively, higher than that of the control group (2.22%, 8.89%, 24.44% respectively, P<0.05). Conclusion Compared with radiotherapy only, concurrent chemoradiotherapy improved the ability of disease control in elderly patients with esophageal squamous cell carcinoma, but it increased the adverse reactions and aggravated the severity of adverse reactions.Therefore, it is necessary to make a careful choice in clinical treatment.

目的 研究自适应调强放疗(ART)同步铂类化疗治疗局部晚期宫颈癌患者的可行性。方法 选取我院诊治的92例局部晚期宫颈癌患者,随机分为研究组与对照组各46例,其中对照组行调强放疗(IMRT)同步铂类化疗,研究组行ART同步铂类化疗。治疗8周后,比较2组患者临床疗效;于治疗前后比较2组患者肿瘤标志物[癌胚抗原(CEA)、鳞状细胞癌抗原(SCC-Ag)]水平;以急性放射损伤分级标准(RTOG)和常见不良反应事件评价标准(CTCAE)比较2组患者不良反应发生情况。结果 治疗8周后,研究组客观缓解率高于对照组(P＜0.05);2组患者CEA、SCC-Ag水平均较治疗前降低,且研究组低于对照组 (P＜0.05);研究组基于RTOG的消化道反应等级与泌尿系统反应等级均低于对照组(P＜0.05);2组患者基于CTCAE的肝功能损害与皮疹评级相比,差异无统计学意义(P＞0.05)。结论 ART同步铂类化疗治疗局部晚期宫颈癌患者疗效较好,使患者病情好转,同时安全性突出,切实可行。

Objective To study the feasibility of adaptive radiotherapy (ART) combined with platinum chemotherapy in the treatment of locally advanced cervical cancer. Methods A total of 92 patients with locally advanced cervical cancer treated in our hospital were randomly divided into study group and control group, with 46 cases in each group. The control group received intensity-modulated radiation therapy (IMRT) combined with platinum chemotherapy and the study group received ART combined with platinum chemotherapy. After 8 weeks of treatment, the clinical effects of the two groups were compared. The levels of tumor markers [carcinoembryonic antigen (CEA) and squamous cell carcinoma associated antigen (SCC-Ag)] were compared between the two groups before and after treatment. The incidence of adverse reactions in the two groups was compared with the grading standard of Acute Radiation Injury Group (RTOG) and Common Terminology Criteria for Adverse Events (CTCAE). Results After 8 weeks of treatment, the Objective remission rate in the study group was higher than that in the control group (P<0.05). The levels of CEA and SCC-Ag in the study group were significantly lower than those in the control group (P<0.05). The reaction grades of digestive tract and urinary system based on RTOG in the study group were significantly lower than those in the control group (P<0.05). There was no significant difference in CTCAE based liver function impairment and rash rating between the two groups (P> 0.05). Conclusions ART combined with platinum chemotherapy is effective and safe in the treatment of locally advanced cervical cancer.

目的 评价调强放疗后颞颌关节损伤的鼻咽癌患者的生存情况。方法 2010年2月—2013年11月期间90例经调强放疗后出现颞颌关节损伤的鼻咽癌患者,鼻咽病灶放疗剂量70～74Gy/32～33f,转移淋巴结放疗剂量64～70Gy/32～33f,高危区预防性放疗剂量58～66Gy/32～33f,低危区预防性放疗剂量54～58Gy/32～33f,采用顺铂、奈达铂或多西他赛行同步化疗。回顾性分析患者的张口困难程度、近期疗效、无局部复发生存、无远处转移生存及总生存情况,同时评价放疗毒副反应。结果 ①颞颌关节损伤:97.8%的患者为Ⅰ级损伤,2.2%的患者为Ⅱ级损伤,无Ⅲ~Ⅳ级重度放射性损伤;②近期疗效:完全缓解67例(74.5%),部分缓解21例(23.3%),稳定1例(1.1%),进展1例(1.1%),总有效率(ORR)为97.8%(88/90),疾病控制率(DCR)为98.9%。③生存情况:中位随访时间57个月(5～84个月),5年无局部复发生存率、无远处转移生存率和总生存率分别为85.6%、71.1%和73.3%。④不良反应:3~4度不良反应有白细胞减少(发生率为24.4%)、中性粒细胞减少(发生率为21.1%)和血小板减少(发生率为1.1%)等血液学毒性以及口腔黏膜炎(发生率为43.3%)、呕吐(发生率为1.1%)和放射性皮炎(发生率为3.3%)等非血液学毒性。结论 鼻咽癌调强放疗后颞颌关节损伤以I度为主;调强放疗后出现颞颌关节损伤的鼻咽癌患者以T3~T4为主,但仍可获得较满意的局控率、较低的远处转移率和较高的总生存率,且安全性较高。

目的 探讨6野切线射野方式调强放疗(6F-IMRT)用于左侧乳腺癌根治术后放疗的临床价值。方法 纳入我院70例左侧乳腺癌根治术患者为研究对象,进行模拟CT增强扫描,三维重建后勾画大体靶区,分别对每个患者靶区设计4F-IMRT、5F-IMRT、6F-IMRT三种治疗计划,规定计划靶区(PTV)达到95%的处方剂量前提下,分析三种治疗计划PTV所受照射的平均剂量、最大剂量、最小剂量,95%、100%等剂量线包绕的靶区体积(V₉₅、V₁₀₀),适形度指数(CI)及剂量不均匀指数(HI),并比较三种计划下心脏、双肺、右乳受照射剂量。结果 各治疗计划靶区最大剂量、最小剂量、平均剂量比较无统计学意义(P＞0.05)。6F-IMRT的V₉₅、V₁₀₀均高于4F-IMRT、5F-IMRT,差异有统计意义(P＜0.05)。4F-IMRT、5F-IMRT、6F-IMRT的CI呈递增趋势,HI呈递减趋势,各组间比较差异有统计学意义(P＜0.05)。三种放疗计划中心脏的平均剂量、V₃₀,双肺的平均剂量、V₂₀、右乳平均剂量比较无显著差异(P＞0.05)。三种放疗计划中,4F-IMRT右乳V₁₀显著低于5F-IMRT、6F-IMRT,差异有统计学意义(P＜0.05),但均在最大耐受剂量范围内。结论 与4F-IMRT、5F-IMRT相比,6F-IMRT用于左侧乳腺癌根治术后放疗有明显剂量学优势,可提高靶区照射剂量,靶区适形程度及剂量均匀性均较好,而且并不会增加周围正常器官照射剂量。