Objective To improve the conformity index(CI)and homogeneity index(HI)of extended fields radiotherapy using field-in-field intensity-modulated radiotherapy(IMRT)technology and to monitor its hematological toxicity.Methods This study included 26 patients treated with field-in-field IMRT technology from 2013 to 2020.All patients underwent standardized positioning verification processes and had IMRT and VMAT plans designed using Pinnacle,Eclipse,and Monaco TPS systems.Hematological toxicity was monitored throughout the radiotherapy.Results Dose verification for the 26 patients showed that the Monaco VMAT plan excelled in terms of CI and HI,with γ pass rates and point dose verification differences meeting clinical requirements.Hematological toxicity monitoring indicated that craniospinal irradiation(CSI)patients mainly experienced mild bone marrow suppression,while seminoma patients had only mild bone marrow suppression,with no case of severe bone marrow suppression.Conclusion Field-in-field IMRT technology significantly improves the CI and HI of extended fields radiotherapy,reduces dose cold and hot spots at the junctions of irradiation fields,and lowers hematological toxicity.
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