鼻咽癌调强放疗与常规放疗后放射性鼻窦炎发生率的对比研究

Comparison of Sinusitis Complication between Intensity Modulated Radiotherapy and Two-dimensional Conventional Radiotherapy in Nasopharyngeal Carcinoma Patients

目的对比鼻咽癌调强放疗和常规放疗后放射性鼻窦炎的发生情况,探讨调强放疗在减少放射性鼻窦炎上的优势。方法收集本院2006年6月—2010年6月210例初治鼻咽癌患者,其中调强组(IMRT组)108例,常规组(2D-CRT组)102例。通过MRI和CT观察其放疗前后鼻窦的影像学改变。结果随访1～42月,中位随访9月。放疗后调强组鼻窦炎总发生率为72.2%,常规组为84.3%,差异有统计学意义(χ2=4.483,P=0.034),其中T3+T4期的鼻咽癌患者调强组放疗后的放射性鼻窦炎发生率明显低于常规组,两组发生率分别为68.3%和87.2%,差异有统计学意义(χ2=4.349,P=0.036)。放疗后,调强组上颌窦炎、筛窦炎、蝶窦炎、额窦炎的发生率分别为62.0%、47.8%、40.7%、19.4%;常规组分别为52.9%、53.9%、32.4%、8.9%,其中调强组的额窦炎发生率明显高于常规组,差异有统计学意义(χ2=4.837,P=0.028)。结论与常规放疗相比调强放疗后放射性鼻窦炎发生率明显降低,尤以T晚期明显。但调强放疗后的放射性鼻窦炎发生率仍然有较高的发生水平,尤其放射性鼻窦炎的发生率较常规放疗明显升高。

Objective To compare the sinusitis complication of Intensity Modulated Radiotherapy（IMRT） with those of Two-Dimensional Conventional Radiotherapy（2D-CRT） in the treatment of patients with nasopharyngeal carcinoma（NPC） and to determine whether IMRT can reduce the sinusitis of NPC patients after radiotherapy.Methods A retrospective review of data from 210 patients,treated in The First Affiliated Hospital of Guangxi Medical University from June,2006 to June,2010 was made.The sinusitis were diagnosed by MRI.All patients with nasopharyngeal carcinoma were diagnosed by pathology.Of 210 NPC patients,108 were treated by IMRT（IMRT group） and 102 by 2D-CRT（2D-CRT group）.Results All patients were followed-up 1 to 42 months and the median time was 9 months.IMRT group（72.2%）had a significantly lower occurrence rate of sinusitis than 2D-CRT group（84.3%）（P0.05）,and especially in T3＋T4 patients in IMRT group（68.3%） compared with 2D-CRT group（87.2%）（P0.05）.The occurrence rates of sinusitis of Maxillary sinusitis,ethmoid sinusitis,sphenoid sinusitis,frontal sinusitis in IMRT group were 62.0%,47.8%,40.7%,19.4% and 2D-CRT group were 52.9%,53.9%,32.4%,8.9%,respectively.Occurrence rate of frontal sinusitis in IMRT group washigher than that in 2D-CRT group（19.4% vs.8.9%,P0.05）.Conclusions Intensity modulated radiotherapy was able to reduce the radioactive sinusitis,especially T3 and T4,although with a higher prevalence of frontal sinus.