3D打印口腔支架在头颈部恶性肿瘤放疗中的应用研究

Study of application of 3D printed oral stents in radiotherapy for head and neck malignancies

目的研究3D打印口腔支架在头颈部恶性肿瘤放疗中对靶区、危及器官的剂量影响及减轻放疗相关急性不良反应的效果。方法选取2020年5月1日—2021年11月30日川北医学院附属医院肿瘤科收治的头颈部恶性肿瘤患者58例,采用回顾性队列研究法将患者分为试验组(A组)28例(放疗中佩戴3D打印口腔支架)、对照组(B组)30例(放疗中佩戴软木塞口腔支架),比较两组患者放疗期间放射性口腔黏膜炎(RTOM)、口干燥症和口咽黏膜损伤疼痛的发生情况。此外,获得A组中21例患者知情同意,采用自身对照法,每位患者分别佩戴3D打印口腔支架(C组)和软木塞口腔支架(D组)制作两组放疗计划,分析两组计划靶区的均匀性指数(CI)、适形指数(HI)和危及器官(D_(max)、D_(mean))受照剂量的差异。采用SPSS 25.0统计软件进行统计分析。计量资料采用xˉ±s表示,两组间的比较采用配对t检验或重复测量分析;计数资料以率表示,两组间的比较选用卡方检验或Fisher确切概率检验。P<0.05为差异有统计学意义。结果 A组RTOM严重程度(P<0.05)、口腔黏膜损伤疼痛程度(P=0.004)、口干评分(P<0.001)显著低于B组。C、D两组靶区的HI、CI对比差异无统计学意义(均为P>0.05);C组上唇、患侧颊黏膜的D_(max)(P=0.014、0.009)、D_(mean)(P<0.001、P=0.033)显著低于D组。结论 3D打印口腔支架在头颈部恶性肿瘤放疗中获得了较好的均匀性与适形度,显著降低口腔周围危及器官的受照剂量,并有效减轻放疗相关急性RTOM、口干燥症和口咽黏膜损伤疼痛的发生和严重程度。

Objective To analyze the dosimetric differences between 3D printed oral stents and corked oral stents in the target area and perioral organ at risk(OAR)in radiotherapy for head and neck cancer,and the effectiveness in reducing acute adverse reactions associated with radiotherapy.Methods A total of 58 patients with head and neck cancer admitted to Department of Oncology of Affiliated Hospital of North Sichuan Medical College were selected and divided into experimental group(Group A,n=28,wearing 3D printed oral stents during radiotherapy)and control group(Group B,n=30,wearing corked oral stents during radiotherapy)in this retrospective cohort study.The incidence of radiotherapy-induced oral mucositis(RTOM),xerostomia and oropharyngeal mucosal pain was compared between two groups.Meanwhile,informed consent was obtained from 21 patients in Group A.Using the self control method,each patient wore a 3D printed oral stent(Group C)and a corked oral stent(Group D)to make two radiotherapy plans.The differences in the conformity index(CI),homogeneity index(HI)and exposure dose of OAR(D_(max),D_(mean))in the target area were analyzed between two groups.SPSS 25.0 statistical software was used for statistical analysis.Measurement data were expressed as Mean±SD.Comparison between two groups was conducted by paired t-test or repeated measurement analysis.Count data were expressed as ratio.Comparison between two groups was performed by Chi-square test or Fisher's exact test.P<0.05 was considered as statistically significant difference.Results The severity of RTOM(P<0.05),oropharyngeal mucosal pain(P=0.004)and xerostomia score(P<0.001)in Group A were significantly lower than those in Group B.There was no significant difference in the HI and CI of the target area between Group C and Group D(both P>0.05).The D_(max)(P=0.014,0.009)and D_(mean)(P<0.001,P=0.033)of the upper lip and the affected buccal mucosa in Group C were significantly lower than those in Group D.Conclusion 3D printed oral stents obtain favorable HI and CI in radiotherapy for head and neck cancer,significantly reduce the irradiated dose to perioral OAR,and effectively lower the incidence and mitigate the severity of acute RTOM,xerostomia and oropharyngeal mucosal pain associated with radiotherapy.