口咽癌放疗中颈部Ⅱ区和口腔靶区优化对涎腺功能及口腔黏膜反应的影响  

Effects of cervical regionⅡand oral target area optimization on salivary gland function and oral mucosal response during radiotherapy for oropharyngeal carcinoma

作　　者：张涛[1] 徐海亭[1] 许晶 丁曼华 杜傲男[1] 张朦 惠华[1] 王强[1] Zhang Tao;Xu Haiting;Xu Jing;Ding Manhua;Du Aonan;Zhang Meng;Hui Hua;Wang Qiang(Department of Radiation Therapy,Xuzhou Cancer Hospital,Xuzhou 221000,China)

机构地区：[1]徐州市肿瘤医院放疗科,徐州221000

出　　处：《肿瘤研究与临床》2022年第2期120-123,共4页Cancer Research and Clinic

基　　金：徐州市科技计划(重点研发计划) (KC19180)。

摘　　要：目的:观察口咽癌调强放疗(IMRT)中颈部Ⅱ区及口腔靶区优化对治疗效果、涎腺功能、口腔黏膜反应的影响。方法:选取徐州市肿瘤医院2012年1月至2017年5月收治的口咽鳞状细胞癌患者50例,采用随机数字表法分为常规放疗组(对照组)25例及口腔、颈部靶区优化组(观察组)25例。两组均采用IMRT同步铂类药物化疗,对照组行双侧颈部Ⅱ~Ⅳ区淋巴引流区照射(颈部淋巴结阳性侧包括Ⅰ B区),双侧颈部Ⅱ区给予肿瘤剂量60 Gy照射(阳性淋巴结予推量照射);观察组进行靶区优化,其中健侧颈部(无阳性淋巴结侧)Ⅱ B区给予肿瘤剂量50 Gy照射;观察组口腔结构勾画为危及器官并限制平均照射剂量(D mean)<32 Gy。比较两组患者腮腺受照射剂量、急性口腔黏膜反应情况、远期(放疗结束6个月以后)口干反应情况、客观缓解率(ORR)、局部复发率(LRR)、3年总生存(OS)率差异。 结果:对照组健侧腮腺D mean为(29±4)Gy,接受34 Gy照射体积占比(V 34)为(48±5)%;观察组健侧腮腺D mean为(23±3)Gy,V 34为(41±5)%;两组比较差异均有统计学意义( t值分别为6.14、4.98,均 P<0.05)。对照组口腔D mean为(35±6)Gy,接受30 Gy照射体积占比(V 30)为(36±5)%;观察组口腔D mean为(29±4)Gy,V 30为(28±4)%;两组比较差异均有统计学意义( t值分别为4.11、5.98,均 P<0.05)。对照组≥Ⅱ级急性口腔黏膜不良反应和口腔黏膜反应持续时间≥2周发生率分别为64%(16/25)和76%(19/25),观察组分别为36%(9/25)和40%(10/25),两组比较差异均有统计学意义( χ^(2)值分别为3.92、6.65, P值分别为0.048、0.009)。≥Ⅱ级远期口干反应对照组为72%(18/25),观察组为44%(11/25),两组比较差异有统计学意义( χ^(2)=4.02, P=0.044)。对照组ORR、LRR、3年OS率为分别为80%、28%、48%,观察组分别为76%、24%、44%,两组OS差异无统计学意义( χ^(2)=0.04, P=0.849)。 结论:口咽癌IMRT中口腔及颈部Ⅱ区靶区优化能改善涎腺功能Objective To observe the effects of cervical regionⅡand oral target area optimization on therapeutic efficacy,salivary gland function and oral mucosal response during intensity modulated radiation therapy(IMRT)for oropharyngeal cancer.Methods A total of 50 patients with oropharyngeal squamous cell carcinoma in Xuzhou Cancer Hospital from January 2012 to May 2017 were collected.According to the random number table,they were divided into normal radiotherapy group(the control group),oral and cervical target area optimization group(the observation group),25 cases in each group.Both groups were treated with IMRT and platinum-chemotherapy.The control group received bilateral cervical regionⅡ-Ⅳlymphatic drainage area irradiation(the positive side of the cervical lymph node includedⅠB region),and bilateral cervical regionⅡwas given a tumor dose of 60 Gy(positive lymph nodes were given intensified irradiation);the observation group was optimized for the target area,and the contralateral cervical regionⅡB(the side with no positive lymph node)was given a tumor dose of 50 Gy;the observation group's oral structure was delineated as an organ at risk and the average radiation dose(Dmean)was limited to<32 Gy.The differences in radiation dose of parotid gland,acute oral mucosal reaction and long-term xerostomia(6 months after the end of radiotherapy),objective remission rate(ORR),local recurrence rate(LRR),3-year overall survival(OS)were compared between the two groups.Results In the control group,the contralateral parotid gland Dmean was(29±4)Gy,the proportion of irradiation volume exposed to 34 Gy(V34)was(48±5)%;in the observation group,contralateral parotid gland Dmean was(23±3)Gy,V34 was(41±5)%,and there are statistically significant differences between the two groups(t values were 6.14,4.98,all P<0.05).In the control group,oral Dmean was(35±6)Gy,the proportion of volume exposed to 30 Gy(V30)was(36±5)%;in the observation group oral Dmean was(29±4)Gy,V30 was(28±4)%,and there were statistically significant d

关 键 词：口咽肿瘤 放射疗法 调强适形 涎腺功能 辐射损伤 靶区优化 

分 类 号：R739.63[医药卫生—肿瘤]