头颈部放射性口腔黏膜炎患者营养状况与生活质量相关性研究

目的 探讨头颈部肿瘤放射性口腔黏膜炎的患者营养状况与生活质量的相关性。 方法 采用一般资料问卷、癌症患者生活质量量表（QLQ-C30）、患者主管整体评定量表（PG-SGA）、美国国家癌症研究所常见毒性反应标准（NCI-CTCAE）量表对80例头颈部放射性口腔黏膜炎患者进行调查。结果 80例符合入选标准的患者,其中男51例,女29例。年龄19~80（58.21±11.84）岁。PG-SGA评价结果：A级患者为12例,B级患者为35例,C级患者为 33例。躯体功能、角色功能、认知功能、社会功能、总体健康状况及疲倦、疼痛、便秘、腹泻等症状与营养状况存在明显相关性（P＜0.05）,情绪功能、恶心呕吐、气促、失眠、食欲丧失、经济困难与营养状况无明显相关性（P>0.05）。 结论 头颈部放射性口腔黏膜炎患者存在着不同程度的营养不良,其营养状况与生活质量呈正相关关系（P＜0.01）。因此,改善头颈部放射性口腔黏膜炎患者的营养状况可大幅度提高患者的生活质量,改善临床治疗结局,为今后制定护理干预措施提供参考依据。     

规范化的营养管理对头颈癌放疗患者营养状况的影响

目的探讨规范化的营养管理对头颈癌放疗患者营养状况的影响。方法收集2016年1月至2017年10月间四川省肿瘤医院放疗科68例头颈癌放疗患者的临床资料,按照随机数字表法分为对照组与观察组各34例,对照组给予常规营养管理,观察组提供规范化的营养管理,对比两组患者治疗期间体重、白蛋白、总淋巴细胞计数、血红蛋白以及血清前白蛋白等相关指标的变化。结果观察组放疗前、放疗4周、放疗结束后体重分别为（62.9±3.5）kg、（60.9±2.5）kg、（60.2±1.4）kg,差异具有统计学意义（F组间=9.79,P<0.001;F时间=23.71,P<0.001;F交互=16.69,P<0.001）;对照组体重分别为（62.4±3.6）kg、（58.9±2.4）kg、（56.2±1.2）kg,差异具有统计学意义（F组间=47.73,P<0.001;F时间=114.38,P<0.001;F交互=88.75,P<0.001）,观察组体重丢失幅度明显低于对照组,差异有统计学意义（P<0.05）;治疗前观察组与对照组白蛋白、血清前白蛋白含量、总淋巴细胞计数、血红蛋白含量分别为（44.2±3.4）g/L、（280.1±58.5）mg/L、（1.86±0.66）×109/L、（129.8±14.1）g/L、（43.6±3.6）g/L、（273.7±49.4）mg/L、（1.89±0.84）×109/L、（140.0±12.6）g/L,放疗4周后、放疗结束时两组各指标均有所下降,观察组各血液指标下降幅度同样低于对照组,差异有统计学意义（P<0.05）;观察组治疗期间放射性口腔炎、放射性皮炎等不良反应发生率分别为5.88%、2.94%,明显低于对照组17.65%、14.71%,差异有统计学意义（P<0.05）。结论规范化的营养管理在头颈癌放疗患者营养干预中效果显著,能有效改善营养状况并降低并发症发生率。     

Impact of radiation-induced xerostomia on quality of life after primary radiotherapy among patients with head and neck cancer

PURPOSE: To investigate the impact of xerostomia on overall quality of life (QoL) outcome and related dimensions among head and neck cancer patients treated with primary radiotherapy. METHODS AND MATERIALS: A total of 288 patients with Stage I-IV disease without distant metastases were included. Late xerostomia according to the Radiation Therapy Oncology Group (RTOG-xerostomia) and QoL (European Organization for Research and Treatment of Cancer QLC-C30) were assessed at baseline and every 6th month from 6 months to 24 months after radiotherapy. RESULTS: A significant association was found between RTOG-xerostomia and overall QoL outcome (effect size [ES] 0.07, p < 0.001). A significant relationship with global QoL, all functioning scales, and fatigue and insomnia was observed. A significant interaction term was present between RTOG-xerostomia and gender and between RTOG-xerostomia and age. In terms of gender, RTOG-xerostomia had a larger impact on overall QoL outcome in women (ES 0.13 for women vs. 0.07 for men). Furthermore, in women ES on individual scales were larger, and a marked worsening was observed with increasing RTOG-xerostomia. No different ES according to age was seen (ES 0.10 for 18-65 years vs. 0.08 for >65 years). An analysis of the impact of RTOG-xerostomia on overall QoL outcome over time showed an increase from 0.09 at 6 months to 0.22 at 24 months. With elapsing time, a worsening was found for these individual scales with increasing RTOG-xerostomia. CONCLUSIONS: The results of this prospective study are the first to show a significant impact of radiation-induced xerostomia on QoL. Although the incidence of Grade > or =2 RTOG-xerostomia decreases with time, its impact on QoL increases. This finding emphasizes the importance of prevention of xerostomia.     

蛋白质摄入量对头颈部肿瘤放化疗期间人体成分及生活质量的影响

目的 探讨蛋白质摄入量对头颈部肿瘤患者放化疗期间营养状况、人体成分及生活质量的影响。方法83例头颈 部肿瘤患者均采用患者主观整体评估方法对放疗前后的营养状态进行评估以及营养干预（饮食指导、ONS、PN）,按实际蛋白质摄入量0.8g/(kg·d)为界分为A组[≥0.8g/(kg·d)]和B组[＜0.8g/(kg.d)],采用生物电阻抗法观察两组患者放疗前后的人体成分变化及肿瘤患者生命质量测定表（EORCT QLQ-C30）观察两组患者放疗前后生活质量的变化。结果 两组患者放疗前营养不良发生率无统计学差异（P≥0.5）,放疗结束后A组营养不良发生率、握力前后变化值明显低于B组,差异有统计学差异,P＜0.05;体成分变化方面,A组在体重变化、体重变化百分比、BMI变化、体脂变化百分比、去脂体重变化、肌肉质量变化、去脂体重指数变化方面均明显低于B组,差异有统计学意义,P＜0.05;两组患者放疗前生活质量评分没有统计学差异,放疗结束后A组在疲劳、失眠、食欲丧失、疼痛、总体生活质量变化方面均优于B组,差异有统计学意义,P＜0.05。结论 应对头颈部肿瘤患者放疗期间进行全程的营养干预,重视头颈部肿瘤患者放化疗期间蛋白质、能量的摄入,可改善患者的营养状态及体力,对体成分变化、提高患者的生活质量有益处。     

能量摄入对头颈癌放化疗患者营养状况和生活质量的影响

目的 探讨能量摄入量对头颈癌患者放化疗期间营养状况、体成分及生活质量的影响。方法 选取符合入选标准 的头颈癌患者 90 例,分别在放化疗前和放疗结束 2 个时段对患者进行调查,调查内容包括：营养评估、膳食调查、体成分 测量以及生活质量四个部分。临床营养师通过 24 小时膳食调查获得患者的能量摄入量,包括膳食能量摄入以及 ONS,同 时采用 Harris-Benedict 公式获得患者的能量需要量,从而计算患者的能量摄入量占需要量的比例,能量摄入占比＜ 70% 为 A 组,能量摄入占比≥ 70% 为 B 组。结果 两组患者的基线资料,包括年龄、性别、BMI、治疗前的营养状况、临床分期、 诊断、放疗剂量以及治疗方式等方面差异均无统计学意义（P ＞ 0.05）,两组具有可比性。放疗结束后,A 组患者营养不 良发生率明显高于 B 组,A 组患者营养不良发生率为 100%,B 组为 84.09%,差异具有统计学意义（P ＜ 0.05）;24 小时 膳食调查发现,A 组患者每天通过膳食和 ONS 摄入的能量分别为 864kcal 和 214kcal,明显低于 B 组,差异具有统计学意义（P ＜ 0.05）。使用放疗前后体成分的变化值来表示能量摄入量对体成分的影响,发现 A 组患者 BMI、体重、肌肉、蛋白质、 骨骼肌和体脂百分比的变化均大于 B 组,两组除了蛋白质和骨骼肌的变化没有统计学意义外,其他指标差异均具有统计 学意义（P ＜ 0.05）;放疗前,两组患者生活质量评分没有明显的统计学差异;放疗结束后,A 组患者功能评分均比 B 组 偏低,而症状评分都偏高;在生活质量、认知功能、疼痛、疲倦、食欲丧失等方面两组间差异都具有统计学意义。结论 头 颈癌患者经放化疗后,营养状况、体成分及生活质量恶化,而在治疗前和治疗过程中保持能量摄入量占比≥ 70% 可以防止 进一步恶化。     

Treatment-related dysgeusia in head and neck cancer patients

Head and neck cancer patients treated with radiotherapy and/or chemotherapy agents may develop altered taste acuity. This, together with radiation induced xerostomia and dysphagia, is a major contributory factor to the anorexia and concomitant morbidity often seen in this group of patients. This paper examines the existing literature in order to assess the prevalence of clinician and patient-reported dysgeusia in HNC patients undergoing oncological treatment. We also describe the temporal manifestations of the same and its reported impact on QOL.     

Phase III trial of low-level laser therapy to prevent oral mucositis in head and neck cancer patients treated with concurrent chemoradiation

Background

Oral mucositis (OM) is a complication of chemoradiotherapy treatment of head and neck squamous cell carcinoma (HNSCC) patients with no effective therapy. This study was designed to assess the efficacy of preventive low-level laser therapy (LLLT) in reducing the incidence of grade 3–4 OM.

Material and methods

From June 2007 to December 2010, 94 HNSCC patients entered a prospective, randomized, double-blind, placebo-controlled phase III trial. Chemoradiotherapy consisted of conventional radiotherapy plus concurrent cisplatin every 3 weeks. A diode InGaAlP (660 nm–100 mW–1 J–4 J/cm²) was used. OM evaluation was performed by WHO and OMAS scales and quality of life by EORTC questionnaires (QLQ).

Results

A six-fold decrease in the incidence of grades 3–4 OM was detected in the LLLT group compared to the placebo; (6.4% versus 40.5%). LLLT impacted the incidence of grades 3–4 OM to a relative risk ratio of 0.158 (CI 95% 0.050–0.498). After treatment QLQ-C30 showed, differences favoring LLLT in physical, emotional functioning, fatigue, and pain; while the QLQ-H&N35 showed improvements in LLLT arm for pain, swallowing, and trouble with social eating.

Conclusion

Preventive LLLT in HNSCC patients receiving chemoradiotherapy is an effective tool for reducing the incidence of grade 3–4 OM. Efficacy data were corroborated by improvements seen in quality of life.     

头颈部肿瘤放疗对甲状腺功能的损伤

头颈部肿瘤放疗后会引起不同程度的甲状腺功能减退.引起甲状腺功能减退的机制包括射线对甲状腺及垂体细胞的直接损伤、对相关血管的损伤以及自身免疫反应等.影响头颈部肿瘤放疗后甲状腺功能的因素主要有:放疗剂量、放疗技术、是否联合手术化疗等.通过对这些影响因素的研究可为防治甲状腺功能减退提供依据,从而提高患者生活质量.     

Increased risk of stroke in young head and neck cancer patients treated with radiotherapy or chemotherapy

Background

Chemo-radiotherapy-induced carotid stenosis and cerebrovascular events in head and neck cancer patients can cause severe disability and death. We aimed to estimate the risk of stroke in such patients over a six-year follow-up period.

Patients and methods

The study cohort consisted of head and neck cancer patients (n = 10,172). Cox proportional hazard model was used to compare the stroke-free survival rate between the patients treated with radiotherapy or chemotherapy, surgery alone, and surgery with adjuvant therapy after adjusting for possible confounding factors.

Results

At the end of follow-up, 384 patients had strokes: 126 (4.3%) from the surgery alone group, 167 (3.8%) from the radiotherapy or chemotherapy group, and 91 (3.2%) from the surgery with adjuvant therapy (P = 0.222). Head and neck cancer patients aged less than 55 years treated with radiotherapy or chemotherapy conferred a 1.8-fold higher risk for stroke (95% CI, 1.22–2.56; P = 0.003) after adjusting for patient characteristics, co-morbidities, geographic region, urbanization level, and socio-economic status. There was no statistical difference in stroke risk between different treatment modalities in head and neck cancer patients aged 55 years and more.

Conclusions

Young head and neck cancer patients treated with radiotherapy or chemotherapy have higher risks for stroke. Different treatment strategies should be considered in such patients.     

调强和常规放疗对头颈部癌患者生存质量影响评估

目的 前瞻性评估调强和常规放疗对头颈部癌患者生存质量(QOL)的影响和差异以指导临床.方法 2007-2008年102例头颈部癌患者(口腔癌76例,口咽癌14例,鼻咽癌11例,颈部转移癌1例)在上海第九人民医院放疗科接受放疗,其中IMRT组52例,至少保护一侧腮腺,其中24例加对侧颌下腺保护;常规放疗组50例,不保护唾液腺.采用EORTC QLQ-C30和头颈部癌HN35通用量表,在放疗前,放疗结束日,放疗后2、6个月对患者QOL中33个领域进行评估,以10分以上的得分变化为有临床意义.结果 调强和常规放疗造成头颈部癌患者QOL 94%(31/33)领域下降,其中49%(16/33)显著下降(U=2.72～5.98,P值均<0.01),33%(11/33)的下降有临床意义;放疗后2个月有12%(4/33)领域出现有临床意义的恢复,但15%(5/33)领域尚未恢复(U=3.10～5.93,P值均<0.01);放疗后6个月QOL继续改善,有21%(7/33)领域出现有统计学和临床意义的恢复,并优于放疗前,但在口干和唾液粘稠症状2个领域尚未恢复(U=4.49、4.87,P<0.01、0.01).IMRT对口干和唾液粘稠领域的影响比常规放疗明显小(U=4.57、5.57,P值均<0.01),并在放疗后持续改善,常规放疗未见改善,组间有非常显著性差异(U=7.23、7.57,P值均<0.01).结论 放疗造成头颈部癌患者QOL显著下降,放疗后出现持续性恢复,但口干和唾液粘稠症状恢复差,是影响QOL的主要原因.IMRT优点是对口干和唾液粘稠症状影响明显小于常规放疗,对保存QOL意义重大.     

Treatment of late sequelae after radiotherapy for head and neck cancer

Radiotherapy (RT) is used to treat approximately 80% of patients with cancer of the head and neck. Despite enormous advances in RT planning and delivery, a significant number of patients will experience radiation-associated toxicities, especially those treated with concurrent systemic agents. Many effective management options are available for acute RT-associated toxicities, but treatment options are much more limited and of variable benefit among patients who develop late sequelae after RT. The adverse impact of developing late tissue damage in irradiated patients may range from bothersome symptoms that negatively affect their quality of life to severe life-threatening complications. In the region of the head and neck, among the most problematic late effects are impaired function of the salivary glands and swallowing apparatus. Other tissues and structures in the region may be at risk, depending mainly on the location of the irradiated tumor relative to the mandible and hearing apparatus. Here, we review the available evidence on the use of different therapeutic strategies to alleviate common late sequelae of RT in head and neck cancer patients, with a focus on the critical assessment of the treatment options for xerostomia, dysphagia, mandibular osteoradionecrosis, trismus, and hearing loss.     

The course of health-related quality of life in head and neck cancer patients treated with chemoradiation: A prospective cohort study

Background and purpose

To evaluate the course of health-related quality of life (HRQOL) from diagnosis to 2 years follow-up in patients with head and neck cancer (HNSCC) treated with chemoradiation (CRT).

Materials and methods

164 patients completed the EORTC QLQ-C30 and QLQ-H&N35 questionnaires 1 week before and 6 weeks and 6, 12, 18, and 24 months after CRT. Patients were compared to a reference group. A linear mixed-model analysis was used to assess changes in HRQOL over time, and whether this was associated with age, gender, comorbidity, and tumor sublocation.

Results

Significant differences for the majority of HRQOL scales were observed between patient and reference group at baseline, and follow-up. The course of HRQOL was different for survivors compared to non-survivors. In survivors, improvement over time was observed (in global quality of life, physical, role, and social function, fatigue, pain, swallowing, speech, social eating, and social contacts), while in non-survivors the pattern over time was either no changes in HRQOL or a deterioration (in physical function, social eating and contacts). In both survivors and non-survivors, emotional functioning improved after treatment, but deteriorated in the longer term. Patients with comorbidity reported worse physical function, and patients with oral/oropharyngeal cancer (compared to hypopharyngeal/laryngeal cancer) reported more oral pain and sexual problems, but fewer speech problems.

Conclusions

The course of HRQOL of HNSCC patients during the first 2 years after CRT is different for survivors compared to non-survivors and is associated with comorbidity and tumor subsite.     

The effect of socioeconomic factors on quality of life after treatment in patients with head and neck cancer

PURPOSE: To determine the effect of socioeconomic factors on quality of life (QoL) after treatment in patients with head and neck carcinoma (HNC). PATIENTS AND METHODS: The study population included 50 HNC patients seen in their control examinations after radiotherapy during a 2-month interval and who were willing to complete the Short-Form 36 QoL questionnaire. Socioeconomic, demographic, and tumor- and treatment-related factors were analyzed for their effect on physical component summary score (PCS) and mental component summary score (MCS) using the Mann-Whitney U test. RESULTS: All patients received radiotherapy, and 33 patients (66%) underwent surgery for the primary tumor and/or neck disease. Chemotherapy was given in 9 patients (18%). Mean PCS and MCS were 47.9 (range, 24.8-59.3) and 46.7 (range, 22-63.3) for the whole patient population. There was no significant factor affecting PCS. Education level of "middle school or higher," perceived economic status of "medium or higher," social security status of not being "absent or minimally covered," and unilateral type of neck surgery were found to increase MCS significantly. According to separate linear regression analyses performed for three socioeconomic variables, the most significant factor for MCS was social security status compared with education level and perceived economic status. It was the only parameter that retained its significance when all five parameters were combined in a linear regression model. CONCLUSION: This study demonstrated that educational status, perceived economic status, and social security status showed a significant effect on the QoL of HNC patients after radiotherapy. When all variables were taken into account, only "social security status" remained significant.     

Effects of radiotherapy on parotid salivary sialochemistry in head and neck cancer patients

Aim

To determine the effects of high dose irradiation on parotid salivary sodium and pH concentration at subsequent duration of 1.5, 3 and 6 months following radiotherapy.

Materials and methods

Eighty parotid glands of head and neck cancer patients were irradiated with mean dose of 66 Gy. The stimulated parotid flow (PF) was collected by a cannulation of Stenson’s duct followed by analysis of sodium (PF sodium) by Easylyte Sodium/Potassium auto analyzer and pH by litmus narrow band pH paper.

Results

A steep elevation of PF sodium was found in post-RT period after 1.5 months of starting RT followed by gradual increase up to 6 months and pH changed towards acidity.

Conclusions

A high dose of 66 Gy causes irreversible damage to parotid salivary duct system.     

The use of radiologically placed gastrostomy tubes in head and neck cancer patients receiving radiotherapy

: Patients undergoing radiotherapy to the head and neck area frequently experience radiation reactions that can markedly restrict oral intake, require hospitalization, and occasionally cause treatment interruptions. The Vancouver Cancer Center (VCC) has recently employed radiologically placed gastrostomy tubes (G-tubes) in the management of this problem. A review of the patients on whom its procedure had been performed is the subject of this review.

: Thirty-four patients had gastrostomy tubes inserted under radiologic guidance. This group is compared to a control group matched for age, sex, irradiated volume, and radiation dose, who did not have gastrostomy tubes. Patients with gastrostomy tubes were divided into two categories: (a) patients who had tubes inserted in anticipation of severe reactions, and (b) patients who developed severe radiation reactions necessitating nutritional support.

: The gastrostomy group consisted of 65% males with an average age of 59 years and stage range of II (12%), III (24%), and IV (65%). In both the elective group and the nonelective group, patients maintained their weight at 95 to 97% of the pretreatment weight, at follow-up of 6 weeks and 3 months. This compared with an average weight loss in the control group of 9% at 6 weeks and 12% at 3 months. The length of hospitalization was a mean of 4.9 days in the elective group and 19 days in the nonelective group. Complication were low compared to those documented in the literature, but included two tube migrations, two aspirations, and one gastrointestinal bleed.

: We believe that gastrostomy tubes contribute significantly to the management of patients with lead and neck cancer, particularly in maintenance of nutrition, and they may decrease the need for hospitalization.     

A phase I trial combining oral cisplatin (CP Ethypharm) with radiotherapy in patients with locally advanced head and neck squamous cell carcinoma

Purpose

To determine the maximum tolerated dose (MTD) of oral cisplatin (CP Ethypharm®) in combination with radiotherapy in head and neck squamous cell carcinoma (HNSCC) and the recommended dose for phase II trials.

Patients and methods

Phase I, multicenter, open-labelled, non-comparative and dose escalating trial. CP Ethypharm® was administered on five consecutive days every other week for 7 weeks (4 treatment cycles) in combination with radiotherapy. Eighteen patients with locally advanced HNSCC were allocated to four cisplatin dose levels: 10 mg/m²/day: 4 patients; 15 mg/m²/day: 4, 20 mg/m²/day: 5 and 25 mg/m²/day: 5. The inclusion of patients was dictated by occurrence of dose limiting toxicities (DLTs) at each dosing level.

Results

The most frequently experienced AEs were gastrointestinal (GI) disorders. Five DLTs were observed, including three at 25 mg/m² level (two grade 2 renal toxicities, one grade 3 GI and renal toxicities), one at 20 mg/m² level (grade 3 GI disorders), one at 10 mg/m² level (grade 4 mucositis). PK analysis showed no significant difference of C_max values between day 1 and day 5 of treatment at each dose level (total & ultrafilterable platinum).

Conclusion

Due to 3 DLTs experienced at 25 mg/m²/day, MTD was reached and the recommended dose for phase II studies was determined as 20 mg/m²/day.     

头颈部肿瘤放疗者营养与支持治疗专家共识

放疗是头颈部肿瘤最常用的治疗手段。恶性肿瘤本身代谢异常及治疗过程中伴随的急性和晚期毒性等极易导致患者发生营养不良,其发生率高达44%~88%,其中重度营养不良的发生率为20%~40%。患者一旦发生营养不良,其治疗耐受性和敏感性会降低,治疗并发症会进一步增高,从而延长住院时间增加治疗费用,最终影响患者疗效。因此,营养与支持治疗是头颈肿瘤患者治疗的重要组成部分。为了使这部分患者得到合理、有效的营养与支持治疗,根据我国目前的肿瘤放疗和肿瘤营养治疗现状,参考国内外相关指南,制定适合我国情况的头颈部肿瘤放疗患者营养与支持治疗专家共识非常必要。     

白细胞介素-11预防和治疗头颈部肿瘤放疗导致口腔黏膜反应的疗效观察

目的 探讨预防和治疗头颈部肿瘤放疗性口腔黏膜反应的有效方法.方法 对2008年3月至2010年3月间50例头颈部肿瘤放疗患者随机分组对照观察.在放射治疗期间,观察组给予白细胞介素-11(IL-11)局部雾化吸入,对照组未给予IL-11.结果 观察组患者对IL-11耐受性良好,并在降低口腔黏膜反应程度、减轻疼痛和增进患者食欲等方面效果显著(P<0.05).患者的疼痛时间由对照组的4.5 d±1.3 d减为观察组的2.3 d±1.0 d,愈合时间由对照组的7.3 d±1.5 d减为观察组的4.1 d±1.7 d,差异有统计学意义(P<0.05).结论 IL-11对预防和治疗头颈部肿瘤放疗性口腔黏膜反应有显著疗效,可减轻放疗性口腔黏膜反应给患者带来的痛苦,提高了生活质量.