个性化口腔定位支架在头颈部肿瘤患者调强放疗中的应用  

Study on the application of personalization customized oral positioning stent in head and neck cancer patients with intensity modulated radiation therapy

作　　者：陈枫 朱磊 朱锡旭[3] 张朦[3] 臧圣奇[2] 穆睿[2] 沈君姝[3] 周晗[3] 史小蕾[2] 金磊[2] 

机构地区：[1]军事口腔医学重点实验室,口腔疾病国家临床医学研究中心,陕西省口腔疾病重点实验室,第四军医大学口腔医院修复科,西安710032 [2]南京大学医学院附属金陵医院(南京军区南京总医院)口腔科,南京210002 [3]南京大学医学院附属金陵医院(南京军区南京总医院)放疗科,南京210002

出　　处：《医学研究生学报》2017年第5期491-494,共4页Journal of Medical Postgraduates

基　　金：国家自然科学基金(81571817);全军后勤科研研究面上项目(CNJ14C005);江苏省自然科学基金(BK20140031);江苏省“六大人才高峰”D类资助(2014-WSN-054)

摘　　要：目的头颈部肿瘤放疗患者常出现口腔黏膜炎、口干、疼痛吞咽困难等口腔并发症。文中旨在探讨鼻咽癌放疗患者应用个性化口腔定位支架,对于将正常组织推离高剂量靶区并保持精确可重复的稳定位置,进而达到保护肿瘤周围口腔正常组织的作用。方法收集2016年3月至同年8月期间于南京总医院放疗科接受治疗的初治鼻咽癌患者15例,并随机分为试验组和对照组。2组患者均采用调强放疗(IMRT)。试验组患者制作个性化口腔定位支架,并在放疗期间佩戴;对照组无处理。待放疗结束后比较两组患者临床靶区(CTV)和口腔正常组织的受照剂量。结果试验组与对照组左侧腮腺平均受照剂量分别为(2 223.56±294.55)和(2 900.56±374.66)cGy,差异有统计学意义(t=3.847,P=0.002);右侧腮腺平均受照剂量分别为(2 284.96±256.67)和(2 994.67±339.26)cGy,差异有统计学意义(t=4.512,P=0.001)。2组患者CTV平均受照剂量差异无统计学意义[(6142.83±135.99)cGy vs(6221.83±173.31)cGy,t=0.971,P=0.349]。结论佩戴个性化口腔定位支架的鼻咽癌放疗患者在调强放疗时可保持上下颌处于精确可重复的稳定位置,并在不影响临床靶区放疗效果的同时减少双侧腮腺的受照剂量。Objective Head and neck cancer radiotherapy patients often appear a series of oral complications including mucositis,xerostomia,pain,dysphagia. The purpose of this study was to investigate whether personalization customized positioning oral stent was able to push normal tissue off the high dose target area and maintain accurate repeatable stable positions,thus protecting the normal tissue during radiotherapy of the nasopharyngeal carcinoma patients.Methods 15 newly diagnosed nasopharyngeal carcinoma patients were collected from March to August 2016 in Department of Radiation Oncology,Nanjing General Hospital of Nanjing Military Region and randomly divided into trial group and control group. Two groups of patients were treated with intensity modulated radiation therapy（ IMRT）. Trial group patients wear personalization customized oral positioning stents during radiotherapy while the control group did not wear. After radiotherapy,we compared the exposure doses of clinical target area（ CTV） and normal oral tissue in two groups. Results The left parotid gland radiotherapy doses of the trail group and the control group were 2 223.557±294.549 c Gy and 2 900.563±374.660 c Gy,the difference was statistically significant（ t = 3.847,P = 0.002）; the right parotid gland radiotherapy doses of the trail group and control group were 2 284.957± 256. 673 c Gy and 2 994. 670 ± 339. 264 c Gy,the difference was statistically significant（ t = 4. 512,P =0.001）. The mean exposure doses of CTV in two groups were no statistically significant difference（ 6 142. 829 ± 135. 986 c Gy vs173.306±6 221.825 c Gy,t = 0.971,P = 0.349. Conclusion During the intensity modulated radiation therapy,patients with personalization customized oral positioning stents can keep the mandible in a precise repeatable stable position. And it can reduce the exposure dose of bilateral parotid without affect the radiotherapy effect of the clinical target area.

关 键 词：鼻咽癌 调强放疗 个性化口腔定位支架 口干症 

分 类 号：R739.8[医药卫生—肿瘤]