鼻咽癌IMRT后发生头颈淋巴水肿的临床特征及危险因素分析

Clinical characteristics and risk factors of head and neck lymphedema after intensity modulated radiotherapy in patients with nasopharyngeal carcinoma

目的 研究鼻咽癌适形调强放疗(IMRT)后发生头颈淋巴水肿的临床特征及危险因素。方法 选取2018年6月至2020年12月在西安国际医学中心医院放疗科接受治疗的68例鼻咽癌患者作为研究对象。随访期间选择我院自制的《放疗后头颈淋巴水肿发生情况和相关因素》调查问卷调查患者的性别、年龄、临床分期、同步放化疗、巩固化疗、诱导化疗、放疗剂量、放射性皮炎、颈部淋巴结清扫、使用改善微循环药物等情况,采用Logistic二分类回归模型分析IMRT后发生头颈淋巴水肿的危险因素。结果 从患者结束治疗后开始进行随访,随访时间10~22个月,中位数为18个月,末次随访时间为2021年12月31日。经《放疗后头颈淋巴水肿发生情况和相关因素》调查问卷的调查,以随访期间测量所得到的最高级别头颈淋巴水肿程度为最终分级情况,共有44例患者出现不同程度的水肿,水肿发生率为64.71%,其中3例为0级水肿,30例为1a级水肿,9例为1b级水肿,1例为2级水肿,1例为3级水肿。所有患者的水肿均出现在颌下、颜面、颏下以及颈部区域。单因素分析结果显示,鼻咽癌放疗后淋巴水肿的发生与高血压、N分期、T分期、有无设置放疗的头颈前后部低剂量淋巴引流保护区有关(P<0.05);经Logistic二分类回归模型分析结果显示,N分期高、放疗未设置保护区为放疗后患者头颈淋巴水肿发生的独立危险因素(P<0.05)。结论 鼻咽癌IMRT后发生头颈淋巴水肿的临床特征为患者水肿均出现在颌下、颜面、颏下以及颈部区域。N分期和未设置引流保护区是放疗后鼻咽癌患者发生头颈淋巴水肿的独立危险因素。

Objective To study the clinical characteristics and risk factors of head and neck lymphedema after conformal intensity modulated radiotherapy(IMRT) for nasopharyngeal carcinoma. Methods Sixty-eight patients with nasopharyngeal carcinoma who were treated in the Department of Radiotherapy, Xi’an International Medical Center Hospital from June 2018 to December 2020 were selected as the study subjects. The self-made questionnaire "incidence of head and neck lymphedema after radiotherapy and related factors" was selected to investigate the gender, age, clinical stage, synchronous radiotherapy and chemotherapy, consolidation chemotherapy, induction chemotherapy, radiation dose, radiation dermatitis, neck lymph node dissection, and use of drugs to improve microcirculation. Logistic model was used to analyze the risk factors of head and neck lymphedema after IMRT. Results The patients were followed up from the end of treatment, for 10 months to 22 months, with a median of 18 months. The last follow-up was on December 31,2021. According to the questionnaire, taking the highest level of head and neck lymphedema measured during the follow-up as the final grading, a total of 44 patients had different degrees of edema, with an incidence of 64.71%, including3 cases of grade 0 edema, 30 cases of grade 1a edema, 9 cases of grade 1b edema, 1 cases of grade 2 edema, and 1 case of grade 3 edema. Edema in all patients occurred in the submaxillary, facial, submental and neck areas. Univariate analysis showed that the occurrence of lymphedema after radiotherapy of nasopharyngeal carcinoma was related to hypertension,N stage, T stage and whether there was a low-dose lymphatic drainage protection area in the front and back of the head and neck(P<0.05). Multivariate analysis using logistic binary regression model showed that patients with high N stage and radiotherapy without low-dose lymphatic drainage protection area in the front and back of the head and neck had a higher risk of lymphedema(P<0.05). High N stage and radiotherapy without low-dose lymphatic drainage protection area in the front and back of the head and neck were independent risk factors for the occurrence of head and neck lymphedema after radiotherapy(P<0.05). Conclusion The clinical feature of head and neck lymphedema after IMRT in nasopharyngeal carcinoma is that the edema occurs in the submaxillary, facial, submental, and neck regions. N stage and radiotherapy without low-dose lymphatic drainage protection area were independent risk factors for head and neck lymphedema in nasopharyngeal carcinoma patients after radiotherapy.