同步加量调强放疗在头颈部肿瘤可疑阳性淋巴结治疗中的应用  

The application of the simultaneous modulated accelerated radiotherapy in the treatment of suspected positive lymph nodes in head and neck

作　　者：高山[1] 梁锦辉[2] 岳成山 胡勇[1] 李冬[1] 刘亚军[1] 董学良[1] Gao Shan;Liang Jinhui;Yue Chengshan;Hu Yong;Li Dong;Liu Yajun;Dong Xueliang(Department of Radiotherapy,Hanzhong Central Hospital,Shaanxi Hanzhong 723000,China;Department of Otolaryngology Head and Neck Surgery,Hanzhong Central Hospital,Shaanxi Hanzhong 723000,China)

机构地区：[1]陕西省汉中市中心医院放疗科,723000 [2]陕西省汉中市中心医院耳鼻咽喉头颈外科,723000

出　　处：《中国医师进修杂志》2021年第9期783-789,共7页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨同步加量调强放疗技术在头颈部肿瘤可疑阳性淋巴结治疗中的临床疗效及应用价值。方法选取2017年1月至2019年2月在陕西省汉中市中心医院接受治疗可疑阳性淋巴结的头颈部肿瘤患者60例,按照治疗方案不同分为试验组和对照组,每组30例。试验组采用同步加量调强放疗技术给予患者63.36~66.66 Gy进行治疗,对照组给予常规颈部预防照射剂量54.12~60.06 Gy治疗。观察两组患者可疑阳性淋巴结最大横截面短径大小的变化,分析两组患者治疗过程中的不良反应,以评估该方法的可行性。结果治疗前两组间患者可疑阳性淋巴结最大横截面短径比较差异无统计学意义(P>0.05)。治疗结束后,两组可疑阳性淋巴结最大横截面短径均较治疗前缩小,试验组淋巴结最大横截面短径与治疗前水平出现缩小[(0.43±0.07)cm比(0.72±0.10)cm],差异有统计学意义(P<0.05);对照组治疗后可疑阳性淋巴结最大横截面短径较治疗前下降,差异无统计学意义(P>0.05)。治疗后试验组可疑阳性最大横截面短径缩小程度较对照组明显[(0.43±0.07)cm比(0.66±0.08)cm],两组患者间可疑阳性最大横断面短径比较差异有统计学意义(t=11.523,P<0.05)。治疗前两组患者血红蛋白(HGB)水平均处于正常生理范围,组间比较均差异无统计学意义(P>0.05);治疗后不同时刻两组白细胞水平[第1周:(7.83±2.53)×10^(9)/L比(8.26±3.16)×10^(9)/L、第3周:(7.14±3.65)×10^(9)/L比(7.08±2.53)×10^(9)/L、第5周:(5.47±2.81)×10^(9)/L比(6.41±2.57)×10^(9)/L、第7周(4.36±2.59)×10^(9)/L比(4.98±1.64)×10^(9)/L]比较差异有统计学意义(P<0.05),提示治疗过程中两组白细胞指标水平均呈逐渐降低趋势,且试验组降低程度高于对照组。两组患者治疗前及治疗后不同监测时刻的HGB和血小板均维持在正常生理范围内,比较差异无统计学意义(P>0.05)。试验组患者治疗过程中出现的相关性并发症以口�Objective To explore the clinical effect and application value of simultaneous modulated accelerated radiotherapy(SMART)in the suspicious positive lymph nodes of head and neck.Methods From January 2017 to February 2019,60 patients with suspected positive lymph nodes in the head and neck in the Hanzhong Central Hospital of Shaanxi Province were divided into experimental group and control group according to different treatment plans,and 30 patients in each group were included.In the experimental group,63.36 to 66.66 Gy patients were treated with SMART,while in the control group,54.12 to 60.06 Gy patients were treated with conventional neck prophylactic radiation.In order to evaluate the feasibility of the method,the change of the short diameter of the largest cross section of the suspicious positive lymph nodes in the two groups were observed,and the adverse reactions in the treatment of the two groups were analyzed.Results There was no significant difference between the two groups before treatment(P>0.05).After treatment,the size of short diameter of lymph nodes in the two groups was smaller than that before treatment.The maximum short diameter of the largest cross section of lymph nodes in the experimental group was smaller than that before treatment:(0.43±0.07)cm vs.(0.72±0.10)cm,and the difference was statistically significant(P<0.05).In the control group,the maximum short diameter of the largest cross section of lymph node decreased after treatment,and the difference was not statistically significant(P>0.05).After treatment,the reduction of the short diameter in the experimental group was more obvious than that in the control group.The maximum short diameter of the largest cross section between the two groups:(0.43±0.07)cm vs.(0.66±0.08)cm was statistically significant(t=11.523,P<0.05).Before treatment,hemoglobin(HGB)levels of the two groups were in the normal physiological range,and there was no significant difference between the two groups(P>0.05);the white blood cell(WBC)levels of the two groups at diff

关 键 词：头颈部肿瘤 同步加量调强放疗 可疑阳性淋巴结 临床治疗 

分 类 号：R739.91[医药卫生—肿瘤]