鼻咽癌调强放疗与三维适形放疗患者生命质量的比较

Quality of life after intensity-modulated radiotherapy versus 3-dimensional conformal radiotherapy for nasopharyngeal carcinoma

目的通过与三维适形放疗比较,探讨调强放疗对鼻咽癌患者生命质量的影响,并分析鼻咽癌患者总体生命质量影响因素。方法以2010年1月至2012年12月我科室行三维适形放疗或者调强放疗的初治鼻咽癌患者为研究对象,采用QLQ-H&N65的中文版本调查表分别对两组患者治疗结束时(观察急性放射治疗反应),治疗结束后3个月(观察亚急性放射治疗反应),治疗结束后1年(观察慢性反应)的生命质量进行问卷调查。结果与三维适形放疗比较,调强放疗改善了总体生命质量、社会功能、口干、吃饭、牙齿问题、唾液黏稠、张口受限、体重下降,两者比较差异有统计学意义(P<0.05),并且家庭经济情况可影响患者的生命质量(P<0.05)。经过Logistic回归分析,结果提示:治疗方式与总体生命质量呈正相关,调强放疗组优势比为2.68,未接受化疗患者与接受化疗患者的优势比为2.39,经济收入所占优势比为1.65,年龄所占优势比为1.76。结论与三维适形放疗比较,调强放疗改善了患者总体生命质量、社会功能、口干、吃饭、牙齿问题、唾液黏稠、张口受限、体重下降;放疗方式、化疗、经济收入、年龄是患者总体生命质量的影响因素。

Objective To directly compare the treatment outcomes of intensity-modulated radiotherapy（IMRT） with that of 3-dimensional conformal radiotherapy and explore the risk factors of quality of life. Methods We studied the quality of life （QOL） of patients who either received intensity-modulated radiotherapy（IMRT） or 3-dimensional conformal radiotherapy （3DCRT） by the Chinese version of the QLQ-H＆amp;N65 questionnaires at the end of treatment（to observe the acute radiation reaction）, in the three months after the end of treatment （to observe sub acute radiation reaction）, at the end of treatment for a year （to observe the chronicity radiation reaction separately）. Results Patients treated with IMRT had a statistically significant improvement in global QOL, social function, dry mouth, dinner function, tooth function, saliva ropiness level, limitation of mouth opening, body weight decrease and so on （P〈0.05）. And family economic conditions could affect the QOL of patients （P〈0.05）. Logistic regression analysis showed that there was a positive correlation between IMRT and global QOL, the odds ratio of IMRT was 2.68, the odds ratio of patients no accepted chemotherapy was 2.68, the odds ratio of economic income was 1.65, the odds ratio of age was 1.65. Conclusion Compared with CRT, IMRT improved the index of global QOL, social function, dry mouth, dinner function, tooth function, saliva ropiness level, limitation of mouth opening, body weight decrease. The major factors influencing global QOL were radiotherapy technique, chemotherapy, economic income and age.