个体化口腔支架在鼻咽癌患者放疗中对口腔正常组织的保护作用

背景与目的:随着鼻咽癌放射治疗技术的进步,鼻咽癌治疗后生存率有了明显提高.生存时间的延长使鼻咽癌患者对放射治疗后的生存质量提出了更高的要求,由放射治疗所导致的各种急性、晚期放射性损伤如放射性粘膜炎和放射性味觉损伤等越来越受到重视.本研究探讨在放射治疗过程中使用个体化的口腔支架(简称口腔支架),将舌和一部分口腔粘膜推离照射野范围,以期达到保护舌、味觉和部分口腔粘膜的作用.方法:首先选取1例合适的鼻咽癌患者,作佩戴口腔支架前后舌受照射剂量和体积的分析;然后将按人组条件收治的鼻咽癌患者随机分为试验组和对照组.临床上共收治鼻咽癌患者43例,其中试验组19例,对照组24例.两组患者均采用CT模拟常规设野的放射治疗技术,在放疗过程中,试验组患者佩戴口腔支架,对照组不佩戴.两组患者均根据病情需要采用诱导、同期或辅助化疗,并酌情使用放射增敏剂,在放疗结束时根据颅底骨质破坏情况及肿瘤消退情况决定是否补量或加量.放疗前和放疗中每周检查两组患者基本味觉、体重、口腔各部分粘膜和舌粘膜反应程度.结果:剂量学分析表明患者佩戴口腔支架后舌的受照射剂量和体积均较佩戴前明显下降.试验组与对照组1～2度和3～4度粘膜反应发生的比例分别为73.68%和62.50%,26.32%和37.50%(P=0.470),但3度以上粘膜反应发生的例数试验组较对照组有减少的趋势(5/19和9/24).味觉检查,至放疗结束时试验组有4例(21.05%)患者出现轻度的味觉减退,对照组患者有19例(79.17%)出现味觉减退,差异有显著性(P=0.000).结论:个体化的口腔支架对于行放射治疗鼻咽癌患者的口腔粘膜特别是舌的味觉具有一定的保护作用.

Sparing normal oral tissues with individual dental stent in radiotherapy for primary nasopharyngeal carcinoma patients

BACKGROUND & OBJECTIVE: With the progression of radiotherapy techniques, the 5-year overall survival rate of nasopharyngeal carcinoma (NPC) patients has increased obviously. As the survival time prolonged, more and more attention was paid to various radiation sequelae and the quality of life of the patients. This study was to explore the role of individual dental stent in sparing normal oral tissues for primary NPC patients in radiotherapy by pushing the tongue and a part of oral mucous membrane away from the radiation fields. METHODS: Irradiation dose and volume of the tongue of a NPC patient before and after wearing dental stent was evaluated. A total of 43 patients were randomized into 2 groups: 19 in trial group and 24 in control group. Trial group wore dental stent during radiotherapy, while control group did not. Patients' weight, taste, oral mucous reaction, and tongue mucous reaction before radiotherapy and every week during radiotherapy were examined. RESULTS: Dosimetric analysis proved that the irradiation dose and volume of the tongue decreased obviously in trial group. The occurrence rate of grade 1-2 mucositis of the oral cavity was higher in trial group than in control group (73.68% vs. 62.50%), but the occurrence rate of grade 3-4 mucositis was lower in trial group than in control group (26.32% vs. 37.50%, P=0.470). By the completion of radiotherapy, 4 (21.05%) patients in trial group and 19 (79.17%) in control group suffered from taste dysfunction (P<0.001). CONCLUSION: Individual dental stent is useful in sparing the oral mucous membrane and preserving taste for primary NPC patients in radiotherapy.