鼻咽癌调强放疗对吞咽功能保护的前瞻性研究  

Prospective study of swallowing function protection with intensity modulated radiation therapy in nasopharyngeal carcinoma

作　　者：徐鹭英[1] 林冯杰[1] 邱素芳[1] 胡彩容[1] 林少俊[1] 陆军[1] 

机构地区：[1]福建医科大学教学医院.福建省肿瘤医院放疗科,福建福州350014

出　　处：《中华肿瘤防治杂志》2015年第21期1695-1699,共5页Chinese Journal of Cancer Prevention and Treatment

基　　金：福建省医学创新课题(2011-CX-15);福建省临床重点专科(西医类别)建设项目

摘　　要：目的吞咽功能障碍是鼻咽癌放疗后的主要并发症之一，不同的放疗技术造成的吞咽功能损伤也有较大区别。本研究旨在探讨调强放疗（intensity modulated radiation therapy，IMRT）技术对鼻咽癌患者吞咽功能的保护作用。方法选取2011-09—01—2012—12—30福建省肿瘤医院初治无远处转移的Ⅰ～ⅣA期鼻咽癌患者90例，分成保护吞咽结构调强组（IMRT—P）、常规调强组（IMRT—C）和二维常规放疗组（2D conventional radiotherapy，2D-CRT），每组30例。比较3组患者吞咽功能损伤的发生率和严重程度以及各吞咽结构在放疗计划中的剂量学差异。结果随访至2014—12—30，随访时间3～36个月，中位随访时间为28个月，随访率100％。吞咽功能损伤总发生率为46．7％（42／90），其中IMRT—P组33．3％（10／30），IMRT—C组50．0％（15／30），2D-CRT组76．7％（23／30）。IMRT—P组重度损伤为0，中度损伤为2％；而2D-CRT组出现重度损伤为13％，中度损伤为7％。在剂量学方面，IMRT—P计划中，吞咽结构咽缩肌（PC）和喉（GSF）的平均剂量（Dmean）、受照体积（V40、V50、V60分别表示接受40、50和60Gy照射体积占整个体积的百分比），明显好于IMRT—C和2D-CRT计划，P〈0．05。其中吞咽结构PC在IMRT—P计划中的Dmean和V50分别为47．4Gy和4．05％；IMRT-C组的Dmean和V50分别为49．4Gy和5．13％；而2D-CRT组的Dmean和V50分别为57．7Gy和10．6％。结论调强放疗可以有效降低吞咽结构照射剂量从而减少吞咽功能损伤的发生率。OBJECTIVE Swallowing dysfunction is one of the major complications of nasopharyngeal carcinoma after radiotherapy, and there is a large difference in swallowing function injury caused by different radiotherapy technology. The objective of this retrospective study is to investigate the swallowing function protection with intensity modulated radiation therapy （IMRT） in Nasopharyngeal Carcinoma. METHODS Between September 2011 and November 2012, 90 newly diagnosed as NPC without distant metastases stage Ⅰ - Ⅳ patients in our hospital were enrolled. All the patients were divided into protection swallowing structure intensity-modulated radiotherapy group （IMRT-P）,conventional intensity-modulated radiotherapy group （IMRT-C） and 2 D conventional radiotherapy group （2D-CRT）, 30 cases in each group. The swallowing function injury incidence and severity and of the swallow structure radiation dosimetry difference of the radiotherapy plan were compaired in three groups. RESULTS The median follow-up time was 28 months（3- 36 months）. The total incidence of swallowing function damage was 46.7% （42/90）, including IMRT-P group 33.3% （10/30）, IMRT-C group 50.0%（15/30）, 2D-CRT group 76.7%（23/30）, meanwhile, the incidence of severe and moderate damage in IMRT-P group and 2D-CRT group were 0 and 2%, 13% and 7%, respectively. In dosimetry, IMRT-P group＇s pharyngeal constrictor muscle （PC） and throat swallowing （GSF） Dmean （average dose）, V40, V50, V60 were significantly lower than that of IMRT-C group and 2D-CRT group （P〈0.05）. The D and V50 of PC in IMRT-P group and IMRT-C group were 47.4 Gy and 4.05% , 49.4 Gy and 5.13% respectively, while in 2D-CRT group, the D （average dose） and V50 of PC were 57.7 Gy and 10.6% . CONCLUSION Intensity-modulated radiation therapy can effectively reduce the swallowing structure dose thereby reduce the incidence of swallowing function damage.

关 键 词：鼻咽癌 调强放疗 吞咽功能损伤 辐射剂量学 

分 类 号：R739.63[医药卫生—肿瘤]