调强放疗或适形放疗可改善鼻咽癌患者的生活质量：四种放疗技术的比较
Intensity-modulated or conformal radiotherapy improves the quality of life of patients with nasopharyngeal carcinoma: comparisons of four radiotherapy techniques.
作者信息
Fang Fu-Min, Tsai Wen-Ling, Chen Hui-Chun, Hsu Hsuan-Chih, Hsiung Ching-Yeh, Chien Chih-Yen, Ko Sheung-Fat
机构信息
Department of Radiation Oncology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan.
出版信息
Cancer. 2007 Jan 15;109(2):313-21. doi: 10.1002/cncr.22396.
BACKGROUND
It was reported previously that the dosimetric superiority of conformal radiotherapy (RT), either 3-dimensional conformal RT (3D-CRT) or intensity-modulated RT (IMRT), over conventional 2D-RT translated into clinical benefits for patients with nasopharyngeal carcinoma (NPC). In this study, the authors compared quality-of-life (QOL) outcomes of NPC survivors who received treatment with 1 of 4 different RT techniques at a single institute during different periods.
METHODS
The authors analyzed QOL data of from 237 patients with NPC who were cancer free for 2 or 3 years when their QOL was assessed. The study population included 152 patients who received conventional RT (2D-RT, 61 patients; 2D-RT plus 3D-CRT boost, 91 patients) and 85 patients who received conformal RT (3D-CRT, 33 patients; IMRT, 52 patients). The European Organization for the Research and Treatment of Cancer (EORTC) Core QOL questionnaire and the EORTC Head and Neck QOL questionnaire were completed.
RESULTS
Compared with patients who received with conventional RT, patients who received conformal RT had both statistically (P < .05) and clinically (a difference in mean scores >or=10 points) significant improvements in the scales of global QOL, pain, appetite loss, senses, speech, social eating, teeth, opening mouth, xerostomia, sticky saliva, and feeling ill. No significant difference was observed in any of the scales that compared 2D-RT with 2D-RT plus 3D-CRT boost or that compared 3D-CRT with IMRT. Survivors who received conformal RT had a 2.01-fold higher probability (odds ratio [OR], 2.01; 95% confidence interval [95% CI], 1.19-3.68) of reporting good global QOL and a 2.70-fold lower probability (OR, 0.37; 95% CI, 0.20-0.66) of reporting a high level of xerostomia than survivors who received conventional RT.
CONCLUSIONS
Conformal RT substantially improved head and neck-related symptoms and broad aspects of QOL for survivors of NPC.
背景
先前有报道称，适形放疗（RT），即三维适形放疗（3D-CRT）或调强放疗（IMRT），相较于传统二维放疗（2D-RT）在剂量学上的优势转化为了鼻咽癌（NPC）患者的临床获益。在本研究中，作者比较了在同一机构不同时期接受4种不同放疗技术之一治疗的NPC幸存者的生活质量（QOL）结果。
方法
作者分析了237例NPC患者的QOL数据，这些患者在评估QOL时已无癌2年或3年。研究人群包括152例接受传统放疗的患者（2D-RT，61例；2D-RT加3D-CRT推量，91例）和85例接受适形放疗的患者（3D-CRT，33例；IMRT，52例）。完成了欧洲癌症研究与治疗组织（EORTC）核心QOL问卷和EORTC头颈QOL问卷。
结果
与接受传统放疗的患者相比，接受适形放疗的患者在总体QOL、疼痛、食欲减退、感觉、言语、社交饮食、牙齿、张口、口干、唾液黏稠和不适等量表上有统计学意义（P < .05）和临床意义（平均得分差异≥10分）的显著改善。在比较2D-RT与2D-RT加3D-CRT推量的任何量表中，或在比较3D-CRT与IMRT的任何量表中，均未观察到显著差异。与接受传统放疗的幸存者相比，接受适形放疗的幸存者报告总体QOL良好的概率高2.01倍（优势比[OR]，2.01；95%置信区间[95%CI]，1.19 - 3.68），报告口干程度高的概率低2.70倍（OR，0.37；95%CI，0.20 - 0.66）。
结论
适形放疗显著改善了NPC幸存者的头颈相关症状和QOL的广泛方面。
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