Thorstad Wade L, Chao K S Clifford, Haughey Bruce
Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO 63110, USA.
Semin Oncol. 2004 Dec;31(6 Suppl 18):8-12. doi: 10.1053/j.seminoncol.2004.12.005.
Standard conventional radiation therapy for advanced head and neck tumors typically involves administering high radiation dose to the major salivary glands bilaterally. In most cases, this causes a marked reduction in oral saliva output. Xerostomia is one of the most prevalent late side effects of radiation for head and neck malignancies, and patients cite it as the major cause of decreased quality of life. The degree of xerostomia has been reported to depend on the radiation dose and volume of salivary gland irradiated. Several studies show dose-volume-response relationships in the salivary glands, suggesting the possibility of significant improvement in saliva production postradiation, as well as quality of life, if radiation techniques can spare the salivary glands. A growing body of literature supports the premise that intensity-modulated radiation therapy (IMRT) allows irradiation of tumor targets in the head and neck while sparing substantial portions of salivary glands. Early clinical experience has shown substantial sparing of salivary flow following IMRT, and suggests at least equal tumor control but improved xerostomia compared with patients receiving standard radiation techniques. We hypothesize that the addition of a radiation protector, such as amifostine (Ethyol; Medimmune Inc, Gaithersburg, MD) may further improve salivary function over that obtained with IMRT alone. To test this hypothesis, we have initiated a pilot clinical trial to compare unstimulated and stimulated salivary flow rates 6 months and 1 year after IMRT + amifostine with historic controls treated with IMRT alone. Twenty-seven patients have been accrued onto this trial, and the toxicity and compliance data are reported herein.
晚期头颈部肿瘤的标准常规放射治疗通常包括双侧对主要唾液腺给予高辐射剂量。在大多数情况下，这会导致口腔唾液分泌显著减少。口干症是头颈部恶性肿瘤放射治疗最常见的晚期副作用之一，患者将其视为生活质量下降的主要原因。据报道，口干症的程度取决于辐射剂量和受照射唾液腺的体积。多项研究表明唾液腺存在剂量 - 体积反应关系，这表明如果放射技术能够保护唾液腺，那么放疗后唾液分泌以及生活质量可能会有显著改善。越来越多的文献支持这样一个前提，即调强放射治疗（IMRT）能够在照射头颈部肿瘤靶区的同时，使大部分唾液腺免受照射。早期临床经验表明，IMRT 后唾液分泌得到了显著保护，并且与接受标准放射技术的患者相比，肿瘤控制效果至少相当，但口干症有所改善。我们假设添加一种放射保护剂，如氨磷汀（Ethyol；Medimmune 公司，马里兰州盖瑟斯堡），可能会比单独使用 IMRT 进一步改善唾液功能。为了验证这一假设，我们启动了一项初步临床试验，以比较 IMRT + 氨磷汀治疗 6 个月和 1 年后未刺激和刺激后的唾液流速与单独接受 IMRT 治疗的历史对照。本试验已纳入 27 名患者，本文报告了毒性和依从性数据。
