Department of Head and Neck Surgery, David E. Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Otolaryngol Head Neck Surg. 2014 Jan;150(1):81-6. doi: 10.1177/0194599813509586. Epub 2013 Oct 21.
To analyze the dental health of patients with head and neck cancer who received comprehensive dental care after intensity-modulated radiation therapy (IMRT) compared with radiation therapy (RT).
Historical cohort study.
Veteran Affairs (VA) hospital.
In total, 158 patients at a single VA hospital who were treated with RT or IMRT between 2003 and 2011 were identified. A complete dental evaluation was performed prior to radiation treatment, including periodontal probing, tooth profile, cavity check, and mobility. The dental treatment plan was formulated to eliminate current and potential dental disease. The rates of dental extractions, infections, caries, mucositis, xerostomia, and osteoradionecrosis (ORN) were analyzed, and a comparison was made between patients treated with IMRT and those treated with RT.
Of the 158 patients, 99 were treated with RT and 59 were treated with IMRT. Compared with those treated with IMRT, significantly more patients treated with RT exhibited xerostomia (46.5% vs 16.9%; P < .001; odds ratio [OR], 0.24; 95% confidence interval [CI], 0.11-0.52), mucositis (46.5% vs 16.9%; P < .001; OR, 0.24; 95% CI, 0.11-0.52), and ORN (10.1% vs 0%; P = .014; OR, 0.07; 95% CI, 0.00-1.21). However, significantly more patients treated with IMRT were edentulous by the conclusion of radiation treatment (32.2% vs 11.1%; P = .002; OR, 3.8; 95% CI, 1.65-8.73).
Patients who were treated with IMRT had fewer instances of dental disease, more salivary flow, and fewer requisite posttreatment extractions compared with those treated with RT. The number of posttreatment extractions has been reduced with the advent of IMRT and more so with a complete dental evaluation prior to treatment.
分析头颈部癌症患者在接受调强放疗（IMRT）与放疗（RT）后接受综合口腔护理的口腔健康情况。
历史队列研究。
退伍军人事务部（VA）医院。
共在一家 VA 医院确定了 158 名于 2003 年至 2011 年间接受 RT 或 IMRT 治疗的患者。在放射治疗前进行了全面的口腔评估，包括牙周探查、牙列、龋齿检查和活动度。制定了口腔治疗计划以消除现有的和潜在的口腔疾病。分析了拔牙、感染、龋齿、黏膜炎、口干和放射性骨坏死（ORN）的发生率，并对接受 IMRT 和 RT 治疗的患者进行了比较。
158 名患者中，99 名接受 RT 治疗，59 名接受 IMRT 治疗。与接受 IMRT 治疗的患者相比，接受 RT 治疗的患者口干（46.5%比 16.9%；P<.001；优势比[OR]，0.24；95%置信区间[CI]，0.11-0.52）、黏膜炎（46.5%比 16.9%；P<.001；OR，0.24；95% CI，0.11-0.52）和 ORN（10.1%比 0%；P=0.014；OR，0.07；95% CI，0.00-1.21）的发生率显著更高。然而，在放射治疗结束时，接受 IMRT 治疗的患者中无牙的比例显著更高（32.2%比 11.1%；P=0.002；OR，3.8；95% CI，1.65-8.73）。
与接受 RT 治疗的患者相比，接受 IMRT 治疗的患者口腔疾病发生率较低，唾液分泌量较多，且治疗后需要拔牙的情况较少。随着 IMRT 的出现，以及治疗前进行全面的口腔评估，治疗后拔牙的数量已经减少。
