鼻咽癌患者调强放疗后颞颌关节损伤的长期随访结果  

Long time follow-up of radiation-induced temporomandibular joint damage in patients with nasopharyngeal carcinoma treated by intensity modulated radiation therapy

作　　者：陈媛媛[1] 赖淑贞[1] 刘源[1] 韩非[1] 陈明[1] 赵充[1] 

机构地区：[1]华南肿瘤学国家重点实验室中山大学肿瘤防治中心放疗科,广州510060

出　　处：《中华放射肿瘤学杂志》2010年第1期1-3,共3页Chinese Journal of Radiation Oncology

基　　金：广东省科技厅科学基金（粤科社字[2003]245号）

摘　　要：目的量化鼻咽癌患者调强放疗后张口困难，并分析颞颌关节放射损伤的情况。方法2001年2月至2004年10月，211例初治鼻咽癌患者接受调强放疗，处方剂量68Gv，分次量2．27Gy／次，中位总疗程时间43d（31～86d）。放疗前、放疗后6个月和每年测量患者最大门齿距。结果全组1、3、5年生存率为97．1％、90．7％、79．1％。颗颌关节区平均剂量6．18～51．36Cy。1级张口困难发生率为5．2％（11例），2级为0．5％（1例，该患者因局部复发接受二程放疗），未观察到3、4级颞颌关节损伤。结论调强放疗技术使颞颌关节受照剂量显著降低，从而有效降低鼻咽癌患者放疗后张口困难的发生率和严重程度。Objective To quantitatively analyze radiation-induced trismus in patients with nasopharyngeal carcinoma （ NPC ） treated by intensity modulated radiation therapy （ IMRT ）, and evaluate temporomandibular joint （TMJ） damage. Methods Between February 2001 and October 2004, 211 NPC patients were treated by IMRT, with a total dose of 68 Gy, 2.27 Gy per fraction within 31 - 86 days （ median, 43 days）. The distances between two dens incisivus medialis （DDIM） were measured before and 6 months after IMRT and then annually thereafter. Results The overall survival at 1-, 3-, and 5-year were 97.1%, 90.7% and 79.1%, respectively. The mean irradiation doses to TMJ were 6.18 -51.36 Gy. Grade 1 TMJ damage was observed in 5.2% patients, and grade 2 occurred in one patients who had received the second course radiotherapy because of local relapse . No grade 3 or 4 TMJ toxicity was observed . Conclusions IMRT can spare the TMJ from high dose irradiation and markedly reduce severe TMJ damage.

关 键 词：鼻咽肿瘤/放射疗法 放射疗法 调强 颞颌关节 放射损伤 

分 类 号：R686[医药卫生—骨科学]