鼻咽癌Ⅱb区优化对唾液腺保护及远期口干改善的作用  

Long-term follow-up of salivary gland protection and improvement of late xerostomia by optimizing clinical target volume in IIB region of nasopharyngeal carcinoma

作　　者：周佳伟 王力[1] 邱婷[1] 高瀚 黄生富[1] 何侠[1] 吴俚蓉 Zhou Jiawei;Wang Li;Qiu Ting;Gao Han;Huang Shengfu;He Xia;Wu Lirong(Department of Radiation Oncology,Affiliated Cancer Hospital of Nanjing Medical University&Jiangsu Cancer Hospital&Jiangsu Institute of Cancer Research,Nanjing 210009,China)

机构地区：[1]南京医科大学附属肿瘤医院/江苏省肿瘤医院/江苏省肿瘤防治研究所放疗科,南京210009

出　　处：《中华放射肿瘤学杂志》2023年第9期791-797,共7页Chinese Journal of Radiation Oncology

基　　金：国家自然科学基金(82003232);江苏省第六期“333工程”优秀青年人才项目;江苏省肿瘤医院临床科技攀登计划-“求真”临床研究专项(ZL202207)。

摘　　要：目的探索临床靶区(CTV)优化对鼻咽癌患者长期生存与远期口干的影响。方法回顾性分析2015年1月至2018年11月江苏省肿瘤医院(简称苏肿)收治的763例接受调强放疗(IMRT)的鼻咽癌患者,分为CTV优化组与CTV常规组。应用倾向评分匹配(PSM)以平衡基线特征的分布。使用美国肿瘤放射治疗协作组(RTOG)/欧洲癌症治疗研究组织(EORTC)口干评估标准和苏肿多维度放射性口干评估量表,分别评估患者的口干程度。用Kaplan-Meier法进行生存分析,比较两组患者的口干程度差异采用秩和检验,比较唾液腺剂量参数采用独立样本t检验,单因素、多因素回归分析生存及口干的影响因素。结果PSM前后CTV常规组与CTV优化组在总生存、无局部复发生存、无远处转移生存和无进展生存方面差异均无统计学意义。两组的RTOG/EORTC 2级以上晚期口干发生率差异无统计学意义,而苏肿多维度口干评估量表晚期口干发生率CTV优化组低于CTV常规组(P<0.05)。优化后双侧腮腺D_(mean)和V_(26 Gy)、双侧下颌下腺D_(mean)和V_(39 Gy)、舌下腺和口腔D_(mean)均低于常规计划(P<0.001)。单因素分析显示肿瘤分期、T分期、N分期为总生存的独立影响因素,多因素分析表明肿瘤分期为总生存的独立影响因素。舌下腺D_(mean)为夜间睡眠口干的危险因素。结论鼻咽癌IMRT中Ⅱb区CTV优化可以在保证长期生存的前提下更好地保护唾液腺,降低远期放射性口干的发生率。Objective To explore the effect of clinical target volume(CTV)optimization on long-term survival and late xerostomia of patients with nasopharyngeal carcinoma(NPC).Methods Clinical data of 763 patients with NPC treated with intensity-modulated radiotherapy(IMRT)in the Jiangsu Cancer Hospital from January 2015 to November 2018 were retrospectively analyzed.All patients were divided into the modified and conventional CTV groups.Propensity score matching(PSM)was applied to balance the distribution of baseline features.The degree of xerostomia was evaluated by Radiation Therapy Oncology Group(RTOG)/European Organisation for Research and Treatment of Cancer(EORTC)standard and Jiangsu Cancer Hospital Multi-dimensional Radiotherapy-Induced Xerostomia scale.Survival analysis was performed by Kaplan-Meier method.The difference of xerostomia between two groups was compared by rank-sum test.The dose parameters of salivary glands were compared by independent sample t-test.Prognostic factors of survival and xerostomia were assessed by univariate/multivariate regression analyses.Results There were no significant differences in overall survival,local recurrence-free survival,distant metastasis-free survival and progression-free survival between conventional and modified CTV groups before and after PSM.There were no significant differences in the incidence of late xerostomia above grade 2 of RTOG/EORTC standard between two groups.Using multi-dimensional scale criteria,NPC patients in the modified CTV group developed less late xerostomia than those in the conventional CTV group(P<0.05).D_(mean)and V_(26 Gy)of bilateral parotid glands,D_(mean)and V_(39 Gy)of bilateral submandibular glands,and D_(mean)of sublingual glands and mouths were reduced after optimization of CTV(all P<0.001).Univariate analysis showed that clinical staging,T staging and N staging were the independent prognostic factors of overall survival.Multivariate analysis demonstrated that clinical staging was the independent prognostic factor of overall survival.The

关 键 词：鼻咽肿瘤 临床靶区 调强放射疗法 放射性口干 长期生存 

分 类 号：R739.63[医药卫生—肿瘤]