鼻咽癌调强放疗后长期生存患者甲状腺功能状态的研究

Evaluation of Thyroid Function Status in Nasopharyngeal Cancer Patients with Long-term Survival After Intensity-modulated Radiation Therapy

[目的]探讨鼻咽癌调强放疗后长期存活的患者甲状腺功能减退的发生率和影响因素。[方法]收集单治疗组收治的目前仍生存的初治鼻咽癌患者82例,检测患者甲状腺功能,并通过TPS计划系统测算患者甲状腺和垂体的放疗剂量参数。[结果]全组甲状腺功能减退发生率为58.5%(48/82)。单因素分析颈部甲状腺的受照剂量和受照体积对甲状腺功能减退发生有显著影响(P<0.05),而患者的性别、年龄、甲状腺体积、垂体的最大剂量和平均剂量对甲状腺功能减退发生无统计学意义;多因素分析则提示颈部淋巴结转移与否、甲状腺平均剂量是放疗后甲状腺功能减退的影响因素(P<0.05)。[结论]在开展鼻咽癌调强放疗的早期阶段,由于经验不足,放疗后甲状腺功能减退发生率较高;对于鼻咽癌N0、N1的患者,应当合理设计靶区,保护好甲状腺组织。

[Purpose]To investigate the incidence and influencing factors of hypothyroidism in nasohpharyngeal carcinoma （NPC） patients with long-term survival after intensity-modulated radiation therapy（IMRT） . [Methods ] Eighty-two cases of NPC with long-term survival were initially treated with [MRT in our single radiotherapy team. Their thyroid functions were determined,and the radiation dose parameters of thyroid gland and pituitary were remeasured by treatment planning system（TPS）. [ Results] The incidence of hypothyroidism was 58.5% （48/82） in the whole group. The univariate analysis showed that the irradiation dose and volume of neck thyroid gland had significant influence on the occurrence of hypothyroidism（P〈0.05）. Factors that were not statistically significant included：gender, age, volume of thyroid ,the maximum dose and average dose of pituitary. Multivariate analysis showed that the positive cervical lymph nodes and average dose of thyroid gland were influence factors of hypothyroidism after radiotherapy. [Conclusion] In the early stage of using IMRT for NPC,due to lack of experience,the incidence rate of hypothyroidism after radiotherapy is relatively high. It is suggested that IMRT target area should be designed carefully to protect the thyroid tissue,especially in NPC patients with stage No or N1.