勾画颌下腺在鼻咽癌三维调强适形放疗中对患者放疗后口干和生活质量的影响

Influence of submandibular gland contouring on the xerostomia and quality of life of patients undergoing three-dimensional intensity modulated radiotherapy for nasopharyngeal carcinoma

目的探究勾画颌下腺在鼻咽癌三维调强适形放疗(intensity modulated radiation therapy,IMRT)中对患者放疗后口干和生活质量的影响。方法选择2015年4月—2017年4月间于温州医科大学附属第三医院行放疗的鼻咽癌患者72例,按随机数表法分为对照组(36例)和实验组(36例),对照组采用常规IMRT,实验组采用在勾画颌下腺并限制颌下腺剂量的基础上进行IMRT,比较2组患者颌下腺平均受照剂量(Dmean)、放疗后颌下腺体积、放疗后口干症状分级和唾液分泌量以及生活质量的差异。结果2组患者患侧Dmean均显著高于健侧(均P<0.05);放疗后对照组患侧颌下腺体积显著低于健侧(P<0.05);实验组健侧和患侧Dmean均显著低于对照组(均P<0.05),且颌下腺体积均明显高于对照组(P<0.05);实验组放疗后不同时间的口干症状分级均明显低于对照组(均P<0.05)。实验组放疗后的基础和刺激唾液分泌量均显著高于对照组(均P<0.05);实验组的各项生活质量领域和总分均显著高于对照组(均P<0.05)。结论在鼻咽癌三维调强适形放疗中采取勾画颌下腺并行剂量限制可以有效降低患者颌下腺的受照射剂量,提高患者放疗后唾液分泌量,降低放疗后口干程度,显著改善患者生活质量。

Objective To investigate the effects of submandibular gland contouring on dry mouth and quality of life after three-dimensional intensity modulated radiation therapy ( IMRT) in patients with nasopharyngeal carcinoma. Methods Total 72 patients with nasopharyngeal carcinoma who underwent radiotherapy in our hospital from April,2015 to April, 2017 were randomly divided into the control group ( 36 cases) and the experimental group ( 36 cases) . The control group received conventional IMRT,while the experimental group received IMRT on the basis of contouring the submandibular gland and limiting the dose of the submandibular gland. The average dose of the submandibular gland ( D mean ) ,the volume of the submandibular gland after radiotherapy,the classification of dry mouth symptoms and the amount of saliva secretion and quality of life after radiotherapy were compared. Results The D mean of the two groups was significantly higher than that of the healthy side ( P < 0. 05) . The volume of the submandibular gland in the control group was significantly lower than that of the healthy side after radiotherapy ( P < 0. 05) . The D mean of the healthy side and the affected side of the experimental group were significant. The volume of the submandibular gland was significantly higher than that of the control group ( P < 0. 05) . The grade of dry mouth symptoms in the experimental group was significantly lower than that of the control group ( P < 0. 05) . The basis and stimulation of saliva secretion in the experimental group were significantly higher than those in the control group ( P < 0. 05) . The quality of life and total scores in the experimental group were significantly higher than those in the control group ( P < 0. 05) . Conclusion The submandibular gland contouring in threedimensional IMRT for nasopharyngeal carcinoma can reduce the dose of submandibular gland in patients with submandibular gland,increase the amount of saliva secretion and reduce the degree of dry mouth after radiotherapy,and significantly improve the quality of life of patients.