鼻咽癌调强放疗致急性放射性口干的剂量学研究  

Acute xerostomia and dosmimetric study in nasopharyngeal carcinoma patients

作　　者：张羽[1] 曲颂[1] 李龄[1] 赵伟[1] 裴苏[1] 陈晓倩[1] 梁忠国[1] 梁振强[1] 朱小东[1] 

机构地区：[1]广西医科大附属肿瘤医院广西壮族自治区肿瘤防治研究所放疗科,南宁530021

出　　处：《中华放射医学与防护杂志》2015年第10期745-750,共6页Chinese Journal of Radiological Medicine and Protection

基　　金：广西自然科学基金（桂科基0575090）;广西医疗卫生重点科研项目（厅重200969）;广西医疗卫生适宜技术研究与开发项目（S201417-04）

摘　　要：目的探讨鼻咽癌调强放疗所致急性放射性口干与放疗剂量的关系。方法收集2013年12月至2014年7月接受调强放疗的109例鼻咽癌患者，分析患者的一般临床资料及双侧腮腺、双侧下颌下腺、双侧涎腺（双侧腮腺＋双侧下颌下腺）的照射剂量等数据。在放疗结束时根据口干程度把患者分为非重度口干组（57例）和重度口干组（52例），并对两组之间的一般资料以及相关的剂量学因素进行比较分析。记录双侧腮腺接受15～50Gy照射剂量的体积百分比，采用Logistic多因素回归法分析急性重度口干的独立预测因子，并用受试者工作特征曲线（ROC）分析其诊断界值点。结果至放疗结束，所有人组患者重度口干的发生率为47．7％（52／109）。临床因素的分析提示年龄、黏膜炎、化疗方式均与急性重度放射性口干的发生无关。非重度口干组和重度口干组剂量学指标比较的结果显示，两组平均剂量差异均有统计学意义（t=-6．179、-6．055、-2．293，P〈0．05）。Logistic回归分析显示，V34是判断急性重度放射性口干的独立预测因素。V34的ROC曲线表明：V34=49％对重度放射性口干预测的敏感度和特异度分别为71．2％和75．4％（OR=1．231，P〈0．05，95％CI：1．116～1．357）。结论在鼻咽癌调强放疗计划中，双侧腮腺的V34是重度急性放射性口干的独立预测因子，可以作为评估发生急性重度放射性口干发生风险的剂量学指标。Objective To evaluate the relationship between radiation-induced acute xerostomia and the dosimetric factor changes of the parotid and submandibular glands. Methods A total of 109 nasopharyngeal carcinoma （NPC） patients who underwent IMRT were included. They were divided into two groups according to the severity of xerostomia： severe（52） and non-severe（57） mucositis groups. Several clinical factors including age, and chemotherapy were analyzed by chi-squarc test. The delivered doses as well as the volumes of the parotid and submandibular were also collected. The t-test was used to compare the differences between the two groups. The dosimetric factors（ V15-V50 ）of the parotid glands were analyzed by Binary Logistic regression （Forward-conditional method）. Results The incidence of severe acute xerostomia was 47.7% （52/109）. There was no statistical difference between severe acute xerostomia and several clinical factors, which included age,mucositis and chemotherapy. The mean radiation doses of the glands between the severe and non-severe xerostomia group were statistically significant （ t = - 6. 179, - 6. 055, - 2. 293 ,P 〈 0.05 ）. Logistic regression of the parotid gland showed that V34 was an independent indicating factor of severe acute xerostomia. When using V34 = 49% as a cut-off to predict severe xerostomia, the sensitivity and specificity were 71.2% and 75.4% , respectively（ OR = 1. 231, P 〈 0.05, 95% CI： 1. 116 -1. 357 ）. Conclusions The study evaluated the delivered doses of the parotid and submandibular glands and their relationship with acute xerostomia. V34 was a valuable indicator for predicting severe acute xerostomia.

关 键 词：口干 放疗 涎腺 鼻咽癌 

分 类 号：R739.63[医药卫生—肿瘤]