口腔癌调强放疗中靶区优化对患者口腔黏膜反应、唾液腺功能的影响  

Effects of optimizing target volume on oral mucosal reaction and salivary gland function in oropharyngeal cancer patients undergoing intensity-modulated radiotherapy

作　　者：王润堃 陆汉强[1] 黄秋生[1] WANG Runkun;LU Hanqiang;HUANG Qiusheng(Department of Otolaryngology,Head and Neck Surgery,Affiliated Hospital of Jiangsu University,Zhenjiang 212000,China)

机构地区：[1]江苏大学附属医院耳鼻咽喉-头颈外科,江苏镇江212000

出　　处：《中国医学物理学杂志》2024年第2期145-150,共6页Chinese Journal of Medical Physics

基　　金：江苏省卫生健康委科研项目(Z2020056)。

摘　　要：目的:分析口腔癌调强放疗中靶区优化对患者口腔黏膜反应、唾液腺功能的影响。方法:选择2020年4月至2022年8月江苏大学附属医院收治的120例口腔癌患者,按随机数表法分组。对照组60例,接受常规调强放疗。试验组60例,在调强放疗中对颈部Ⅱ区与口腔靶区进行优化。对比两组调强放疗后3个月疗效、腮腺受量、急性口腔黏膜反应发生率、口干反应发生率与口腔疼痛发生率,并观察放疗前、放疗第4周、放疗结束、放疗后3个月患者腮腺、颌下腺静息状态下表观弥散系数(ADC)值变化。结果:试验组客观缓解率与对照组相比[80.00%(48/60)vs 75.00%(45/60)],差异无统计学意义(P>0.05);试验组健侧腮腺限制平均照射剂量(D_(mean))、V_(34)及口腔D_(mean)、V_(30)均比对照组低(P<0.05);试验组放疗后3个月急性口腔黏膜反应、口干反应与口腔疼痛发生率(41.67%、50.00%、58.33%)均比对照组(75.00%、78.33%、85.00%)低(P<0.05);两组放疗第4周、放疗结束、放疗后3个月腮腺、颌下腺静息状态下ADC值均比放疗前升高(P<0.05);试验组放疗第4周、放疗结束、放疗后3个月腮腺、颌下腺静息状态下ADC值均比对照组低(P<0.05)。结论:口腔癌调强放疗中靶区优化可有效预防相关口腔黏膜炎的发生,降低口腔黏膜反应、口腔疼痛及口干程度,减少腮腺受量,减轻调强放疗对患者唾液腺功能的影响。Objective To analyze the effects of target volume optimization on oral mucosal reaction and salivary gland function in oropharyngeal cancer patients receiving intensity-modulated radiotherapy (IMRT).Methods A total of 120patients with oropharyngeal cancer admitted to Affiliated Hospital of Jiangsu University from April 2020 to August 2022were selected and randomly grouped into control group (n=60,conventional IMRT) and treatment group (n=60,cervical region II and the oral target region were optimized during IMRT).The therapeutic efficacy,parotid gland dose,incidence of acute oral mucosal reaction,dry mouth and oral pain at 3 months after IMRT were compared between two groups.The resting-state apparent diffusion coefficient (ADC) values of parotid and submandibular glands at different time points (before radiotherapy,the 4th week of radiotherapy,the end of radiotherapy and 3 months after radiotherapy) were recorded.Results The difference in the objective reaction rate between two groups was trivial[80.00%(48/60) vs 75.00%(45/60),P>0.05].The mean dose (D_(mean)) and V_(34)of the unaffected parotid gland and the D_(mean)and V_(30)of the oral cavity in treatment group were lower than those in control group (P<0.05).The incidences of acute oral mucosal reaction,dry mouth and oral pain at 3months after radiotherapy in treatment group were 41.67%,50.00%,and 58.33%,lower than those in control group (75.00%,78.33%,and 85.00%)(P<0.05).The resting-state ADC values of parotid and submandibular glands at the 4th week of radiotherapy,the end of radiotherapy,and 3 months after radiotherapy in both two groups were higher than those before radiotherapy (P<0.05).At the 4th week of radiotherapy,the end of radiotherapy,and 3 months after radiotherapy,the restingstate ADC values of parotid and submandibular glands in treatment group were lower than those in control group (P<0.05).Conclusion Optimizing target volume during oropharyngeal IMRT can effectively prevent the occurrence of radiationinduced mucositis,alleviate oral mucosal re

关 键 词：口腔癌 调强放疗 靶区优化 口腔黏膜反应 唾液腺功能 

分 类 号：R739.8[医药卫生—肿瘤] R811.1[医药卫生—临床医学]