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1、TheAppliedResearchofPhasedIntensity-modulatedRadiotherapyintheTrcatmcntofLocal-advancedNasopharyngealCarcinomaABSTRACTObjective:Theaimofthisstudywastoevaluateprospectivelythevolumetricanddosimetricchangesoftargetvolumesandorgansatrisk(OARs)duringthecourseofintensity-modulatedradiationthera
2、py(IMRT)forlocal-advancednasopharyngealcarcinoma(NPC)andthenecessityandthebesttimingofphasedintensity-modulatedradiotherapy.Methods：20local-advaneednasopharyngealcareinomapatientstreatedbyconcurrcntchcmothcrapyandIMRTwereincluded.CTandMRimageswereacquiredforeachpatientbeforetreatmentandatw
3、eeks2,3,4,5emd6duringtreatment.ThetargetvolumesandOARswerecontouredbasedonthefusedCT-MRIimagesandhybridplansweregenerated.Thevolumetricchangesandthedosimetricchangesweremeasuredbycomparingtheoriginalplanandhybridplans.ResuIts：Significantvolumctricchangesoftargetvolumesandparotidglandwereob
4、servedduringthetreatmentcourse.Theprimarynasophar)mgealtumor(GTVnx),CTV1,involvedlymphnodes(GTVnd)andleftandrightparotidglands,shrankatameanrateof14.7%,11.56%,11.40%,6.54%,6.78%pertreatmentweek,respectively.TherewerenosignificantdosimetricdifferencesinGTVnx,GTVnd,CTV1,thespinalcordandbrain
5、stemwhencomparingtheinitialCTimagingbeforetreatmentwiththesubsequentweeklyCTimaging.Onthecontrary,thedifferencesinthedosimitricparameterstothebilateralparotidglandsweresignificant(F=6.73,P=0.007;F=7.43,P二0.007).Conelusion:Remarkablyvolumetricchangeswereobserved,howeverthedosimctricchangesw
6、ereinconspicuousexceptparotid.Phasedintensity-modulatedradiothcrapymightbringbenefitsforprotectingtheparotidgland.KEYWORDS:nasopharyngealcareinoma;intensity-modulatedradiationthcropy;adaptivcradiotherapy;radiodosimctry鼻咽癌（nasopharyngealcarcinoma,NPC）为我国常见的恶性肿瘤之一，在美国、西欧和日木，鼻咽癌发病率约为1.0-1.5/1
7、0万，在所有恶性肿瘤中所占比例不足1%。但是在中国南部，特别是在香港、广东，鼻咽癌发病率较之美国、西欧和口本则翻了约80倍,从10/10万到150/10万⑴由于其解剖位置、病理分化程度及生物学行为的特殊性，如鼻咽癌发病部位特殊，手术根治困难，病例类型多为低分化鳞癌，放射治疗效果较好，故放射治疗为其主要治疗手段，并且是目前首选治疗方法。上世纪末发展起来的调强放射治疗技术（intensitymodulatedradiationtherapy,1MRT）被视为20世纪放射治疗学上历史性的进步，与常规放疗技术相比，其关键优
