Objective To investigate the effect of 18 F-FDG PET/CT in patients with locally advanced nasopharyngeal push the same pe-riod the amount of IMRT combined clinical curative effect of the chemotherapy. Methods 67 cases of patients with locally advanced nasopharyn-geal carcinoma( stage Ⅲ41 cases,ⅣA 26 cases)were randomly divided into three groups:A:CT-guided uniform dose IMRT group( computed tomography guided uniform dose-intensity modulated radiation therapy,CT-IMRT)(24 patients),group B:CT-guided synchronization plus the amount of intensity modulated radiation therapy group(CT guided-simultaneous modulated accelerated radiation therapy,CT-SMART)(22 patients),group C:FDG high metabolic imaging plus the amount of synchronization guided IMRT group( high metabolic imaging guided -SMART,HIG-SMART)(21 cases). The first two groups outlined target using CT images,the third group was treated with CT and PET-CT fu-sion images outlined targets. Impact on the short-term efficacy and toxicity were evaluated according to different images under target delineation and illumination technology. Results The total effective rate( RR)of group A was 79. 1%,while in group B and C were 100%. The RR of group B and C were higher than the group A. The difference was statistically significant( P 0. 05). Group C 2-year local progression-free survival and dis-tant metastasis-free survival rates were higher than the rise in group A and group B. Compared with the A group,the difference was statistically significant( P 0. 05). Conclusion PET-CT image fusion with the machine in favor of precise targets outlined by increasing the tumor volume and total dose fractionated improve GTVˊs BED,there is a good short-term effect.%目的：探讨18 F-FDG PET/CT引导下靶区勾画在局部晚期鼻咽癌患者同期推量调强放疗联合化疗中对临床近期疗效的影响。方法67例局部晚期鼻咽癌患者随机分成三组：A组为CT引导的均匀剂量的调强放射治疗组（CT-IMRT）（24例），B组为CT引导的同步加量调强放射治疗组（CT-SMART）（22例），C组为FDG高代谢显像引导的同步加量调强放射治疗组（ HIG-SMART）（21例）。前两组采用CT图像勾画靶区，第三组采用CT与PET-CT融合图像勾画靶区。评价不同图像下靶区勾画及照射技术对近期疗效及毒性反应的影响。结果 A组近期总有效率（ RR）为79.1%，而B组和C组均达到100%，B、C组RR均高于A组，差异均有统计学意义（ P ＜0.05）。A、B、C三组2年无局部进展生存率分别为：83.3%、95.5%和100%；2年无区域进展生存率分别为：95.8%、100%和100%；2年无远处转移生存率分别为：83.3%、90.9%和100%；2年总生存率分别为：87.5%、95.5%和100%。三组间急性放疗反应无统计学差异（ P ＞0.05）。C组2年局部无进展生存率和无远处转移生存率均高于升A组与B组，但与A组相比差异有统计学意义（ P ＜0.05），与B组比较差异无统计学意义（ P ＞0.05）。结论 PET-CT同机图像融合有利于靶区的精确勾画，通过提高肿瘤的分次量和总剂量，提高肿瘤靶区的生物有效剂量，有较好的近期疗效。
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