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放射治疗治疗唾液分泌过多:50 例肌萎缩侧索硬化症患者的前瞻性研究。

Radiation therapy for hypersalivation: a prospective study in 50 amyotrophic lateral sclerosis patients.

机构信息

Department of Radiation Oncology, Centre Clinique de la Porte de Saint Cloud, Boulogne-Billancourt, France; Department of Radiation Oncology, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.

Department of Radiation Oncology, Gustave Roussy, Université Paris-Sud XI, Villejuif, France.

出版信息

Int J Radiat Oncol Biol Phys. 2014 Mar 1;88(3):589-95. doi: 10.1016/j.ijrobp.2013.11.230. Epub 2014 Jan 7.

Abstract

PURPOSE

This study aimed to evaluate the efficiency and the tolerance of radiation therapy (RT) on salivary glands in a large series of amyotrophic lateral sclerosis (ALS) patients with hypersalivation.

METHODS AND MATERIALS

Fifty ALS patients that had medically failure pretreatment were included in this prospective study. RT was delivered through a conventional linear accelerator with 6-MV photons and 2 opposed beams fields including both submandibular glands and two-thirds of both parotid glands. Total RT dose was 10 Gy in 2 fractions (n=30) or 20 Gy in 4 fractions (n=20). RT efficacy was assessed with the 9-grade Sialorrhea Scoring Scale (SSS), recently prospectively validated as the most effective and sensitive tool to measure sialorrhea in ALS patients.

RESULTS

At the end of RT, all patients had improved: 46 had a complete response (92% CR, SSS 1-3) and 4 had a partial response (8% PR, SSS 4-5). A significant lasting salivary reduction was observed 6 months after RT completion: there was 71% CR and 26% PR, and there was a significant SSS reduction versus baseline (P<10(-6)). There was no grade 3 to 4 toxicity, and most side effects (34%) occurred during RT. Nine patients (18%) underwent a second salivary gland RT course, with a 3-months mean delay from the first RT, resulting in a SSS decrease (-77%). Both RT dose regimens induced a significant SSS decrease with no significant toxicity. There were, however, more patients with CR/PR in the 20-Gy protocol (P=.02), and 8 of 9 patients (89%) receiving a second RT course had previously been treated within the 10-Gy protocol.

CONCLUSION

Radiation therapy of 20 Gy in 4 fractions is an efficient and safe treatment for ALS patients with sialorrhea. A shorter RT course (10 Gy in 2 fractions) may be proposed in patients in poor medical condition.

摘要

目的

本研究旨在评估放射治疗(RT)对大系列伴有唾液分泌过多的肌萎缩侧索硬化症(ALS)患者唾液腺的疗效和耐受性。

方法和材料

本前瞻性研究纳入了 50 例经预处理后药物治疗失败的 ALS 患者。RT 采用 6-MV 光子常规直线加速器进行,使用 2 个对向野,包括双侧下颌下腺和双侧腮腺的 2/3。总 RT 剂量为 10 Gy 分 2 次(n=30)或 20 Gy 分 4 次(n=20)。采用 9 级唾液流率评分量表(SSS)评估 RT 疗效,该量表最近前瞻性验证为评估 ALS 患者唾液流率的最有效和最敏感的工具。

结果

RT 结束时,所有患者均得到改善:46 例完全缓解(92%CR,SSS 1-3),4 例部分缓解(8%PR,SSS 4-5)。RT 完成后 6 个月观察到唾液持续减少:71%CR 和 26%PR,与基线相比 SSS 显著降低(P<10(-6))。无 3-4 级毒性,大多数不良反应(34%)发生在 RT 期间。9 例(18%)患者接受了第二次唾液腺 RT 治疗,两次治疗的平均间隔时间为 3 个月,SSS 降低(-77%)。两种 RT 剂量方案均能显著降低 SSS,且无明显毒性。然而,20-Gy 方案的 CR/PR 患者更多(P=.02),9 例接受第二次 RT 治疗的患者中有 8 例(89%)之前接受过 10-Gy 方案的治疗。

结论

对于伴有唾液分泌过多的 ALS 患者,20 Gy 分 4 次的 RT 是一种有效且安全的治疗方法。对于身体状况较差的患者,可能需要更短的 RT 疗程(10 Gy 分 2 次)。

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