容积旋转调强放疗对初治鼻咽癌患者甲状腺血流动力学及功能的影响研究

Effect of volumetric modulated arc therapy radiotherapy on thyroid hemodynamics and function in the initial treatment of nasopharyngeal carcinoma

目的 研究容积旋转调强放疗(VMAT)对初治鼻咽癌患者甲状腺血流动力学及功能的影响。方法选取黑龙江大庆油田总医院2015年1月至2017年6月74例VMAT初治鼻咽癌患者作为研究对象,分析其放疗前、放疗后3个月和6个月的头颈部肿瘤患者生命质量测评量表(FACT-H&N)、甲状腺激素、甲状腺血流动力学指标、体积以及甲状腺体积百分比变化情况。结果放疗后6个月与放疗前FACT-H&N总分比较,差异无统计学意义(P>0.05);放疗后3个月FACT-H&N总分低于放疗前,差异有统计学意义(P<0.05)。放疗前的三碘甲腺原氨酸、血清游离甲状腺素高于放疗后3个月,差异均有统计学意义(P<0.05);放疗前的促甲状腺激素低于放疗后3个月、6个月,差异均有统计学意义(P<0.05);放疗后3个月的促甲状腺激素高于放疗后6个月,差异有统计学意义(P<0.05)。放疗前的收缩期峰值流速、舒张期末期流速低于放疗后3个月、6个月,放疗前的阻力指数、甲状腺左侧叶体积高于放疗后3个月、6个月,差异均有统计学意义(P<0.05);放疗前的甲状腺右侧叶体积高于放疗后3个月,放疗后3个月的甲状腺右侧叶体积低于放疗后6个月,差异均有统计学意义(P<0.05);放疗后6个月甲状腺体积低于放疗前(P<0.05);放疗后6个月甲状腺体积百分比与放疗前相比差异有统计学意义(P<0.05);放疗结束后6个月发生甲状腺功能衰退与放疗前甲状腺接受的平均照射剂量有关(P<0.05);放疗结束即刻甲状腺减退发生与甲状腺剂量-体积参数V40相关(P<0.05)。结论VMAT放疗能够显著改善初治鼻咽癌患者甲状腺血流动力学、功能,从而提高患者的生存质量,提高临床疗效。

Objective To investigate the effect of volumetric modulated arc therapy (VMAT) radiotherapy on thyroid hemodynamics and function in the initial treatment of nasopharyngeal carcinoma.Methods 74 nasopharyngeal carcinoma patients underwent VMAT radiotherapy as their initial treatment in our hospital from Jan2015 to Jun 2017 were selected;The scores of Functional Assessment Of Cancer Therapy-Head and Neck (FACT-H&N),thyroid hormone, hemodynamic index and volume of thyroid were analyzed before radiotherapy,3 months and 6 months after radiotherapy.Results The FACT-H&N score before radiotherapy showed no significant difference with that at postradiotherapy 6mon ( P > 0.05),while was higher that at the postradiotherapy3mon ( P < 0.05);The FT3 and FT4 before radiotherapy were significantly higher than those at the postradiotherapy3mon ( P < 0.05);The TSH before radiotherapy was significantly lower than that at the postradiotherapy3mon and 6mon ( P < 0.05),and was higher at the postradiotherapy3mon than that at the postradiotherapy 6mon ( P < 0.05);The PSV and EDV before radiotherapy were significantly lower than those at the postradiotherapy3mon and 6mon,moreover,the volume of RI and left thyroid lobe before radiotherapy was significantly higher than that at the postradiotherapy 3mon and 6mon ( P < 0.05);The volume of the right thyroid lobe at the postradiotherapy3mon was significantly lower than that before radiotherapy and postradiotherapy 6mon.Conclusions VMAT radiotherapy can significantly improve the thyroid hemodynamics and function in the initial treatment of nasopharyngeal carcinoma,thereby improving the quality of life and clinical efficacy.