调强和常规放疗对头颈部癌患者生存质量影响评估

A prospective study on quality of life in patients with head and neck cancer treated by intensity-modulated radiotherapy versus conventional radiotherapy

目的前瞻性评估调强和常规放疗对头颈部癌患者生存质量（QOL）的影响和差异以指导临床。方法2007-2008年102例头颈部癌患者（口腔癌76例，口咽癌14例，鼻咽癌11例，颈部转移癌1例）在上海第九人民医院放疗科接受放疗，其中IMRT组52例，至少保护一侧腮腺，其中24例加对侧颌下腺保护；常规放疗组50例，不保护唾液腺。采用EORTCQLQ-C30和头颈部癌HN35通用量表，在放疗前，放疗结束日，放疗后2、6个月对患者QOL中33个领域进行评估，以10分以上的得分变化为有临床意义。结果调强和常规放疗造成头颈部癌患者QOL94％（31／33）领域下降，其中49％（16／33）显著下降（U=2．72～5．98，P值均〈0．01），33％（11／33）的下降有临床意义；放疗后2个月有12％（4／33）领域出现有临床意义的恢复，但15％（5／33）领域尚未恢复（U=3．10—5．93，P值均〈0．01）；放疗后6个月QOL继续改善，有21％（7／33）领域出现有统计学和临床意义的恢复，并优于放疗前，但在口干和唾液粘稠症状2个领域尚未恢复（U=4．49、4．87，P〈0．01、0．01）。IMRT对口干和唾液粘稠领域的影响比常规放疗明显小（U=4．57、5．57，P值均〈0．01），并在放疗后持续改善，常规放疗未见改善，组间有非常显著性差异（U=7．23、7．57，P值均〈0．01）。结论放疗造成头颈部癌患者QOL显著下降，放疗后出现持续性恢复，但口干和唾液粘稠症状恢复差，是影响QOL的主要原因。IMRT优点是对口干和唾液粘稠症状影响明显小于常规放疗，对保存QOL意义重大。

Objective To prospectively assess the influence of intensity-modulated radiotherapy （IMRT） and conventional radiotherapy on quality of life （QOL） in patients with head and neck cancer （HNC） for clinical guidance. Methods From May 2007 to May 2008, 102 HNC patients were enrolled in this study. Fifty-two patients were treated with IMRT and 50 with conventional radiotherapy. In patients with IMRT, at least one parotid gland was spared, and the contralateral submandibular gland was spared in 24 patients. The parotid and submandihular gland were not spared in patient with conventional radiotherapy. QOL was assessed using EORTC QLQ c30 and HN35 questionnaires at 4 time points （ before radiotherapy, end of radiotherapy, 2 months and 6 months after radiotherapy）. A change of 10% in scores of the instrument range had been previously demonstrated to be clinically significant. Results In the study, 94% （31/33） of the QOL domains were worse after IMRT or conventional radiotherapy, including 49% （16/33） with significant difference （ U = 2.72 - 5.98, all values of P 〈 0.01 ） and 33% （ 11/33 ） with clinical significance. At 2 months after radiotherapy, 12% （4/33） of the domains showed clinically significant improvement, however, 15% （5/33） of the domains did not show any improvement （ U = 3.10 -5.93, all value of P 〈 0.01 ）. Continuous improvement in most domains of QOL was shown at 6 months after radiotherapy. Clinically and statistically significant improvement were shown in 21% （ 7/33 ） of the domains, and some were evenbetter than pretreatment except in dry mouth and sticky saliva scales （ U = 4.49 , P 〈 0.01 and U 4.87 ,P 〈 0.01 ）. Compared with conventional radiotherapy, the dry mouth and sticky saliva caused by IM-RT were milder （ U = 4.57, P 〈 0.01 and U = 5.57, P 〈 0.01 ） and continuous improvement were shown over time after radiotherapy （ U = 7.23, P 〈 0.01 and U = 7.57, P 〈 0.01 ）. Similar improvement weren＇t shown in patients with conventional radiotherapy. Conclusions QOL in HNC patients is significant worse after radiotherapy. QOL can be improved continuously over time after treatment except dry mouth and sticky saliva which are the main factors affecting QOL. IMRT, causing less dry mouth and sticky saliva when compared with conventional radiotherapy, has benefits for the preservation of QOL.