鼻咽癌放疗靶区优化对甲状腺功能保护作用研究

Protective Effect of Radiotherapy Target Area Optimization on Thyroid Function of Patients with Nasopharyngeal Carcinoma

[目的]探讨鼻咽癌放疗靶区优化对甲状腺功能的保护作用。[方法]2010年1月至2014年1月间进行鼻咽癌根治性放射治疗的患者62例作为研究对象,其中进行颈部Ⅳ区优化的32例患者纳入优化组,未进行颈部Ⅳ区优化的30例患者纳入未优化组。采用彩色多普勒超声评价放疗前后甲状腺形态,并对比两组患者放疗前后甲状腺激素水平以及生活质量。[结果 ]两组患者放疗后甲状腺体积均缩小,FT3、FT4均下降,TSH升高,与放疗前比较有显著性差异（P均〈0.05）,其中优化组患者甲状腺体积大于非优化组,FT3、FT4高于非优化组,TSH低于非优化组（P均〈0.05）;优化组的淋巴结失败率为3.13%（1/32）,低于非优化组的10.0%（3/30）,差异有统计学意义（P〈0.05）;放疗结束后12个月时优化组的生活质量优于非优化组,差异有统计学意义（P=0.027）。[结论]对鼻咽癌放疗患者进行颈部Ⅳ区优化有助于甲状腺功能保护,对于患者生活质量提高具有积极意义,值得临床推广。

[Objective] To assess the protective effect of radiotherapy target area optimization on thyroid function of patients with nasopharyngeal carcinoma. [Methods] Clinical data of 62 patients with nasopharyngeal carcinoma undergoing radical radiotherapy from January 2010 to January2014 were retrospectively analyzed. The target area cervical IV was optimized in 32 patients（op-timization group） and not optimized in 30 patients（non-optimization group）. The thyroid morphology was examined by color Doppler ultrasonography and the levels of thyroid hormone were mea-sured and the quality of life was evaluated before and after radiotherapy. [Results] The volume of thyroid was decreased after radiotherapy,FT3 and FT4 levels were decreased and TSH increased,which was significantly different from those before radiotherapy（all P〈0.05）. The FT3 and FT4 levels in optimization group were significantly higher and the TSH was lower than those in non-optimal group（all P〈0.05）. The rate of lymph node failure in optimized group was significantly lower than that in non-optimized group（3.13% vs 10.0%,P〈0.05）. The quality of life at 12 months after radiotherapy in optimized group was superior to that in non-optimized group（P=0.027）.[ Conclusion]The optimization of cervical Ⅳ area protects thyroid function in patients with nasopharyngeal carcinoma receiving radiotherapy,which can improve the quality of life of the patients.