Loorents Vera, Rosell Johan, Karlsson Charlott, Lidbäck Maria, Hultman Kristina, Börjeson Sussanne
Department of Radiation Oncology, County Council of Östergötland , Linköping , Sweden.
Acta Oncol. 2014 Apr;53(4):530-8. doi: 10.3109/0284186X.2014.892211. Epub 2014 Mar 17.
Radiotherapy-induced trismus (RTIT) is a debilitating condition without any proven effective treatment. This study investigates the effectiveness of prophylactic training to prevent RTIT during and up to 12 months after completed RT in patients with head and neck cancer (HNC), also investigating the incidence of RTIT.
Sixty-six consecutive patients from two RT clinics in Sweden were randomised into one of two groups: training with TheraBite(®) Jaw Motion Rehabilitation System(™) or a control group. Maximum interincisal openings (MIO) were recorded at baseline and once a week during treatment, three, six and 12 months after completed RT. Training frequency was recorded by patients in a log book.
There were no significant differences in MIO between the intervention and control groups at any of the measurement points. Patients in both groups maintained their normal variation in MIO at 12 months after completed RT. A small group of patients in the control group had a 17% mean decrease in MIO by week 6 compared to baseline and improved their MIO by using the training programme. There was a significant mean difference in MIO from baseline to week 6 (3 mm, p = 0.018), and month 6 (2.7 mm, p = 0.040), for patients receiving 3D conformal radiotherapy. There was a significant difference in MIO between patients treated with RT and concurrent chemotherapy compared to patients with RT only at 12 months (p = 0.033).
Patients with HNC undergoing high dose RT do not need to be burdened with an intense prophylactic training programme during RT and up to 12 months after completed RT. MIO measurements during RT and up to 12 months after completed RT are recommended to identify a small risk group who are an exception and may need a training programme.
放射治疗引起的牙关紧闭（RTIT）是一种使人衰弱的疾病，尚无经证实有效的治疗方法。本研究调查了预防性训练在预防头颈癌（HNC）患者放疗期间及放疗结束后长达12个月内发生RTIT的有效性，同时也调查了RTIT的发生率。
来自瑞典两家放疗诊所的66例连续患者被随机分为两组之一：使用TheraBite（®）下颌运动康复系统（™）进行训练组或对照组。在基线时以及治疗期间、放疗结束后3个月、6个月和12个月时每周记录一次最大切牙间开口度（MIO）。患者在日志中记录训练频率。
在任何测量点，干预组和对照组之间的MIO均无显著差异。两组患者在放疗结束后12个月时MIO均保持其正常变化。对照组中有一小部分患者在第6周时MIO较基线平均下降了17%，通过使用训练计划其MIO有所改善。接受三维适形放疗的患者从基线到第6周（3毫米，p = 0.018）和第6个月（2.7毫米，p = 0.040）MIO存在显著平均差异。在放疗联合同步化疗的患者与仅接受放疗的患者之间，12个月时MIO存在显著差异（p = 0.033）。
接受高剂量放疗的HNC患者在放疗期间及放疗结束后长达12个月内无需承受强化的预防性训练计划。建议在放疗期间及放疗结束后长达12个月时测量MIO，以识别一小部分属于例外且可能需要训练计划的高危患者群体。
