口腔癌调强放疗中靶区优化对患者口腔黏膜反应、唾液腺功能的影响

Effects of optimizing target volume on oral mucosal reaction and salivary gland function in oropharyngeal cancer patients undergoing intensity-modulated radiotherapy

目的:分析口腔癌调强放疗中靶区优化对患者口腔黏膜反应、唾液腺功能的影响。方法:选择2020年4月至2022年8月江苏大学附属医院收治的120例口腔癌患者,按随机数表法分组。对照组60例,接受常规调强放疗。试验组60例,在调强放疗中对颈部Ⅱ区与口腔靶区进行优化。对比两组调强放疗后3个月疗效、腮腺受量、急性口腔黏膜反应发生率、口干反应发生率与口腔疼痛发生率,并观察放疗前、放疗第4周、放疗结束、放疗后3个月患者腮腺、颌下腺静息状态下表观弥散系数(ADC)值变化。结果:试验组客观缓解率与对照组相比[80.00%(48/60)vs 75.00%(45/60)],差异无统计学意义(P>0.05);试验组健侧腮腺限制平均照射剂量(D_(mean))、V_(34)及口腔D_(mean)、V_(30)均比对照组低(P<0.05);试验组放疗后3个月急性口腔黏膜反应、口干反应与口腔疼痛发生率(41.67%、50.00%、58.33%)均比对照组(75.00%、78.33%、85.00%)低(P<0.05);两组放疗第4周、放疗结束、放疗后3个月腮腺、颌下腺静息状态下ADC值均比放疗前升高(P<0.05);试验组放疗第4周、放疗结束、放疗后3个月腮腺、颌下腺静息状态下ADC值均比对照组低(P<0.05)。结论:口腔癌调强放疗中靶区优化可有效预防相关口腔黏膜炎的发生,降低口腔黏膜反应、口腔疼痛及口干程度,减少腮腺受量,减轻调强放疗对患者唾液腺功能的影响。

Objective To analyze the effects of target volume optimization on oral mucosal reaction and salivary gland function in oropharyngeal cancer patients receiving intensity-modulated radiotherapy (IMRT).Methods A total of 120patients with oropharyngeal cancer admitted to Affiliated Hospital of Jiangsu University from April 2020 to August 2022were selected and randomly grouped into control group (n=60,conventional IMRT) and treatment group (n=60,cervical region II and the oral target region were optimized during IMRT).The therapeutic efficacy,parotid gland dose,incidence of acute oral mucosal reaction,dry mouth and oral pain at 3 months after IMRT were compared between two groups.The resting-state apparent diffusion coefficient (ADC) values of parotid and submandibular glands at different time points (before radiotherapy,the 4th week of radiotherapy,the end of radiotherapy and 3 months after radiotherapy) were recorded.Results The difference in the objective reaction rate between two groups was trivial[80.00%(48/60) vs 75.00%(45/60),P>0.05].The mean dose (D_(mean)) and V_(34)of the unaffected parotid gland and the D_(mean)and V_(30)of the oral cavity in treatment group were lower than those in control group (P<0.05).The incidences of acute oral mucosal reaction,dry mouth and oral pain at 3months after radiotherapy in treatment group were 41.67%,50.00%,and 58.33%,lower than those in control group (75.00%,78.33%,and 85.00%)(P<0.05).The resting-state ADC values of parotid and submandibular glands at the 4th week of radiotherapy,the end of radiotherapy,and 3 months after radiotherapy in both two groups were higher than those before radiotherapy (P<0.05).At the 4th week of radiotherapy,the end of radiotherapy,and 3 months after radiotherapy,the restingstate ADC values of parotid and submandibular glands in treatment group were lower than those in control group (P<0.05).Conclusion Optimizing target volume during oropharyngeal IMRT can effectively prevent the occurrence of radiationinduced mucositis,alleviate oral mucosal reaction,oral pain and dry mouth,reduce parotid gland dose,and diminish the effects of IMRT on salivary gland function in patients.