数字化头颈部放疗口腔定位支架临床应用的初步评价

Preliminary clinical effect evaluation of digital head and neck radiotherapy oral positioning stents

目的基于自主研发的专用软件系统设计制作数字化头颈部放疗口腔定位支架,评价其与传统放疗口腔定位支架的临床效果差异。方法选取2021年7至12月于南京大学医学院附属口腔医院·南京市口腔医院口腔修复科就诊的鼻咽癌放疗术前行口腔检查的患者30例,年龄20~71岁,男性15例,女性15例。根据患者意愿分为3组,对照组(不戴用放疗口腔定位支架)、传统支架组(戴用传统放疗口腔定位支架)、数字化支架组(戴用数字化放疗口腔定位支架),每组各10例。计算两种定位支架的制作耗时,分别于初戴和放疗结束时由患者对支架戴用舒适度进行视觉模拟评分,并于放疗结束后统计分析放疗靶区和周围健康组织的受照剂量。结果数字化放疗口腔定位支架的制作耗时[(209±7)min]显著短于传统放疗口腔定位支架[(490±10)min](t=69.85,P<0.001)。数字化支架组支架戴用舒适度评分[初戴和放疗结束时分别为5(3,6)和4(3,5)分]显著优于传统支架组[初戴和放疗结束时分别为7(3,7)和7(3,7)分](U=22.00,P=0.033;U=20.50,P=0.023)。3组患者放疗靶区总受照剂量差异无统计学意义(F=0.94,P=0.404),传统支架组和数字化支架组患者舌[分别为(36.74±5.45)和(35.96±4.98)Gy]和下颌骨[分别为(35.46±4.19)和(35.34±3.98)Gy]的受照剂量均显著小于对照组患者[舌:(41.49±4.46)Gy;下颌骨:(39.32±3.52)Gy](P<0.05)。结论鼻咽癌头颈部放疗口腔定位支架可显著降低患者舌和下颌骨的受照剂量,数字化放疗口腔定位支架比传统支架的制作耗时更短,患者戴用舒适度更佳。

Objective To develop a designing software of digital oral positioning stent for radiotherapy of head and neck,and to compare its clinical effect with traditional oral positioning stents made by lost wax process.Methods Thirty patients with nasopharyngeal cancer who received oral examination before radiotherapy in the prosthodontics department from July to December,2021,were selected and divided into three groups according to the patients′wishes,10 per group:one group without radiotherapy oral positioning stents,one group with traditional oral positioning stents(traditional stents group),and the third group with digital oral positioning stents(digital stents group).Patients'ages range from 20 years old to 71 years old.There were 15 males and 15 females involved in this study.The manufacturing time and comfort of the two positioning stents were evaluated,and the radiation doses of the radiotherapy target areas and surrounding healthy tissues were statistically analyzed at the end of radiotherapy.Results The manufacturing time of digital stents group[(209±7)min]was much less than that of traditional stents group[(490±10)min](t=69.85,P<0.001).The comfort of patients'wearing of digital stents[first wearing:5(3,6)score;at the end of radiotherapy:4(3,5)score]was better than that of traditional ones[first wearing:7(3,7)score;at the end of radiotherapy:7(3,7)score](U=22.00,P=0.033;U=20.50,P=0.023).There was no significant differences in the target radiation doses among the three groups,and the radiation doses of tongue[traditional stents group:(36.74±5.45)Gy;digital stents group:(35.96±4.98)Gy]and mandible[traditional stents group:(35.46±4.19)Gy;digital stents group:(35.34±3.98)Gy]were significantly lower in the patients wearing oral positioning stents than in the patients without oral positioning stents[tongue:(41.49±4.46)Gy;madible:(39.32±3.52)Gy](P<0.05).Conclusions Oral positioning stents for nasopharyngeal carcinoma radiotherapy could greatly reduce the exposure doses of tongue and madible of patients.Digital oral positioning stents designed and manufactured by independently developed software had higher production efficiency than the traditional method,and patients′evaluation of comfort was better.