同期放化疗治疗局部晚期鼻咽癌对腮腺功能影响的临床研究

Clinical studies of the effect of concurrent chemoradiotherapy on parotid function for locally advanced nasopharyngeal carcinoma

目的:探讨采用同期放化疗治疗局部晚期鼻咽癌对腮腺功能的影响。方法:选择初治的局部晚期鼻咽癌患者共50例,其中实验组25例,进行调强放疗及同期TP方案化疗;另外25例作为对照组,采用单纯放疗;50例患者分别在放疗前、放疗中(照射剂量为30 Gy)、放疗结束时及放疗后6个月采用99mTc O-4腮腺动态SPECT显像测定腮腺的摄取指数(UI)、分泌指数(EI),并进行统计学分析。结果:实验组与对照组腮腺EI值放疗前分别为0.70±0.12、0.65±0.10,放疗中分别为0.24±0.20、0.20±0.11,放疗结束时分别为0.11±0.10、0.15±0.14,随访6个月时分别为0.50±0.15、0.60±0.11,放疗中和放疗结束时两组EI值均比放疗前明显下降,随访6个月时比放疗结束时均有上升,EI值在同一组内不同观测时间点差异有统计学意义(P=0.000),但同一时间点两组之间差异无统计学意义(P>0.05)。实验组UI值在4个时间点分别为5.10±2.28、5.78±2.41、5.48±2.10和4.50±2.24,差异无统计学意义(P=0.070);对照组UI值在4个时间点分别为5.02±2.20、5.68±2.38、5.30±2.20和4.30±2.18,差异无统计学意义(P=0.060),同一时间点两组之间差异也无统计学意义(P>0.05)。结论:采用同期放化疗治疗局部晚期鼻咽癌,主要影响腮腺的分泌功能,而不是摄取功能,并且腮腺功能没有因为同期化疗药物的介入而加重或恢复延迟。

Objective： To explore the effects of concurrent chemoradiotherapy（ CCRT） on parotid function in the treatment of locoregionally advanced nasopharyngeal carcinoma（ NPC）. Methods： 50 patients of locally advanced NPC were selected,including 25 cases in the experimental group,with the intensity modulated radiotherapy（ IMRT） and concurrent chemotherapy; the other 25 cases as control group with IMRT alone. Excretion index（ EI）and uptake index（ UI） of parotids in 50 NPC patients were examined by radionuclide imaging prior to IMRT,at median dose 30 Gy,at the end of radiotherapy,and the fo Ilow-up six months after radiotherapy. The relationship between parotid function（ EI and UI） and concurrent chemoradiotherapy were statistically analyzed. Results：Scintigraphy showed that the EI of parotid in experimental group and control group were 0. 70 ± 0. 12 and 0. 65 ±0. 10,0. 24 ± 0. 20 and 0. 20 ± 0. 11,0. 11 ± 0. 10 and 0. 15 ± 0. 14,0. 50 ± 0. 15 and 0. 60 ± 0. 11 at the beginning,the median dose DT30 Gy,the end of radionuclide,and the follow-up 6 months,respectively. The EI was significantly decreased after radiation as compared to that of pretherapy,and to the lowest level at the end of radiotherapy. During the follow-up time period,a recovery of EI was observed over time,the difference in the different observed points of the same group was statistically significant（ P = 0. 000）; But there was no significant difference in the same observed points between the two groups（ P〉0. 05）. In addition,the UI value of the experimental group in the above 4 time points were 5. 10 ± 2. 28,5. 78 ± 2. 41,5. 48 ± 2. 10 and 4. 50 ± 2. 24 respectively,no difference statistically significant（ P = 0. 070）; While in the control group,the UI value in the above 4 time points were 5. 02 ± 2. 20,5. 68 ± 2. 38,5. 30 ± 2. 20,4. 30 ± 2. 18 respectively,no difference statistically significant（ P = 0. 060）; There was also no significant difference in the same observed points between the two groups（ P〉0. 05）. Conclusion： Adopting the CCRT in the treatment of locally advanced nasopharyngeal carcinoma primarily affects the parotid excretion function,rather than uptake function,and parotid gland function is not aggravated or delayed because of the concurrent chemotherapy drug intervention.