Long-term outcomes of interventions for radiation-induced xerostomia:A review

Xerostomia, or dry mouth, is a significant problem affecting quality of life in patients treated with radiation therapy for head and neck cancer. Strategies for reduction of xerostomia burden vary widely, with options including: sialagogue medications, saliva substitutes, acupuncture, vitamins, hyperbaric oxygen,submandibular gland transfer, and acupuncture or associated treatments. In this review, we sought to evaluate long-term outcomes of patients treated with various interventions for radiation-induced xerostomia. A literature search was performed using the terms "xerostomia" and "radiation" or "radiotherapy"; all prospective clinical trials were evaluated, and only studies that reported 1 year follow up were included. The search results yielded 2193 studies, 1977 of which were in English. Of those, 304 were clinical trials or clinical studies. After abstract review, 23 trials were included in the review evaluating the following treatment modalities: pilocarpine(three); cevimeline(one); amifostine(eleven);submandibular gland transfer(five); acupuncture like transcutaneous electrical nerve stimulation(ALTENS)(one); hyperbaric oxygen(one); and acupuncture(one). Pilocarpine, cevimeline, and amifostine have been shown in some studies to improve xerostomia outcomes, at the cost of toxicity. ALTENS has similar efficacy with fewer side effects. Submandibular gland transfer is effective but requires an elective surgery, and thus may not always be appropriate or practical.The use of intensity-modulated radiation therapy, in addition to dose deescalation in select patients, may result in fewer patients with late xerostomia,reducing the need for additional interventions.

Influence of the Radiation Dose to Salivary Glands on Xerostomia in Patients with Head and Neck Carcinomas

Purpose: Investigation of the influence of radiation dose to salivary glands on xerostomia in patients with head and neck cancers. Methods: From October 2002 to December 2011, 548 patients with head and neck carcinomas were treated in our department using intensity modulated radiotherapy (IMRT). 325 patients were eligible for analysis more than 1 year after irradiation. Xerostomia was evaluated according to the criteria of Radiation Therapy and Oncology Group (RTOG) and xerostomia related questionnaire. For statistical analysis grade 1 and 2 were recorded as mild and grade 3 and 4 as severe xerostomia. The dosimetric values for absolute mean dose, biological equivalent mean dose (EQD2), the relative organ volume not exceeding 20 Gy, 25 Gy and 30 Gy (V20, V25, V30) for all 4 major salivary glands or for both parotid glands only were used for analysis. V20 revealed the best discrimination between both patient groups (with vs. without xerostomia), compared to parameters V25 and V30. Therefore the volume of the salivary glands receiving less than 20 Gy (V 20Gy) was analyzed additionally. Mann-Whitney-U-test, Kruskal-Wallis-test and logistic regression were used in statistical analysis. Results: A TD 50 can be determined for the occurrence of xerostomia more than one year after radiotherapy for both parotid glands of 19.3 Gy for the mean dose absolute, 11.2 Gy for the mean dose EQD2, 38.2% for V20, 26.8% for V25, 18.7% for V30, 34.9 ml for V 20Gy. For all major salivary glands theses values were 25.7 Gy for the mean dose absolute, 15.6 Gy for the mean dose EQD2, 51.3% for V20, 41.1% for V25, 33.9% for V30 and 34.8 ml for V 20Gy. Conclusions: The identification of a tolerance dose for the salivary glands for treatment planning appears to be difficult, as the dose-response correlation only shows a flat slope. Additionally, a large interindividual variability seems to exist. We could not found any threshold dose for development of xerostomia.

Evaluation of Xerostomia in Patients with Head and Neck Squamous Cell Carcinoma Treated with Radiotherapy

Background: The sixth most prevalent cancer in the world is head and neck squamous cell carcinoma (HNSCC). In multiple combinations, surgery, radiation and chemotherapy are used in HNC control. As radiation-induced salivary gland damage and xerostomia is one of the most usual and distressing impacts,?diffusion-weighted magnetic resonance imaging (DW-MRI) is a promising technique for the assessment of alterations due to radiation therapy.?The aim of the study is?to evaluate the effect of Chemoradiotherapy either concurrent or sequential/RTH on salivary glands using DW-MRI performed before and after chemoradiotherapy/RTH,?correlation between DW-MRI changes?and delivered radiation dose to salivary glands,?study the acute toxicity of chemoradiotherapy/RTH on salivary glands and assess quality of life for patients with radiation-induced xerostomia.?Patients and Methods: This prospective study included 43 patients with Head and Neck squamous cell carcinoma treated with definitive radiotherapy, sequential therapy or concurrent chemoradiotherapy at Clinical Oncology and Nuclear Medicine Department, MRI diffusion scans were done at Diagnostic Radiology Department Tanta University Hospitals throughout the period from May 2016 to May 2019.?DW-MRI performed before and after RTH. For patients receiving CCRTH, DW sequence will be performed before starting RTH and 2?-?3 months post-RTH once at rest and then repeated continuously during salivary stimulation by ascorbic acid. In case of induction chemotherapy, DW-MRI was done before and after induction and 2?-?3 months post-RTH.?Results:?In all time periods, ADC values were lower for the PG than the SMG.?ADC change of PGs was higher in hypopharyngeal carcinoma, while ADC change of SMGs?were?higher in oropharyngeal carcinoma.?ADC change in PGs & SMGs was higher in advanced stage.?Conclusion:?To assess the radiation-induced xerostomia, DW-MRI can be used as non-invasive tool. Xerostomia questionnaire is helpful instrument for evaluating of quality of life for patients with radiation-induced xerostomia. There was a significant correlation between xerostomia and quality of life.

Evaluation of xerostomia closely associated with systemic diseases using a dental approach

Based on the findings of epidemiological surveys in western countries, the number of person with suspected xerostomia in Japan is estimated to be 30,000,000. Xerostomia is caused by: 1) Systemic diseases;2) Medications;3) Tumors or trauma;4) Radiotherapy;and 5) Neurological factors. Its symptoms can be alleviated, and its progression can be stopped by close cooperation between the dental and medical departments. However, at present, symptomatic treatment methods such as water drinking, oral rinsing with water, and administration of Kampo medicines or parasymptomimetic drugs are mainly used, and a standard treatment has not been established. On the other hand, previous studies on xerostomia have reported improvement in dry mouth symptoms using dental approaches or a relationship between the development of candidiasis and the salivary flow rate. Therefore, in this study, to establish a dental method useful for improving xerostomia associated with systemic diseases and medications for them, we restored occlusal function, and as a result, increased the salivary flow rate, and evaluated changes in oral findings.

Intervention effect of chewing sugar-free gum on xerostomia in hemodialysis patients: A meta-analysis

目的:采用Meta分析的方法,评价咀嚼无糖口香糖对血液透析患者口腔干燥症干预的效果。方法:检索中国知网、万方、维普、中国生物医学、Pubmed、Embase、Cochance、Web of science、Ovid及CINAHL数据库中有关咀嚼无糖口香糖对血液透析患者口腔干燥症干预效果的随机对照试验或半随机临床试验。将符合纳入、排除标准的研究进行数据提取和质量评价后,使用Review Manager 5.3软件对结局指标进行Meta分析。结果:共纳入5项研究,包括237名患者。结果显示,咀嚼无糖口香糖能改善患者的口干症状[MD=-2.12,95%CI(-2.53,-1.71),P<0.001];但对患者透析间的口渴症状[MD=-1.57,95%CI(-3.41,0.27),P=0.09]和体重增加[MD=-0.38,95%CI(-1.02,0.27),P=0.25]没有影响。结论:咀嚼无糖口香糖对血液透析患者的口干症状有所改善,但对患者透析间口渴症状和体重增加无影响。但由于本研究纳入的文献数量较少,且文献质量不高,因此仍需开展大样本、多中心的高质量随机对照试验,以进一步探讨咀嚼无糖口香糖对血液透析患者口腔干燥症的干预效果。

Predicting late radiation-induced xerostomia in nasopharyngeal carcinoma based on radiomics features extracted from T2WI images of parotids

Objective:To explore the value of radiomics features extracted from the T2-weighted imaging(T2WI)images of parotids in predicting late radiation-induced xerostomia in nasopharyngeal carcinoma(NPC)patients after radiotherapy(RT).Methods:A retrospective analysis was conducted for 123 NPC patients who received RT at the Affiliated Tumour Hospital of Xinjiang Medical University from January 2019 to March 2021.All the patients underwent MRI pre-RT and post-RT.They were randomly divided into a training set and a testing set at a ratio of 4:1 using a random number table,with the former and the latter comprising 98 and 25 cases,respectively.The ipsilateral parotid gland(iPG)and the contralateral parotid gland(cPG)were delineated on T2WI images pre-RT and post-RT as regions of interest(ROIs).A total of 851 radiomics features were extracted from each ROI.Spearman analysis was used to remove redundant features,and the recursive feature elimination(RFE)method was then used to determine useful features.Using radiomics features extracted from images pre-treatment,images post-treatment,and differences between images pre-and post-treatment,this study constructed three radiomic models,namely the pre-treatment radiomics model(preRT),the post-treatment radiomics model(postRT),and the deltaradiomics model(DeltaRT).Then,this study plotted the receiver operating characteristic(ROC)curves based on the late radiation-induced xerostomia grades of patients post-RT.Furthermore,the models’effectiveness and performance in predicting late radiation-induced xerostomia and advanced radioactive xerostomia was evaluated.In addition,the area under the curve(AUC),sensitivity,specificity,accuracy,precision,and negative predictive value(NPV)were calculated.Results:Among the features extracted from bilateral parotid glands(PGs),20 were determined pre-RT(six from iPG and 14 from cPG),19 were determined post-RT(six from iPG and 13 from cPG),and 20 were derived from the DeltaRT(20 from cPG).The PGs pre-RT and post-RT in the training set had AUCs of 0.902(95%CI:0.895-0.909)and 0.761(95%CI:0.744-0.778),respectively,while those in the testing set had AUCs of 0.740(95%CI:0.504-0.983)and 0.701(95%CI:0.478-0.924),respectively.In contrast,the AUC of the cPG derived from the DeltaRT was 0.867(95%CI:0.856-0.878)in the training set and 0.851(95%CI:0.697-0.999)in the testing set.Conclusions:There are significant correlations between radiomics features extracted from MRI T2WI images of parotids and late radiation-induced xerostomia in NPC patients.Among the radiomics features,the changes in cPG features pre-RT and post-RT have higher accuracy in predicting late radiation-induced xerostomia.

The Standardization of Acupuncture Treatment for Radiation-Induced Xerostomia:A Literature Review

Objective： To assess the relative standardization of acupuncture protocols for radiation-induced xerostomia. Methods： A literature search was carried out up to November 10, 2012 in the databases PubMed/ MEDLINE, EMBASE and China National Knowledge Infrastruction with the terms： radiation-induced xerostomia, acupuncture, acupuncture treatment, and acupuncture therapy. Five ancient Chinese classic acupuncture works were also reviewed with the keywords ＂dry mouth, thirst, dry tongue, dry eyes and dry lips＂ to search the effective acupuncture points for dry mouth-associated symptoms in ancient China. Results： Twenty-two full-text articles relevant to acupuncture treatment for radiation-induced xerostomia were included and a total of 48 acupuncture points were searched in the 5 ancient Chinese classic acupuncture works, in which the most commonly used points were Chengjiang （CV24）, Shuigou （GV 26）, Duiduan （GV 27）, Jinjin （EX-HN 12）, and Yuye （EX-HN 13） on head and neck, Sanjian （LI 3）, Shangyang （LI 1）, Shaoshang （LU 11）, Shaoze （SI 1）, Xialian （LI 8） on hand, Fuliu （KI 7）, Dazhong （KI 4）, Zuqiaoyin （GB 44）, Taichong （LR 3）, Zhaohai （KI 6） on foot, Burong （ST 19）, Zhangmen （LR 13）, Tiantu （CV 22）, Qimen （LR 14） on abdomen, Feishu （BL 13）, Danshu （BL 19）, Xiaochaogshu （BL 27）, Ganshu （BL 18） on back, Shenmen （TF 4）, Shen （CO10, Kidney）, Yidan （CO11, Pancreas） and Pi （CO13, Spleen） on ear. Conclusion： There were considerable heterogeneities in the current acupuncture treatment protocols for radiation-induced xerostomia. Based on the results of the review and the personal perspectives, the authors provide a recommendation for manual acupuncture protocols in treating radiationinduced xerostomia patients with head and neck cancer.

Efficacy of a traditional Persian medicine preparation for radiation-induced xerostomia:a randomized,open-label,active-controlled trial

BACKGROUND： Xerostomia is one of the most common side effects of radiation therapy among patients with head and neck cancers （HNC）. However, conventional medicine lacks an effective treatment for radiation-induced xerostomia. OBJECTIVE： Synthesizing the traditional use ofAIcea digitata and Malva sylvestris with their known beneficial effects from recent studies, we evaluated the efficacy of the herbs in the quality of life （QOL） of HNC patients with radiation-induced xerostomia. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS： This study is a randomized, double-arm, open-label active-controlled clinical trial. We evaluated the effect ofA. digitata and M. sy/vestris on QOL of HNC patients with radiation-induced xerostomia compared with Hypozalix （artificial saliva）. Patients were enrolled from the Imam Hossein Hospital＇s oncology clinic in Shahid Beheshti University of Medica Sciences. Tehran, Iran. MAIN OUTCOME MEASURES： Primary outcome measures in this trial were changes in patients＇ QOL assessed by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, Head and Neck Module （EORTC QLQ-H＆N 35）. RESULTS： Between-group analysis showed that the intervention group patients obtained significantly lower （better） total EORTC QLQ-H＆N 35 scores as compared to the control group at the end of the intervention period （P = 0.007）. Mean scores of dry mouth of EORTC QLQ-H＆N 35 was also significantly lower （better） in the intervention group as compared to the control group （P = 0.017）.

口腔干燥患者唾液性质变化情况与龋齿之间的相关性分析

目的:分析口腔干燥症患者唾液的唾液流率(SFR),pH值及缓冲能力(SBC)与龋齿发病状况之间的关系,为早期临床干预口腔干燥症患者龋病提供相关参考依据。方法:收集180例门诊初次就诊的口腔干燥症患者作为研究对象(口腔干燥组),并同期在体检中心选取性别、年龄与之相匹配的以及无系统性疾病的180例健康者作为对照(对照组),对两组人群进行口腔检查和唾液检测,比较两组的患龋率、龋失补牙数(DMFT)、静息状态下全唾液流率(UWSFR)及刺激状态下全唾液流率(SWSFR)、唾液pH值和SBC,并采用SPSS 20.0统计学软件分析口腔干燥组DMFT与唾液性质之间的关系。结果:口腔干燥症组的患龋率、DMFT均显著高于对照组;口腔干燥症组主要以UWSFR减少为主,其UWSFR,SWSFR及唾液pH值和SBC均显著低于对照组,差异有统计学意义(P<0.01);口腔干燥组的DMFT与UWSFR,SWSFR呈负相关,但无统计学意义(P>0.05),DMFT与唾液pH值呈显著负相关(r=-0.660,P=0.001),与SBC呈显著负相关(r=-0.301,P=0.002)。结论:口腔干燥症患者是龋病发生的高危人群,且患龋程度较为严重;其SFR减少与龋病严重程度之间不存在线性相关关系,仅与其龋病高发病率微弱相关。口腔干燥症患者的唾液pH值减小和SBC减弱可能是其患龋较为严重的重要因素。

清热敛阴汤干预头颈部肿瘤放疗后放射性口腔黏膜炎及口干症临床研究

目的 观察清热敛阴汤对头颈部肿瘤患者放疗引起的口干和放射性黏膜炎防治效果。方法 采用项前瞻性随机对照研究,将2021年1月-2022年12月江阴市人民医院收治的80例头颈部肿瘤行首次放疗患者按1∶1比例随机至试验组及对照组;试验组放疗期间口服清热敛阴汤(至口腔黏膜炎症状消失停服);对照组仅当患者出现≥2级以上黏膜炎时应用利多卡因、地塞米松和庆大霉素混合液含服对症处理。比较两组放疗前、放疗期间、放疗后唾液腺功能及口腔黏膜炎分级等。结果 放疗10次,对照组2级放射性口腔黏膜炎5例,试验组0例,组间比较差异无统计学意义(P>0.05);放疗20次、放疗结束,试验组放射性黏膜反应均轻于对照组(P<0.05)。放疗结束后1、2、3、4周,试验组放射性黏膜反应平均分级均小于对照组(P<0.05),放疗10次、20次、放疗结束,试验组口感分级均轻于对照组(P<0.05);放疗结束后3个月,试验组口感分级均轻于对照组(P<0.05);放疗结束后6、9、12个月,两组口干程度比较,差异无统计学意义(P>0.05),放疗前两组患者唾液腺超声评分均为阴性,放疗结束时,试验组唾液腺超声评分小于对照组(P<0.05);放疗结束后3、6、9、12个月,两组唾液腺超声评分均有下降,放疗结束后3、6个月,试验组唾液腺超声评分小于对照组(P<0.05),放疗结束9、12个月,两组唾液腺超声评分比较,差异无统计学意义(P>0.05)。结论 清热敛阴汤对干预放疗引起的放射性口腔黏膜炎及口干症有效;唾液腺超声对于评估放射性口干症严重程度有一定参考价值。

口腔干燥评估工具的研究进展

对口腔干燥的概念、流行病学现状及评估方法进行综述,以期提高医护人员对口干燥症的认识,为临床选择或制订设计合理的评估方案提供参考。

注射用紫杉醇(白蛋白结合型)致口干1例

1例67岁女性乳腺恶性肿瘤患者使用AT方案(表柔吡星:120 mg d1;多西他赛:120 mg d1)行新辅助治疗一个周期后,因患者拒绝服用大量激素预防多西他赛的过敏反应,随将化疗药物多西他赛更换为注射用紫杉醇(白蛋白结合型,艾越)200 mg d1,d8,化疗4个周期。患者每次在输注完注射用紫杉醇(白蛋白结合型,艾越)第二天出现口干的不适反应,通过适当的饮水并使用喷壶向口中喷水可明显缓解不适症状。考虑患者出现口干症状很可能与注射用紫杉醇(白蛋白结合型)有关。

基于脂肪抑制增强T1WIDelta影像组学预测鼻咽癌患者放射治疗后口干分级

目的 基于脂肪抑制(FS)增强T1WI构建预测放射治疗(放疗)后鼻咽癌(NPC)患者口干级别的Delta影像组学模型,并评估其效能。方法 回顾性分析227例于诱导化学治疗(IC)后接受放疗或同步放化疗(CCRT)NPC患者IC前2周内及IC结束后鼻咽部MRI。于放疗结束后1周根据放射治疗肿瘤协作组标准评估患者口干分级(0~4级),将0、1级口干归为轻度口干(n=81),≥2级口干归为重度口干(n=146)。基于IC前、后FS增强T1WI提取双侧腮腺影像组学特征,计算Delta影像组学特征值。采用最小绝对收缩和选择算子和随机森林算法降维,筛选最优Delta影像组学特征,构建Delta影像组学模型。按8∶2比例将患者分为训练集(n=182)及测试集(n=45),绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评估Delta影像组学模型预测训练集及测试集NPC患者放疗后口干分级的效能;绘制校准曲线,评估模型性能。结果 分别基于IC前、后FS增强T1WI提取2 286个影像组学特征,最终筛选出8个最优Delta影像组学特征并以之构建模型,其预测训练集和测试集NPC患者放疗后口干分级的AUC分别为0.762、0.733;校准曲线显示,模型对于训练集及测试集的预测性能均良好。结论 基于FS增强T1WI Delta影像组学模型能及时有效地预测NPC患者放疗后口干分级。

口咽癌相关口咽干燥症“分期论治”思路探析

口咽癌作为头颈部恶性肿瘤,病势凶险、病位特殊,放射性疗法临床获益明显,但易损伤口咽部黏膜及腺体造成口咽干燥症,由此不仅影响患者生活质量也阻碍治疗进程。故口咽干燥症病机:先有正气亏虚、癌毒内生、蕴结弥漫阻滞于口咽经络,后有热毒侵袭、伤津耗气、伏邪内藏以致脉络枯萎。因此以“三焦辨证”法为基础,通过分期论治达到明确病程分期、辨析疾病病机、灵活用药、燥湿相济、攻补兼施、升降相宜,其疗效颇佳。现将临证辨治思路及用药特点总结如下,并结合案例进一步分析,以兹借鉴。

唾液腺灌洗缓解干燥综合征患者口干:随访40周的单盲随机对照临床试验

目的验证曲安奈德(TA)和生理盐水(NS)灌洗唾液腺长期缓解干燥综合征(SS)患者口干症的效果。方法将纳入的49例SS患者随机分为对照组(不灌洗,n=16)、NS组(NS灌洗,n=17)和TA组(TA灌洗,n=16)。在灌洗前1周(0W)和灌洗后8周(8W)、16周(16W)、32周(32W)和40周(40W)检查未刺激的全唾液流(unstimulated whole salivary flow,UWS)、咀嚼刺激的全唾液流(chewing-stimulated whole saliva flow,SWS)、柠檬酸刺激的腮腺流(citric acid-stimulated parotid flow,SPF)、临床口腔干燥评分(CODS)、口干量表(XI)和EULAR SS患者报告指数(ESSPRI)。结果每组14例患者完成随访。与0W相比,经TA和NS灌洗后8W、16W、24W和32W的SWS和SPF增高(P<0.05),而40W无显著差异(P>0.05)。与0W相比,TA和NS组8W、16W、24W和32W的ESSPRI(口干症状)降低(P<0.05)。TA组16W、24W和32W的SWS和SPF均高于对照组(P<0.05)。TA组8W、24W和32W的CODS低于对照组(P<0.05)。结论TA和NS灌洗大唾液腺可以持续32周缓解SS患者口干。

基于数据库数据分析口干症证型、高频中药药对及其作用机制

目的基于数据库数据分析口干症证型,筛选出口干症的高频中药药对并分析其作用机制。方法以“口干、口腔干燥症、口腔干燥综合征、燥痹”为主题词,检索中国知网、万方、维普数据库,检索时限为1980年10月—2022年9月。经文献筛选、资料提取后,使用Excel软件对疾病种类、证型、证素及高频药物的使用频数、四气、五味、归经和功效分类进行统计,使用SPSS软件对374味药物进行关联分析,对使用频次大于50的40味高频药进行聚类分析、因子分析以挖掘出治疗口干症的高频中药药对。从PubChem、TCMSP数据库获取支持度、实例数最高的高频中药药对的主要活性成分及靶点,在GeneCards、DrugBank数据库中检索口干症的疾病靶点。取交集靶点,导入Cytoscape3.8.0软件进行PPI绘制,上传至DAVID进行生物学功能分析(GO分析、KEGG分析)。结果口干症在干燥综合征、糖尿病、中老年增龄性口干等疾病中最常见;证型以阴虚内热、肺胃阴虚、气阴两虚为主;病位证素多集中在肺、胃;病性证素以阴虚、热、气虚最常见。治疗口干症的药物中,麦冬出现频次最高;高频药中四气五味以寒、温、甘、苦为主;多入肺、胃经,功效分类以补虚药多见。根据关联分析得出支持度、实例数最高的高频中药药对是“麦冬—玉竹”,依据聚类分析和因子分析得出三类新方。麦冬、玉竹高频药对有效化学成分15种,共得到446个潜在作用靶点。高频中药药对与口干症的共同作用靶点有STAT3、MAPK3、MAPK1、ESR1、EGFR、IL2等。GO富集分析结果显示,高频中药药对—疾病交集靶点具有生物学过程(BP)258条、细胞成分(CC)34条、分子功能(MF)64条,BP主要涉及细胞内信息传递、蛋白质磷酸化、细胞凋亡过程的正向调节等;CC主要涉及小腔、大分子复合物、黏着斑等;MF主要涉及蛋白质磷酸酶结合等。高频中药药对—疾病交集靶点共富集于癌症通路、PI3K-Akt信号通路、甲状腺激素信号通路、内分泌抵抗通路、JAK-STAT信号通路等128条通路中。结论口干症可能以肺、脾、胃等脏腑阴虚、气虚为始动因素,津液不能润泽口腔为其根本病机,兼热、湿、瘀等证象。“麦冬—玉竹”为治疗口干症的高频中药药对,主要通过AKT1、ESR1、EGFR等靶点,调控PI3K-Akt、JAK-STAT等信号通路发挥作用。

鼻咽癌放射性口干症的中西医治疗进展

放疗是治疗鼻咽癌的重要手段,由于头颈部位置的特殊性,X射线外照射常不可避免损伤唾液腺,并导致放射性口干症的发生,严重影响生活质量。治疗方面,西医主要是通过对症使用西药、外科手段、改良放疗方案等方法改善口干反应,中医主要采用辨证使用中药、针灸、穴位贴敷、口腔按摩等方式治疗放射性口干症,中医、西医各有疗效。临床上,尝试采用中西医结合治疗的案例还较少,但大都取得不错的效果。本文对近5年来关于鼻咽癌放射性口干症的中西医治疗进展进行综述,为放射性口干症的治疗提供一点新思路。

敛疮解毒方中药含漱护理改善鼻咽癌放疗患者口腔干燥症的效果研究

目的观察敛疮解毒方中药含漱护理应用于鼻咽癌放疗患者口腔干燥症的效果。方法选取鼻咽癌放疗患者110例作为研究对象,随机抽取密封有随机数字的信封,随机数字奇数入组对照组(55例)、偶数入组试验组(55例)。两组患者在常规护理下,试验组采用敛疮解毒方中药含漱的护理方法干预口腔干燥症,对照组采用2.5%碳酸氢钠溶液漱口的护理方法干预口腔干燥症,以放疗结束为干预终点,记录两组患者咽痛、口腔干燥发生时间以及不同时间咽痛、口腔干燥的程度,以及干预过程由漱口液引起的不良反应。结果放疗第21天开始至放疗结束,两组患者不同程度咽痛比较,差异具有统计学意义(P<0.05);自放疗第14天开始至放疗结束,两组患者不同程度口干比较,差异具有统计学意义(P<0.05);两组患者在使用漱口液期间均未见由漱口液引起的胃肠道反应、变态反应等不良反应。结论敛疮解毒方中药含漱护理方案能明显改善鼻咽癌放疗患者咽痛、口腔干燥症状,提高患者口腔舒适度。

杨氏玉漱生津液对头颈部肿瘤放化疗后口干症疗效观察

目的观察杨氏玉漱生津液对头颈部肿瘤放化疗后口干症的疗效。方法选取因头颈部肿瘤放化疗后口干症患者50例,随机分为观察组和对照组,对照组湿润口腔予0.9%氯化钠溶液,观察组予杨氏玉漱生津液湿润口腔。治疗4周后,比较两组主观口干感VAS评分、RTOG分级和唾液流率、咀嚼效率。结果观察组RTOG分级,VAS评分低于对照组,差异有统计学意义(P<0.05);观察组唾液流率,咀嚼效率高于对照组,差异有统计学意义(P<0.05)。结论杨氏玉漱生津液可以缓解头颈部肿瘤放化疗引起的口干症,可改善患者生活质量,值得临床推广。

干燥综合征患者唾液流率与口干症状的一致性分析

目的:分析干燥综合征(Sjögren's syndrome,SS)患者口干症状与静息唾液流率下降的一致性,并探讨影响静息唾液流率的相关因素。方法:采集151例确诊SS患者的临床资料,包括口干症状、静息唾液流率、血液学指标及临床病史等,应用Kappa一致性检验和Spearman相关性检验进行统计学分析。结果:干燥综合征患者中唾液流率下降与口干症有极低的一致性,进一步分析发现,静息唾液流率下降与SS病程、ANA抗体滴度、IgM水平及自身免疫性肝病呈正相关关系。结论:SS患者唾液流率下降与口干症状缺乏一致表现,静息唾液流率虽然对SS有一定的预测及监控价值,但受到多种因素影响可能出现波动,了解其影响因素并实施定向干预,有助于SS患者的口腔健康管理。