鼻咽癌适形调强放疗后头颈淋巴水肿的危险因素分析

Analysis of risk factors of head and neck lymphedema after intensity modulated radiation therapy for nasopharyngeal carcinoma

目的分析鼻咽癌患者适形调强放疗后头颈淋巴水肿的危险因素。方法纳入接受适形调强放疗的鼻咽癌患者135例,随访10~22个月。采用χ^(2)检验单因素分析和logistic回归多因素分析探讨年龄、性别、体质量指数(body mass index,BMI)、T分期、N分期、放疗是否设置头颈前后部低剂量淋巴引流保护区、放射性皮炎、高血压以及糖尿病与放疗后淋巴水肿的关系。结果鼻咽癌调强放疗后淋巴水肿发生率为65.2%。多因素分析显示,N分期和放疗是否设置头颈前后部低剂量淋巴引流保护区是影响淋巴水肿发生的独立危险因素(均P<0.05)。结论 N分期高的鼻咽癌患者调强放疗后发生头颈淋巴水肿的风险较高。放疗设置头颈前后部低剂量淋巴引流保护区可减少淋巴水肿的发生。

Objective To investigate the risk factors of head and neck lymphedema after intensity modulated radiation therapy(IMRT)for nasopharyngeal carcinoma.Methods One-hundred-and-thirty-five patients with nasopharyngeal carcinoma who received IMRT were enrolled,and followed up for 10 to 22 months.Univariate and multivariate logistic regression analysis were used to investigate the relationship between age,sex,body mass index(BMI),T stage,N stage,setting up low-dose lymphatic drainage protection area in the anterior and posterior head and neck for radiotherapy,radiodermatitis,hypertension and diabetes and the development of lymphedema after radiotherapy.Results The incidence of lymphedema with nasopharyngeal carcinoma after IMRT was 65.2%.Multivariate analysis showed that N stage and setting up low-dose lymphatic drainage protection area in the anterior and posterior head and neck for radiotherapy were independent risk factors for lymphedema(both P<0.05).Conclusions Patients with high N stage have a higher risk of developing lymphedema after radiotherapy.Setting up low-dose lymphatic drainage protection area in the anterior and posterior head and neck for radiotherapy can reduce the occurrence of lymphedema.