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调强放疗提高了局部和区域控制率,降低了并发症,是鼻咽癌放疗发展的方向。CT和MRI融合能更充分展示鼻咽癌原发病变范围,被认为是目前较理想的影像模式;目前困扰颈淋巴结范围描绘的关键因素是怎样将颈淋巴结分区转换为CT层面可描绘的影像边界,欧美共同描绘规范缩小了各肿瘤中心在勾画颈淋巴结区域时的差异而值得推荐;世界各主要肿瘤中心鼻咽癌调强计划规范中,大体肿瘤区的定义基本一致,且处方剂量接近甚至高于80Gy,主要差异是对鼻咽CTV范围的定义及鼻咽CTV和上颈部的处方剂量方案。根据随访结果分析,建议鼻咽CTV的范围除在鼻咽原发肿瘤外扩一定边径外,还应包括整个鼻咽腔、咽后淋巴结区、斜坡、颅底骨质结构、翼腭窝、咽旁间隙、部分蝶窦、鼻腔和上颌窦后1/3,且处方剂量宜≥60Gy;双侧上颈部应列为高危淋巴结转移区,施予至少60Gy的照射量。
IMRT improves the local and regional control rate and reduces complications, which is the direction of radiotherapy for nasopharyngeal carcinoma. The fusion of CT and MRI can fully display the primary lesion of nasopharyngeal carcinoma and is considered to be the ideal imaging modality at present. What is the key factor that disturbs the range of cervical lymph node at present? How to transform the cervical lymph node metastasis into CT image delineation , Europe and the United States commonly describe norms to narrow the center of the tumor in the delineation of cervical lymph node region difference is worth recommending; the world’s major cancer center regulation plan of NPC, the general definition of tumor area is basically the same, and the prescription dose is close to even high At 80 Gy, the main differences are the definition of the nasopharyngeal CTV range and the nasal pharyngeal CTV and top-neck prescription dosage regimen. According to follow-up results analysis, it is suggested that the scope of nasopharyngeal CTV in addition to a certain diameter outside the nasopharyngeal primary tumor should also include the entire nasopharyngeal cavity, posterior pharyngeal lymph node area, slope, skull base bone structure, pterygopalatine fossa, Parapharyngeal space, part of the sphenoid sinus, nasal cavity and maxillary sinus after 1/3, and the prescription dose should be ≥ 60Gy; bilateral upper neck should be classified as high-risk lymph node metastasis, at least 60Gy irradiation.