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[目的]探讨宫颈癌术后正向调强放射治疗计划的设计方法。[方法]15例宫颈癌术后患者,给予50.4Gy的处方剂量,分28次完成。依据靶区形状与大小并考虑危及器官耐受量的同时,使用多叶准直器(MLC)预设照射野方向和形状,通过一系列的射野优化与射束调整,获得符合临床要求的正向调强计划。[结果]15例宫颈癌术后患者的正向调强放疗计划,其适形度CI为0.6~0.8,平均0.71,平均照射野数18个,跳数444。而四野计划的CI只有0.54,正向调强计划提高了靶区适形度CI,且大大降低了危及器官直肠、膀胱、股骨头、小肠在高剂量区45Gy、50Gy等剂量水平的相对受照体积。45Gy时,直肠、膀胱、股骨头、小肠的受照体积分别降低55%、44%、47%、26%;50Gy时则分别为86%、63%、70%、43%。[结论]宫颈癌正向调强放疗计划优于四野适形计划,可操作性强,掌握一定的方法和技巧后,通过合理布野,可得到符合临床要求的放疗计划。
[Objective] To discuss the design method of positive intensity modulated radiation therapy after cervical cancer surgery. [Method] Fifteen patients with cervical cancer were given prescription dose of 50.4Gy and finished in 28 times. Based on the shape and size of the target zone and considering the amount of endangered organs, a multi-leaf collimator (MLC) is used to preset the direction and shape of the irradiation field. Through a series of field optimization and beam adjustment, Forward plan to strengthen. [Result] The positive IMRT plans of 15 patients with cervical cancer postoperatively had conformal CI of 0.6-0.8 with an average of 0.71, average irradiation field number of 18 and number of hops of 444. The Shino project CI only 0.54, the positive intensity plan to improve the target conformal CI, and greatly reduce the endanger the organ rectum, bladder, femoral head, small intestine in the high-dose area of 45Gy, 50Gy and other dose-relative dose volume. At 45 Gy, the volume of rectum, bladder, femoral head and small intestine were reduced by 55%, 44%, 47% and 26%, respectively, while those at 50 Gy were 86%, 63%, 70% and 43%, respectively. [Conclusion] The positive IMRT plan of cervical cancer is superior to Shusuo conformal plan, and it has strong maneuverability and mastery of certain methods and techniques, and the radiotherapy plan meeting the clinical requirements can be obtained through rational distribution.