Institute for Reconstructive Sciences in Medicine, Covenant Health, University of Alberta, Alberta Health Services.
J Otolaryngol Head Neck Surg. 2012 Dec;41(6):389-95.
Advanced radiotherapy (RT) such as intensity-modulated radiotherapy (IMRT) has become more common in the management of head and neck cancer (HNC). IMRT includes focused target volume coverage while sparing salivary tissues to protect function. However, the long-term effects on dentition after IMRT are not well established. This investigation sought to understand dental status by comparing tooth loss after IMRT and conventional RT in HNC patients.
A retrospective chart review was conducted on individuals who received IMRT or conventional RT (± surgery, ± chemotherapy) for oropharyngeal, oral cavity, and nasopharyngeal cancer between 2000 and 2010 at the Institute for Reconstructive Sciences in Medicine. Tooth loss, the primary outcome measure, was assessed using intraoral photographs, radiographs, and clinical records. The influence of patient demographics on tooth loss was assessed as well.
Eighty-six patients were eligible for review at baseline; 44 received IMRT and 42 received conventional RT. Twenty-four had data collected up to 2 years after RT. After adjusting for baseline number of teeth, no significant differences were found between groups 2 years after RT using repeated measures analysis of covariance (p = .079). The site of disease was significantly different between groups.
No statistically significant differences in tooth loss between RT groups were found 2 years after RT; however, trends in the data suggest that tooth loss increased each year after RT. The early findings need to be viewed with caution as data beyond 3 to 5 years and a larger sample size are needed to understand the dental effects after advanced RT.
调强放疗（IMRT）等先进放疗技术在头颈部癌症（HNC）的治疗中越来越普遍。IMRT 包括集中靶区覆盖，同时保护唾液腺组织以保护功能。然而，IMRT 后对牙齿的长期影响尚未得到很好的确定。本研究旨在通过比较 HNC 患者接受 IMRT 和常规放疗后牙齿缺失的情况，了解牙齿状况。
对 2000 年至 2010 年期间在医学重建科学研究所接受调强放疗或常规放疗（±手术、±化疗）治疗口咽、口腔和鼻咽癌症的患者进行回顾性图表审查。使用口腔内照片、射线照片和临床记录评估主要结局指标牙齿缺失情况。还评估了患者人口统计学特征对牙齿缺失的影响。
在基线时有 86 名患者符合审查条件；44 名患者接受 IMRT，42 名患者接受常规 RT。24 名患者在 RT 后 2 年内收集了数据。在调整基线牙齿数量后，使用重复测量协方差分析（ANCOVA），在 RT 后 2 年内两组间没有发现显著差异（p=0.079）。疾病部位在两组间存在显著差异。
在 RT 后 2 年内，两组间牙齿缺失无统计学显著差异；然而，数据趋势表明，RT 后每年牙齿缺失都会增加。早期发现需要谨慎看待，因为需要 3 至 5 年以上的数据和更大的样本量才能了解先进 RT 后的牙齿影响。
