Liu Yuan, Chen Ming, Zhao Chong, Lu Li-Xia, Han Fei, Bao Yong, Huang Shao-Min, Deng Xiao-Wu, Lu Tai-Xiang, Cui Nian-Ji
State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, 510060, P. R. China.
Ai Zheng. 2007 Jan;26(1):64-7.
BACKGROUND & OBJECTIVE: Radiation-induced temporomandibular joint damage is a kind of common complication after radiotherapy for nasopharyngeal carcinoma (NPC) patients. Trimus is the main symptom of this damage, and severely affects the quality of life of the patients. This study was to evaluate radiation-induced temporomandibular joint damage in NPC patients treated with intensity-modulated radiotherapy (IMRT), and analyze its affecting factors.
From Feb. 2001 to Feb. 2003, 148 naive NPC patients were treated with IMRT by 2.27-2.80 Gy per fraction at a total dose of 63-77 Gy within 31-86 days. The distance between 2 dens incisivus medialis (DDIM) was measured before radiotherapy, and 6 months, 1 year, 2 years, and 3 years after radiotherapy, respectively.
The overall 1-, 2-, and 3-year survival rates were 97.26%, 94.83%, and 92.04%. The irradiation dose to temporomandibular joint was 17.9-51.36 Gy. Seven (4.73%) patients suffered from grade I-II temporomandibular joint damage after IMRT; no patient had grade III-IV temporomandibular joint damage.
IMRT can spare the temporomandibular joint from high dose irradiation. The risk of radiation-induced severe temporomandibular joint damage in NPC patients after IMRT is low.
放射性颞下颌关节损伤是鼻咽癌患者放疗后常见的并发症之一。张口受限是该损伤的主要症状，严重影响患者生活质量。本研究旨在评估调强放疗（IMRT）治疗的鼻咽癌患者放射性颞下颌关节损伤情况，并分析其影响因素。
2001年2月至2003年2月，148例初治鼻咽癌患者接受IMRT治疗，每次分割剂量为2.27 - 2.80 Gy，总剂量63 - 77 Gy，在31 - 86天内完成。分别于放疗前、放疗后6个月、1年、2年及3年测量双侧中切牙切缘间距离（DDIM）。
1年、2年、3年总生存率分别为97.26%、94.83%、92.04%。颞下颌关节照射剂量为17.9 - 51.36 Gy。IMRT后7例（4.73%）患者发生Ⅰ - Ⅱ级颞下颌关节损伤；无Ⅲ - Ⅳ级颞下颌关节损伤患者。
IMRT可使颞下颌关节免受高剂量照射。IMRT治疗后鼻咽癌患者发生严重放射性颞下颌关节损伤的风险较低。
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