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目的：前瞻性地观察改进鼻咽癌外照射技术对临床治疗疗效的影响。方法：从1992年3月至1995年6月，124例初治鼻咽癌病人按T、N、M分层配对分为改进方案治疗组(先面颈联合野照射40～45Gy，后用面颈分野照射至根治量或预防量，采用低熔点挡块技术)或常规方案治疗组(全程放疗均采用面颈分野)进行治疗，然后比较两组的近远期疗效及其正常组织的早发和晚发放射反应。结果：放疗后2～3月的CT检查显示改进方案治疗组原发灶完全消退率(58.06％)高于常规方案治疗组(30.64％)(P<0.05)，而改进方案治疗组口腔粘膜和胃肠早发放射反应轻于常规方案治疗组(P<0.05)。远期随访显示改进方案治疗组1、3和5年总的生存率、无瘤生存率和无局部区域复发率均高于常规方案治疗组(P<0.05)，且改进方案治疗组的后组颅神经放射损伤率(4.8％)低于常规方案治疗组(16.1％)(P<0.05)。结论：与常规方案相比，改进方案提高了鼻咽癌的局部区域控制率，提高了病人的生存率和生存质量，值得推广应用。
Objective: To prospectively observe the effect of improving the external therapeutic effect of nasopharyngeal carcinoma on clinical curative effect. Methods: From March 1992 to June 1995, 124 patients with newly diagnosed nasopharyngeal carcinoma were divided into three groups according to T, N and M stratification. The patients in the frontal and neck combined field irradiation 40 ~ 45Gy, Neck irradiation to the amount of radical or prevention, the use of low melting point block technology) or conventional regimen group (full radiotherapy face and neck are divided) for treatment, and then compare the two groups of short-term and long-term efficacy of normal early tissue And late radiation reaction. Results: CT examination from February to March after radiotherapy showed that the complete regression rate of the primary tumor in the improved treatment group was significantly higher than that in the conventional treatment group (58.06% vs 30.64%, P <0.05) Early gastrointestinal radiotherapy was lighter than the conventional treatment group (P <0.05). Long-term follow-up showed that the overall survival rate, tumor-free survival rate and no regional recurrence rate in the improved regimen for 1, 3 and 5-year treatment group were significantly higher than those for the conventional regimen group (P <0.05) The rate of cranial nerve radiation injury (4.8%) was lower than that of the conventional regimen (16.1%) (P <0.05). Conclusion: Compared with the conventional regimen, the improved regimen improves the control rate of the local area of NPC and improves the survival rate and quality of life of the patients, which is worth popularizing and applying.