调强放射治疗局部晚期头颈癌患者口干症的客观与主观评估
Objective and subjective assessment of xerostomia in patients of locally advanced head-and-neck cancers treated by intensity-modulated radiotherapy.
作者信息
Lal Punita, Nautiyal Vipul, Verma Mranalini, Yadav Rajan, Maria Das K J, Kumar Shaleen
机构信息
Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Department of Radiotherapy, CRI, Himalayan Institute of Medical Sciences, SRHU, Dehradun, Uttarakhand, India.
出版信息
J Cancer Res Ther. 2018 Oct-Dec;14(6):1196-1201. doi: 10.4103/jcrt.JCRT_200_17.
BACKGROUND
Parotid-sparing intensity-modulated radiotherapy (IMRT) effectively reduces xerostomia in head-and-neck cancer (HNC). Changes in the salivary output at 1 year were studied and correlation with quality of life (QOL) changes in patients of locally advanced HNC (LAHNC) was drawn.
MATERIALS AND METHODS
Between October 2009 and October 2011, 20 patients of LAHNC were treated with IMRT using simultaneous integrated boost technique. High-risk clinical target volume (CTV) was given a dose of 66 Gy/30 fr, intermediate-risk CTV 60 Gy/30 fr, and low-risk CTV 54 Gy/30 fr. The saliva flow rate was estimated for 5 min at rest (unstimulated) and after using lemon drops (stimulated) for the next 5 min, at baseline (pretreatment), and 3, 6, and 12 months following treatment. Evaluation of patients' perception of dry mouth was done using EORTC-QLQ-C30 and HN35 questionnaires at the same time points.
RESULTS
Baseline unstimulated and stimulated salivary flow rates were 0.659 ml/min and 1.69 ml/min, respectively. At 3 months, a significant reduction in unstimulated (0.346 ml/min) and stimulated (0.80 ml/min) flow rate was observed. Unstimulated flow rate continued to decrease further till 6 months (0.295 ml/min), but slight improvement was seen in stimulated flow rate (0.91 ml/min). At 12 months, minimal recovery was observed in both unstimulated (0.362 ml/min) and stimulated flow rates (1.09 ml/min). EORTC-QOL questionnaire mean scores for dryness and stickiness of saliva were 10 and 15 at baseline and increased to 36 and 25, respectively, at 3 months. At 6 months, symptom score for dryness further increased to 45 and then decreased to 33 at 12 months. Stickiness score remained static from 3 to 12 months. Salivary flow rate correlated well with dry mouth (P < 0.05) but not with the perception of sticky saliva (P = 0.82) at 6 months and beyond.
CONCLUSIONS
Both salivary flow rate and xerostomia-related questions worsened at 3 months even with IMRT and showed a similar pattern of recovery.
背景
保留腮腺的调强放射治疗（IMRT）可有效降低头颈癌（HNC）患者的口干症。本研究观察了患者放疗1年后唾液分泌量的变化，并分析其与局部晚期头颈癌（LAHNC）患者生活质量（QOL）变化的相关性。
材料与方法
2009年10月至2011年10月期间，20例LAHNC患者采用同步整合加量技术进行IMRT治疗。高危临床靶区（CTV）给予66 Gy/30次的剂量，中危CTV给予60 Gy/30次，低危CTV给予54 Gy/30次。在基线期（治疗前）以及治疗后3、6和12个月，分别于静息状态下（未刺激）估计5分钟的唾液流速，随后使用柠檬糖刺激5分钟后再次估计唾液流速。在相同时间点，使用欧洲癌症研究与治疗组织生活质量问卷（EORTC-QLQ-C30）和头颈部特异性问卷（HN35）评估患者对口干的感受。
结果
基线期未刺激和刺激后的唾液流速分别为0.659 ml/分钟和1.69 ml/分钟。在3个月时，观察到未刺激（0.346 ml/分钟）和刺激（0.80 ml/分钟）的唾液流速显著降低。未刺激的唾液流速持续下降至6个月时（0.295 ml/分钟），但刺激后的唾液流速略有改善（0.91 ml/分钟）。在12个月时，未刺激（0.362 ml/分钟）和刺激后的唾液流速（1.09 ml/分钟）均观察到最小程度的恢复。EORTC生活质量问卷中关于唾液干燥和黏稠的平均得分在基线期分别为10和15，在3个月时分别增至36和25。在6个月时，干燥症状评分进一步增至45，然后在12个月时降至33。黏稠评分在3至12个月保持稳定。在6个月及以后，唾液流速与口干显著相关（P < 0.05），但与唾液黏稠感无关（P = 0.82）。
结论
即使采用IMRT治疗，唾液流速和口干相关问题在3个月时仍会恶化，且呈现出相似的恢复模式。
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