3D-CRT和VMAT对头颈部肿瘤患者甲状腺功能的影响

The Effect of 3D-CRT and VMAT on Thyroid Function in Patients with Head and Neck Cancers

目的:研究三维适形放疗(3D-CRT)和容积调强放疗(VMAT)对头颈部肿瘤患者甲状腺功能的影响。方法:将2011年1月至2014年6月在重庆三峡中心医院肿瘤分院行放射治疗的14头颈部肿瘤患者随机分为3D-CRT组和VMAT组,各70例,3D-CRT组行3D-CRT治疗,VMATVMAT治疗,所有患者均完成放射治疗,随访24个月。观察放疗后临床疗效,分别检测放疗前、放束时、放疗后3、6、12、18、24个月血清促甲状腺激素(TSH)、游离三碘甲腺原氨酸(FT3)和游离甲状素(FT4)水平,采用QLQ-H&N35量表评分评价患者放疗前、放疗1个月、放疗后及放疗后6个月质量,记录随访期间甲状腺功能减退发生情况。结果:两组放疗后总有效率差异无统计学意义(05);放疗后6、12、18、24个月甲状腺功能减退情况,VMAT组TSH均显著低于3D-CRT组(P<0.0)疗后12、18、24个月,VMAT组FT3、FT4均显著高于3D-CRT组(P<0.05);放疗后6个月,VMAT组-H&N35量表评分显著低于3D-CRT组(P<0.05);随访24个月内两组甲状腺功能减退发生率差异统计学意义(P>0.05)。结论:3D-CRT和VMAT均是治疗头颈部肿瘤的有效放疗方法,但VMAT护患者甲状腺功能及改善治疗后生活质量方面优于3D-CRT。

Objective： To study the effects of three-dimensional conformal radiation therapy（ 3 D-CRT）and volume modulated arc therapy（ VMAT） on thyroid function in patients with head and neck cancers.Methods： 140 patients with head and neck tumors from January 2011 to June 2014 underwent radiotherapeutics in Nuclear Medicine Department of Central Hospital of Chongqing Three Gorges Tumour Branch were randomly divided into group 3 D-CRT and group VMAT,with 70 cases in each group,group 3 D-CRT was treated with 3 D-CRT,group VMAT was treated with VMAT,all patients were treated for 2 months and followed up for 24 months. The clinical efficacy at 2 months after radiotherapy was observed,the levels of serum thyroid stimulating hormone（ TSH）,free triiodothyronine（ FT3） and free thyroxine（ FT4） were measured before radiotherapy,at the end of radiotherapy,and at 3,6,12,18 and 24 months after radiotherapy,QLQ-HN35 scale score was used to evaluate the quality of life of patients before radiotherapy,1 months for radiotherapy,after radiotherapy and 6 months after radiotherapy,the occurrence of hypothyrea during follow-up was recorded. Results： There was no significant difference in the total effective rate between the two groups at 2 months after radiotherapy（ P〈0.05）; at 6,12,18 and 24 months after radiotherapy,the TSH in group VMAT was significantly lower than that in group 3 D-CRT（ P〈0.05）; at 12,18 and 24 months after radiotherapy,the FT3 and FT4 in group VMAT were significantly higher than those in group 3 D-CRT（ P〈0.05）; at 6 months after radiotherapy,the score of QLQ-HN35 scale in group VMAT was significantly lower than that in group 3 DCRT（ P〈0.05）; there was no significant difference in the incidence rate of hypothyrea between the two groups during the 24 months follow-up（ P〈0. 05）. Conclusion： 3 D-CRT and VMAT are effective radiotherapy methods for head and neck cancers,but VMAT is superior to 3 D-CRT in protecting thyroid function and improving quality of life after treatment.