头颈部癌放疗后的并发症

放射治疗是治疗恶性肿瘤最常用的方法之一,特别是头颈部早期肿瘤的放射治疗,能够达到与手术等同的治愈率,且有很好的器官功能保全优势[1].     

吞咽功能训练对头颈部肿瘤放射治疗患者吞咽困难的效果

目的探讨吞咽功能训练对头颈部肿瘤放射治疗患者吞咽困难的干预效果。方法 2014年3月~2015年8月60例头颈部肿瘤患者随机分为干预组和对照组,每组各30例。对照组接受常规护理及相关健康教育,干预组在此基础上于放射治疗前2周至放射治疗结束后3个月进行吞咽功能训练。放射治疗结束后1周、3个月采用功能性经口摄食量表、安德森吞咽困难量表进行评价。结果放射治疗结束后1周,干预组患者功能性经口摄食量表得分(Z=-3.195,P0.01)、安德森吞咽困难量表总分及各维度评分(t4.385,P0.001)明显优于对照组。放射治疗结束后3个月,干预组患者功能性经口摄食量表得分(Z=-4.436,P0.01)、安德森吞咽困难量表总分及各维度评分(t5.361,P0.001)明显优于对照组。结论吞咽功能训练可改善头颈部肿瘤患者放射治疗引起的吞咽困难。     

头颈部肿瘤患者放射治疗后认知功能障碍的影响因素研究

目的研究头颈部肿瘤患者经放射治疗后的认知功能障碍情况及其影响因素。 方法采用神经行为认知状态测试(NCSE)量表对58例经放射治疗后的头颈部肿瘤患者进行认知功能评估,以了解其认知功能状况,并分析影响因素。 结果入选58例患者中发生认知功能障碍者占70.6%（41/58）;NCSE量表8个认知项目中以记忆能力及计算能力的障碍发生率较高;合并高血压、糖尿病或化疗亦会显著增加认知功能障碍发生率;多发病灶及常规放疗患者发生认知功能障碍的比例显著高于单病灶及适形放疗患者。 结论对头颈部肿瘤患者放射治疗后进行认知功能评估,有助于早期发现及防治放射性脑损伤。     

康复新液治疗口腔黏膜急性放射反应的护理

头颈部是肿瘤的好发部位,所发生的各种肿瘤约占全身肿瘤的20%.头颈部恶性肿瘤在治疗过程的不同时期大多数需接受放疗.放射治疗在头颈部肿瘤的治疗中占有极其重要的地位,但放射治疗亦可造成正常组织的损伤,尤以口腔粘膜反应为重,严重影响患者的生活质量.     

头颈部肿瘤患者功能状态评分与放射治疗急性放射性损伤及近期效果的相关性

目的探讨头颈部肿瘤患者功能状态(PS)评分与放射治疗急性放射性损伤及近期效果的相关性。方法对在我院首次行根治性放射治疗的头颈部肿瘤37例采用Zubrod-ECOG-WHO(ZPS 5分法)评分标准评估放射治疗前PS评分,于放射治疗结束后1个月评估近期效果,采用多元Logistic回归分析分析患者放射治疗前PS评分、放射剂量与急性放射性损伤的相关性,同时分析患者放射治疗前PS评分与放射治疗近期效果的相关性。结果多元Logistic回归分析显示放射治疗前PS评分、放射剂量与口干、放射性皮炎、黏膜炎、味觉障碍、咽炎或咽喉炎、疲劳及吞咽困难有明显相关性,差异有统计学意义(P=0.001或P0.001);放射剂量与厌食有相关性,差异有统计学意义(P0.001)。放射治疗结束后1个月本组完全缓解(CR)者占32.43%,部分缓解者占37.84%,稳定者占21.62%,进展者占8.11%。多元Logistic回归分析显示放射治疗前PS评分与放射治疗近期效果有明显相关性,差异有统计学意义(P0.001)。结论头颈部肿瘤患者放射治疗前PS评分越高、放射剂量越大,急性放射性损伤越严重;放射治疗前PS评分越高近期治疗效果越差。     

康复新液治疗口腔黏膜急性放射反应的护理

头颈部是肿瘤的好发部位,所发生的各种肿瘤约占全身肿瘤的20％。头颈部恶性肿瘤在治疗过程的不同时期大多数需接受放疗。放射治疗在头颈部肿瘤的治疗中占与有极其重要的地位,但放射治疗亦可造成正常组织的损伤,尤以口腔粘膜反应为重,严重影响患者的生活质量。2005年1月--2009年6月本科共收治头颈部恶性肿瘤放疗患者120例,作者改进了护理方法,同时注重对患者口腔黏膜的保护和修复,从而大大减轻了患者的放疗反应,较满意地完成了放疗计划。现将护理体会报道如下。     

头颈部肿瘤放射性皮肤损伤的研究进展

在我国,恶性肿瘤是致死率最高的疾病[1],其中头颈部肿瘤[2]排名第六,且多为鳞状细胞癌[3]。70%的头颈部肿瘤的患者在确诊时已为中晚期,且头颈部解剖结构复杂,具有较多的重要器官,在治疗的选择上除了疗效以外还要兼顾器官功能的保留。国际上多项研究显示综合手术和放化疗的治疗方式可以得到更好的疗效[4-5]。放射治疗是治疗肿瘤的主要方法之一,放射线对病变肿瘤产生作用的同时,也极易对照射部位周围的组织造成损伤,放射治疗时照射线作用于局部皮肤组织产生的损伤均称之为放射性皮肤损伤[6]。     

调强放射治疗的体位固定与摆位技术

目的：介绍调强放射治疗的体位固定与摆位技术。方法：采用热塑面罩和体膜等固定装置分别对10例头颈部和10例胸腹部肿瘤患者进行体位固定,治疗过程中每周拍一次电子射野影像片（EPID）,将射野片和计划系统中的数字重建射野（DRR）图像片与首次验证片进行比较分析。结果：照射野中心移位误差均在3 mm以内,允许误差〈3 mm。结论：应用体位固定技术的摆位重复性好,能满足调强放射治疗的要求。     

头颈部恶性肿瘤适行调强放射治疗的护理

放射治疗是治疗头颈部恶性肿瘤的重要手段之一,在原发性头颈部恶性肿瘤(鼻咽癌、喉癌、下咽癌、口腔癌等)治疗中取得了非常好的疗效.近年来,随着计算机技术及放射物理技术的进步,适行调强放射治疗逐渐应用于临床头颈部恶性肿瘤的治疗,由于头颈肿瘤位置好固定、解剖结构复杂,调强放射治疗是最适宜的放射治疗手段.调强放射治疗同传统放疗相比更加精细,在三维方向上,剂量分布同肿瘤大体形状相一致,且可以在不同区域进行同步加量照射.现将护理报告如下.     

康复新液联合医用射线防护剂对头颈部肿瘤放射性皮炎的应用研究

目的探讨康复新液联合医用射线防护剂治疗头颈部肿瘤放射性皮炎的临床疗效。方法选择90例需行放射治疗的头颈部肿瘤患者随机分成A、B、C 3个组,每组30例。A组患者放射治疗时用康复新液联合医用射线防护剂治疗放射性皮炎;B组患者在放疗时单用医用射线防护剂;C组患者在放疗时单用康复新液。所有患者均行放射治疗,医用射线防护剂与康复新液每日使用3次,使用前与放射治疗结束后拍照片,根据美国肿瘤放射治疗协会皮肤急性放射损伤分级标准评估疗效。结果 A组治疗后有效率高于对照组B组(χ~2=5.76,P0.05)及C组(χ~2=5.23,P0.05)。B组与C组患者放射性皮炎疗效比较,差异无统计学意义(χ~2=1.26,P0.05)。结论康复新液联合医用射线防护剂对防治头颈部肿瘤放射性皮炎有明显疗效,延缓皮肤损伤的发生,加快皮肤损伤的愈合,值得在临床肿瘤放射治疗护理中进一步推广应用。     

The value of positron emission tomography for monitoring response to radiotherapy in head and neck cancer.

Positron emission tomography (PET) is a molecular imaging technique that allows for accurate measurements of specific tissue functions. Staging of cancer using 2-deoxy-2-[18F]fluoro-D-glucose (FDG) is the most widely used diagnostic application. As PET is able to measure functional changes quantitatively, interest is growing in its use for monitoring response to therapy. This review describes both biologic characteristics of FDG and methodologic issues regarding its use in the head and neck region. In addition, the potential use of FDG for predicting and monitoring response to radiotherapy is discussed. Finally, the potential of some other tracers for monitoring response is reviewed.     

立体聚焦支持护理在头颈部肿瘤放疗患者中的应用

目的 观察立体聚焦支持护理在头颈部肿瘤放疗患者中的应用效果.方法 将2016年1月至2016年6月收治于本院的头颈部放疗患者112例作为研究对象,随机分为对照组与试验组各56例,对照组接受常规放疗护理,试验组接受立体聚焦支持护理,比较干预后两组头颈部肿瘤放疗病例在各相关观察指标方面的差异.结果 试验组头颈部肿瘤放疗病例干预后的生活质量评分和护理满意度评分均显著高于对照组同类病例,差异有统计学意义(P<0.05).结论 采用立体聚焦支持护理对头颈部肿瘤放疗患者实施干预,在提升该类病例生活质量及护理满意度方面均具备积极效应.     

护理干预对头颈部肿瘤放射治疗所致口腔黏膜炎的影响

目的：探讨护理干预对头颈部肿瘤放射治疗所致口腔黏膜炎的影响。方法：99例头颈部肿瘤患者随机分为两组,干预组在对照组的基础上,加强对患者的口腔卫生知识教育,实行口腔护理及物理性预防措施,合理使用抗生素。比较其与对照组之间口腔黏膜炎发生率的差异。结果：干预组口腔黏膜炎发生率66．7％,对照组发生率85．7％,两组比较差异有显著性（P〈0.05）,且干预组发生口腔黏膜炎的程度较轻,差异亦有显著性（P〈0.05）。结论：积极的护理干预可降低头颈部肿瘤放射治疗所致口腔黏膜炎的发生率。     

头颈部肿瘤放疗中口腔黏膜反应的治疗

目的探讨2种漱口液治疗肿瘤患者在放射治疗过程中急性上口腔黏膜炎的疗效。方法将87例头颈部肿瘤患者按随机数字表法分为2组,自制漱口液组（n=43例）和口泰漱口液组（n=44例）。2组在放疗过程中分别采用自制漱口液和口泰漱口液含漱,每次10mL,4～5次.d-1,自放射治疗开始后1周内使用,连续使用7周。根据RTOG/EORTC急性放射性黏膜炎分级标准对2组患者的疗效及口腔黏膜损伤情况进行比较。结果自制漱口液组有效率高于口泰漱口液组、Ⅲ级急性放射性黏膜炎发生率低于口泰漱口液组（均P〈0.05）。结论头颈部肿瘤患者在放疗过程中口腔黏膜反应是不可避免的,自制漱口液配制简单、价格便宜、疗效确定,在头颈部肿瘤患者放射治疗过程中可作为预防和治疗用药。     

The hidden experience of radiotherapy to the head and neck: a qualitative study of patients after completion of treatment

The hidden experience of radiotherapy to the head and neck: a qualitative study of patients after completion of treatment Only a small proportion of cancer patients undergo radical radiotherapy to the head and neck, but their needs are particularly complex. Radiation reactions often exacerbate existing functional difficulties and may severely limit 'normal' life . Few existing studies examine what happens when radiotherapy is over, yet this is the time when reactions are at their peak and day to day links with the hospital are severed. This naturalistic inquiry uses a combination of methods to explore the experiences of 12 patients after completion of radiotherapy to the head and neck. The impact of radiotherapy and the profound disruption to daily life is shown by the uncertainty and unpredictability of symptoms, the waiting, ambiguity and loss of self integrity which occurs throughout this time. Despite considerable physical and emotional trauma, patients showed remarkable resilience and a profound reluctance to ask for help. The findings demand that we re-examine our styles of communication, and consider how well we give information and listen to what is really happening. It is imperative that we provide greater consistency and continuity of care during radiotherapy, recognize the impact of the whole experience and respond to the post-treatment needs of this unique patient group.     

个体化健康教育对头颈部肿瘤放疗病人口腔黏膜炎的影响1）

[目的]探讨个体化健康教育对头颈部肿瘤放疗病人口腔黏膜炎的影响。[方法]将78例头颈部肿瘤放疗病人随机分为观察组与对照组,每组39例,观察组采取个体化健康教育模式,对照组采取放疗科常规健康教育模式,比较两组病人放疗后口腔黏膜炎的分级。[结果]观察组病人3级、4级严重口腔黏膜炎发生率低于对照组（P＆lt;0.05）。[结论]个体化健康教育可以减少头颈部肿瘤放疗病人严重口腔黏膜炎的发生。     

头颈部肿瘤放射治疗对甲状腺功能的影响

报道５５例头颈部肿瘤放射治疗（放疗）后甲状腺功能发生的变化。其中１６例放疗后促甲状腺激素（ＴＳＨ）水平高于正常，８例Ｔ_４水平下降，但临床上出现甲状腺功能减退（甲减）者仅２例，多数病人处于亚临床表现。提示临床不能忽视放疗对甲状腺功能的影响。     

Pain experience following radical treatment for head and neck cancer.

During an investigation into the quality of life of people in the year following radical treatment for head and neck cancer, it became apparent that pain was a significant problem. Therefore, the current study was conducted to gain an understanding of the incidence and nature of pain in people who had received radical treatment for head and neck cancer and to explore their attitudes to pain and pain relief. A single cohort study was undertaken using a structured questionnaire designed for people with head and neck cancer (the EORTC QLQ-C30 and the EORTC QLQ H+N35). Fifty questionnaires were received from people who had received radical treatment between 6 and 12 months previously and who were disease-free. Twenty nine of the respondents also consented to a follow-up semi-structured interview. The interviews generated qualitative data about personal experiences of pain and pain management in head and neck cancer. Patient recollections from interviews identified that only nine out of 29 (31%) interviewees had pain at diagnosis. However, 74% (37) of respondents to the questionnaire reported some degree of pain at follow-up. Patients having both surgery and radiotherapy were significantly more likely to have troublesome pain than patients who received radiotherapy only (Fisher's exact test=0.039). The qualitative data identified a wide variety of pain sites, a number of which were not covered by the EORTC tool. A significant number of patients were rejecting regular pharmacological management and using a variety of other pain-relieving measures. We conclude that through an understanding of pain experience and attitudes to pain management, nurses can facilitate the care and support of patients in pain following treatment for head and neck cancer.     

Oral complications in the head and neck radiation patient

Head and neck cancer arises in the upper aerodigestive tract, most commonly in the oral cavity, pharynx, and larynx. The anatomy and physiology of this region are uniquely complex, and the function and appearance are critical to patients' self-image and quality of life. Head and neck cancer is related to tobacco and alcohol exposure, and is hence found more frequently in males in lower socio-economic classes. These patients therefore tend to be less health conscious and to have less social support than most other groups of cancer patients. Most head and neck cancer patients are treated with high-dose radiotherapy to large irradiation fields encompassing sensitive structures, including the oral cavity and surrounding structures. Significant side effects occur in both the acute and the chronic phase, and dealing with these is a complex issue. Increasing intensity of treatment has improved survival but has also increased treatment side effects. A dedicated multidisciplinary team of oncologist, head and neck surgeon, dentist, nurse, dietician, physical therapist, social worker and in some instances plastic surgeon, prosthodontist, and psychologist is needed to provide the optimal supportive care for these patients. New developments in radiotherapy techniques are expected to lead to even higher cure rates and fewer side effects in patients with head and neck cancer.     

Longitudinal quality of life in Turkish patients with head and neck cancer undergoing radiotherapy

Purpose

This study aims to assess the quality of life and to define its determinants in patients with head and neck cancer undergoing radiotherapy.

Method

This prospective study was performed in an outpatient clinic of radiation oncology with a sample of 54 consecutive patients. Interview forms—European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire and Head and Neck Module to measure quality of life, Radiation Therapy Oncology Group criteria to determine radiation toxicity, and Patient-Generated Subjective Global Assessment to assess nutritional status—were used to obtain personal and disease-related data before, at the end of radiotherapy, and 1 and 3 months post-therapy.

Results

It was determined that various subscales of functional and symptom scales of quality of life were deteriorated at the end of radiotherapy and started to improve at 1 month after treatment. However, dry mouth and sticky saliva symptom scales did not follow the same pattern, and they took more time to improve. Quality of life (QoL) was found to be worse in younger age, higher education, higher income level, type of cancer, advanced stage, presence of tracheostomy, chemoradiation, higher dose of RT, bad nutritional status, and radiation toxicity.

Conclusions

Our results emphasize the vital need of support for head and neck cancer patients during radiotherapy, especially during the first month.