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目的利用正向调强计划实现鼻咽癌放射治疗计划设计,总结出适合笔者单位的计划设计方案。方法选择2009年1月至2010年5月40例鼻咽癌患者,其中男性26例,女性14例,年龄30～70岁,平均年龄45岁。进行鼻咽癌治疗计划设计,讨论鼻咽癌计划设计的技巧。根据靶区和危及器官的形态和位置、预设射野方向,人工设置射野形状,根据处方剂量做射野权重的优化,再人为增加子野并调整子野形状,再优化,循环调整和优化,最后得到合适的计划。结果在所有病例中,一般预设7个大野,角度是210°、260°、300°、0°、60°、100°、150°,实际射野角度可以在预设方向附近做调整。根据处方剂量设计计划,大体靶体积(GTV1)为(6636.45±126.43)cGy,均匀度为1.0660±0.0217;临床靶体积(CTV1)为(6396.08±106.01)cGy,均匀度为1.1440±0.0306;CTV2为(5647.16±197.53)cGy,均匀度为(1.0860±0.0456)。并且所有计划基本满足90%CTV达到100%处方剂量,95%以上GTV达到100%处方剂量。结论调强放射治疗(IMRT)是先进的放射治疗技术,但正向调强计划的优劣很大程度上取决于操作者的经验,掌握合适技巧,运用合理方案,才可以得到符合要求的计划,总体说来鼻咽癌的正向调强计划比逆向调强计划有更加灵活的射野形状设置和权重给予,更有助于满足临床要求。
OBJECTIVE: To achieve the plan of radiation therapy for nasopharyngeal carcinoma by using positive intensity modulation plan and to summarize the plan design suitable for the author’s unit. Methods Forty patients with nasopharyngeal carcinoma from January 2009 to May 2010 were selected, including 26 males and 14 females, aged from 30 to 70 years with a mean age of 45 years. NPC treatment plan design to discuss the design of nasopharyngeal cancer skills. According to the shape and position of target area and endangered organ, the direction of field is preset, the shape of field is set manually, the weight of field is optimized according to the prescription dose, then the field is adjusted and the shape of field is adjusted, Optimization, and finally get the right plan. Results In all the cases, seven fields were preset with angles of 210 °, 260 °, 300 °, 0 °, 60 °, 100 ° and 150 °. The actual field angle can be adjusted around the preset direction. According to the prescription dose design plan, the gross target volume (GTV1) was (6636.45 ± 126.43) cGy, the uniformity was 1.0660 ± 0.0217, the clinical target volume (CTV1) was (6396.08 ± 106.01) cGy and the uniformity was 1.1440 ± 0.0306. CTV2 was (5647.16 ± 197.53) cGy, and the evenness was (1.0860 ± 0.0456). And all plans basically meet the 90% CTV to 100% prescription dose, more than 95% GTV reach 100% prescription dose. Conclusions IMRT is an advanced radiotherapy technique. However, the pros and cons of the IMRT depends largely on the operator’s experience. Appropriate techniques can be used and the reasonable plan can be used to get the satisfactory plan Generally speaking, the positive intensity modulation plan of nasopharyngeal carcinoma has a more flexible radiation field shape setting and weight giving than the reverse intensity modulation plan, which is more helpful to meet the clinical requirements.