调强适形放疗中优化靶区勾画对不同分期鼻咽癌患者吞咽功能的保护作用

The protective effect of optimized target delineation in intensity modulated radiation therapy on swallowing function in patients with different TNM staging of nasopharyngeal carcinoma

目的:研究调强适形放疗(IMRT)中优化靶区勾画对不同TNM分期鼻咽癌患者吞咽功能的影响。方法:将50例鼻咽癌患者按数字表法随机分为实验组及对照组,每组25例,所有患者均接受IMRT治疗。对照组患者仅进行常规靶区勾画,实验组患者在对照组的基础上增加对吞咽相关部位的勾画。然后分别比较放疗期间及放疗后两组患者的吞咽困难程度、口干程度、体重减轻量以及生活质量变化情况。结果:放疗期间,Ⅱ期患者吞咽困难程度无显著变化,而Ⅲ期及Ⅳ期患者的吞咽困难程度随放疗时间增长有不同程度增加;放疗结束后,对照组患者吞咽困难程度无显著变化,而与放疗结束第0周比较,实验组Ⅱ期患者在第12周出现显著好转(P<0.05),而Ⅲ期及Ⅳ期患者均在放疗结束后第24周出现显著好转(P<0.05)。两组患者在放疗期间及放疗结束后,口干症状均不同程度持续加重(P<0.05或P<0.01)。两组患者在放疗期间的体重随着放疗时间的增长不断减轻,并在放疗结束后开始逐渐恢复,且实验组患者在第12周及第24周体重减轻量均显著低于同期对照组(P<0.05)。在放疗期间,与放疗开始第0周比较,两组患者的生活质量评分随着放疗时间的增加越来越低;在放疗结束后生活质量均开始逐渐好转,且在放疗结束后第24周实验组患者生活质量评分显著高于对照组(P<0.05)。结论:在鼻咽癌患者放疗期间对其与吞咽功能相关的结构器官给予个体化的靶区勾画有助于减少患者因放疗引起的吞咽困难发生,并改善放疗后的生活质量。

Objective：To investigate the protective effect of optimized target delineation in intensity modulated radiation therapy（IMRT）on swallowing function in patients with different TNM staging of nasopharyngeal carcinoma.Method：Fifty patients with nasopharyngeal carcinoma were enrolled in this study.They were randomly divided into 25 cases of experimental group and 25 cases of control group by random number table and received IMRT treatment.Patients in control group only received routine delineation of target areas,the patients in experimental group were given the delineation of the relevant parts of the swallowing on the basis of the control group.And then,the degree of dysphagia,xerostomia,weight loss,and quality of life were assessed in the two groups of patients during and after IMRT.Result：There was no significant change in the degree of dysphagia in stageⅡ patients during radiotherapy,but the degree of dysphagia in stageⅢ and Ⅳ patients increased with the increase of radiotherapy time.After the end of radiotherapy,there was no significant change in the degree of dysphagia in the control group of patients.Compared with the 0 th week after the end of radiotherapy,the stageⅡ patients in experimental group showed significant improvement in week 12（P0.05）,while the stage Ⅲ and Ⅳ patients showed significant improvement in week 24 after radiotherapy（P0.05）.The degree of xerostomia of two groups of patients continued to increase with varying degrees during and after IMRT（P0.05 or P0.01）.The weight of the two groups of patients during radiotherapy continued to decrease with the increase of radiotherapy time,and gradually recovered after the end of radiotherapy.And in the experimental group,the weight loss was significantly lower in week 12 and week 24 than in the control group（P0.05）.During radiotherapy,the quality of life scores of the two groups became lower and lower with the increase of radiotherapy time compared with the0 th week of radiotherapy.After the end of radiotherapy,the quality of life began to gradually improve,and in week 24 after the end of radiotherapy,the quality of life of the experimental group of patients was significantly higher than that of the control group（P0.05）.Conclusion：During radiotherapy of patients with nasopharyngeal carcinoma,the structural organs associated with swallowing function are given individualized target delineation can reduce the occurring of dysphagia due to radiotherapy and improve the quality of life of patients after radiotherapy.