144例鼻咽癌常规放疗后鼻窦炎发生的因素分析

目的 探讨鼻咽癌患者常规放疗后鼻窦炎的发生情况及其影响因素。方法 回顾分析本院2000—2005年收治的放疗前无鼻窦炎而放疗后发生鼻窦炎的144例鼻咽癌患者资料,并就其影响因素进行分析。鼻窦炎的诊断用MRI法。T₁+T₂期82例,T₃+T₄期62例。鼻腔受侵58例,无鼻腔受侵86例。鼻咽灶为面颈联合野6 MV X线常规分割照射68~78 Gy, 6~8周,其中>70 Gy 55例、≤70 Gy 89例。颈部为6 MV X线+高能电子线照射,淋巴结阳性者64~74 Gy, 6~8周;阴性者50~54 Gy, 4~5周。结果 全组患者放疗后鼻窦炎总的发生率为86.8%(125例),其中T₃+T₄期的高于T₁+T₂期的,分别为94%(58例)和82%(67例),差异有统计学意义(χ²=4.32, P<0.05);鼻咽灶剂量>70 Gy的高于≤70 Gy的,分别为95%(52例)和82%(73例),差异有统计学意义(χ²=4.65, P<0.05) ;鼻腔受侵的高于未受侵的,分别为95%(55例)和81%(70例),差异有统计学意义(χ²=5.46, P<0.05)。鼻窦炎发生在放疗后3、6、12、>12个月的比例不同,分别占13.6%(17例)、31.2%(39例)、48.8%(61例)及6.4%(8例),差异有统计学意义(χ²=70.48, P<0.01)。结论 鼻咽癌患者常规放疗后鼻窦炎的发生率较高,并在1年内达最高峰;鼻腔有无侵犯、鼻咽照射剂量和T分期与放疗后鼻窦炎的发生有关。

Related factors of sinusitis after radiotherapy for nasopharyngeal carcinoma

Objective To explore the incidence and factors of paranasal sinusitis among nasopharyngeal carcinoma (NPC) patients after radiotherapy. Methods Retrospectively evaluated the clinical data of 144 NPC patients without paranasal sinusitis before radiotherapy, including 82 cases in T1/T2 stage and 62 cases in T3/T4 stage treated in the First Affiliated Hospital of Bengbu Medical College from 2000 to 2005. MRI images before and after radiotherapy were compared. The incidence and factors of paranasal sinusitis were analyzed. There were 58 cases of nasal invasion. Nasopharyngeal carcinoma was given at face-neck joint portal with 6 MV X-ray fractionated irradiation 68-78 Gy during 6-8 weeks. The number of patients who received radiotherapy with less than or equal to 70 Gy, more than 70 Gy radiation doses were 89 and 55, respectively. Cervical part were treated with high-energy electron beam, patients with positive neck lymph nodes and with negative neck lymph nodes received 64-74 Gy doses during 6-8 weeks and 50-54 Gy during 4-5 weeks, respectively. Results Among the 144 NPC patients 86.8%(125/144) developed paranasal sinusitis after radiotherapy, the incidence rates of paranasal sinusitis (IRPS) was higher among stage T3 + T4 patients than that among stage T1 + T2 patients (94% vs 82% ,x2=4.32, P ＜0.05). Among patients who were given radiotherapy with more than 70 Gy,less than or equal to 70 Gy radiation doses on the nasopharynx, the IRPS were 95% and 82.0% (x2 = 4.65, P ＜ 0.05 ). The IRPS in patients with nasal cavity infringement was higher than that in others (95% vs. 81% , x2 = 5.46,P ＜0.05). The IRPS at 3, 6, 12 months, and more than 1 year after radiotherapy were 13.6% ,31.2% ,48.8% and 6.4%, respectively (x2 = 70.48, P ＜ 0.001 ). Conclusions The incidence of paranasal sinusitis in NPC patients after radiotherapy was very high, and reached a peak in one year. It was influeneed by invasion of nasal cavity or not, the dose of radiotherapy and T stage.