头颈癌术后调强放疗后口干症的综合评价

Combined assessment of xerostomia in head and neck cancer patients treated with surgery and postoperative intensity-modulated radiotherapy or conventional radiotherapy

目的:对头颈癌术后调强和常规放疗后的口干症行前瞻性评估,以确定调强放疗预防口干症的效果。方法:82例头颈癌患者(口腔癌71例、口咽癌11例)分别行调强放疗(40例)和常规放疗(42例),在放疗前、后5个时间点,对口干进行综合评估。应用SPSS13.0软件包对数据进行统计学处理。结果:调强组腮腺平均放射剂量(22.21±5.02)Gy显著低于常规放疗组的(50.22±5.86)Gy(P<0.01);调强和常规组在放疗后6个月的中重度口干发生率,分别为RTOG评分法30%和92.9%,上海九院评分法25%和90.5%;口干问卷法15%和83.3%;调强组放疗后6个月时的静态和刺激唾液流为放疗前的51.0%和72.5%,常规组仅为放疗前的3.6%和8.2%(P<0.01);九院口干评分法结果与2种唾液流率均显著相关(r=0.79和0.78,P<0.01)。结论:调强放疗后口干症明显减少,推荐上海九院评分法用于口干症评估。

PURPOSE： This prospective longitudinal study was aimed to evaluate xerostomia in head and neck cancer patients treated with surgery followed by intensity-modulated radiotherapy （IMRT） or conventional radiotherapy （CRT）. METHODS： 82 head and neck cancer patients who received surgery and postoperative radiotherapy were enrolled in this study. For radiation techniques, 40 patients were treated with IMRT and 42 patients were treated with CRT. The xerostomia was evaluated using combined methods at 5 time points before and after RT. SPSS13.0 software package was used for statistical analysis. RESULTS： The mean dose of the parotids in IMRT patients （22.21±5.02Gy） was significantly lower than that in CRT patients （50.22±5.86Gy） （P〈0.01）. At 6-month after radiotherapy, the rates of moderate and severe xerostomia in patients with IMRT and CRT were 30% and 92.9% ,respectively, according to criteria of Radiation Therapy Oncology Group （RTOG）; 25% and 90.5%, respectively, according to criteria of Shanghai Ninth People＇s Hospital; 15% and 83.3%, respectively, according to scores of xerostomia questionnaire （XQ） （all P〈0.01）. The mean unstimulated and stimulated salivary flow rates in patients with IMRT at 6-month were 51.0% and 72.5%, respectively, compared with preradiation levels. Those in patients with CRT were 3.6% and 8.2%, respectively. The subjective score of criteria of Shanghai Ninth People＇s Hospital for xerostomia was in consistent the objective result from the saliva flow rate measurement （r=0.79 and 0.78, respectively, P〈0.01 ）. CONCLUSIONS： Postoperative IMRT reduces significantly postradiation xerostomia in the study. The criteria of Shanghai Ninth People＇s Hospital is easy to use, and it should be recommended for evaluation of xerostomia.