鼻咽癌IMRT后长期存活者晚期损伤及其变化趋势——患者评价和医生评价结果  

The change trend of late complications in patients with nasopharyngeal carcinoma treated by intensity-modulated radiotherapy：the clinician-and patient-reported outcomes

作　　者：张烨 黄晓东 高黎 徐国镇 肖建平 罗京伟 张世平 王凯 曲媛 易俊林 Zhang Ye;Huang Xiaodong;Gao Li;Xu Guozhen;Xiao Jianping;Luo Jingwei;Zhang Shiping;Wang Kai;Qu Yuan;Yi dunlin(Department of Radiation Ontology,National Cancer Center/National Clinical Research Center for Cancer/ Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)

机构地区：[1]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院放疗科,北京100021

出　　处：《中华放射肿瘤学杂志》2018年第8期721-726,共6页Chinese Journal of Radiation Oncology

基　　金：国家重点研发计划（2016YFC0904600）;国家重点研发计划（2017YFC0107500）

摘　　要：目的采用患者评价和医生评价调查鼻咽癌IMRT治疗后存活〉5年患者晚期损伤及其变化趋势。方法2014—2015年我院门诊随访根治性IMRT后存活时间〉5年鼻咽癌患者，并在3年后再次门诊随访调查。晚期损伤的医生评价根据CTCAE4．0标准，患者评价分为“非常好、好、一般、差、非常差”5个等级。结果第1次调查共116例患者，中位随访时间6．5年（5．0～11．3年）。到第2次调查，21例未定期随访，7例出现鼻咽局部复发和转移，7例出现第二原发肿瘤，仅81例患者符合最终分析。第1次调查时医生评价的≥2级晚期损伤以皮下纤维化（17例，21．0％）和听力下降（13例，16．0％）为主；常见的患者评价“差”以及“非常差”晚期损伤以龋齿（27例，33．3％）、皮下纤维化（17例，21．0％）和听力下降（12例，14．8％）。第2次调查时最常见症状加重或新增晚期损伤，分别为听力下降16例（20％）、龋齿16例（20％）和后组颅神经损伤9例（11％）。结论鼻咽癌根治性IMRT治疗后晚期损伤发生率高．长期存恬患者皮下纤维化和听力下降是主要的晚期损伤，随着存活时间延长，听力下降、龋齿和后组颅神经损伤发生率增加，以及部分患者听力下降和龋齿级别加重。Objective To investigate the change trend of late complications of patients with nasopharyngeal carcinoma （NPC） treated with intensity-modulated radiotherapy （IMRT） after 5-year follow up according to the clinician-and patient-reported outcomes. Methods From 2014 to 2015,NPC patients surviving〉 5 years after radical IMRT at our outpatients department and were followed up 3 years later. The late complications were evaluated by the clinician based upon the CTCAE 4.0 rating criteria and assessed by patients themselves into 5 grades including very good, good, fair, poor and very poor. Results A total of 116 NPC patients were included in the first survey with a median follow-up time of 6. 5 years （range, 5.0- 11.3 years）, During the second survey, 21 patients were lost to follow-up, 7 patients developed nasopharyngeal recurrence or metastases, 7 patients had second primary tumors and 81 patients were eligible for final analysis. In the first survey, the most common clinician-reported ≥ grade 2 late complications were subcutaneous fibrosis （ n = 17,21.0%） and hearing impairment （n= 13,16.0%）. The most frequent patientreported ＂poor＂ and ＂very poor＂ late complications included dental caries （n= 27,33.3% ） , subcutaneous fibrosis （ n= 17,21.0%） and hearing impairment （ n= 12, 14. 8%）. During the second survey, the most common complications were aggravated or new late complications occurred including hearing impairment （ n = 16,20. 0% ）, dental caries （ n = 16,20. 0% ） and posterior cranial neuropathy （ n = 9,11.0% ）. Conclusions The incidence of late complications is high after radical IMRT for NPC. During the long-term survival, subcutaneous fibrosis and hearing impairment are the main late complications. The incidence of hearing impairment, dental caries and posterior cranial neuropathy is increased over time. The symptoms of bearing impairment and dental caries are aggravated in partial patients.

关 键 词：鼻咽肿瘤/调强放射疗法 放射性损伤 评价 

分 类 号：R739.63[医药卫生—肿瘤]