鼻咽癌调强放疗后鼻窦炎的临床观察及影响因素分析

目的 探讨鼻咽癌患者调强放疗前后鼻窦炎的发生发展情况及影响因素。方法 回顾分析2009—2011年间283例鼻咽癌患者调强放疗前后影像学资料,观察鼻窦炎发生发展情况。采用Logrank法单因素分析及Logistic法多因素分析其影响因素。结果 放疗前T₁、T₂、T₃、T₄期鼻窦炎发生率分别为22.6%、37.5%、46.8%、61.3%(P=0.002)。放疗前无鼻窦炎的155例鼻咽癌患者放疗后1、3、6、9、12、18个月鼻窦炎发生率分别为32.9%、43.2%、61.3%、68.4%、73.5%、69.7%、61.3%(P=0.000)。单因素分析显示T分期、鼻腔受侵、鼻咽冲洗及鼻咽部照射剂量与调强放疗后鼻窦炎发生有关(P=0.003、0.006、0.002、0.020),多因素分析显示T分期、鼻腔受侵、鼻咽冲洗影响调强放疗后鼻窦炎发生(P=0.002、0.002、0.000)。结论 鼻咽癌患者放疗前鼻窦炎发生率随着T分期增高而增加,调强放疗后鼻窦炎在3个月内发生发展最快,9个月达高峰,1年后趋于稳定。T分期、鼻腔侵犯、鼻咽冲洗影响调强放疗后鼻窦炎的发生发展。

Incidence of sinusitis and its influential factors in nasopharyngeal carcinoma patients after intensity-modulated radiotherapy

Objective To investigate the incidence of sinusitis in nasopharyngeal carcinoma (NPC) patients before and after intensity-modulated radiotherapy (IMRT) and analyze the influential factors for incidence of sinusitis after IMRT. Methods A retrospective analysis was performed on 283 NPC patients who received IMRT in our hospital from March 2009 to May 2011. CT or MRI scans were performed before and after IMRT to evaluate the incidence of sinusitis. The influential factors for incidence of sinusitis were analyzed by log-rank univariate analysis and logistic multivariate analysis. Results The incidence rates of sinusitis in patients with T₁, T₂, T₃, and T₄ NPC before radiotherapy were 22.6%, 37.5%, 46.8%, and 61.3%, respectively (P=0.002). Among the 155 NPC patients without sinusitis before radiotherapy, the incidence rates of sinusitis at the end of radiotherapy and 1, 3, 6, 9, 12, and 18 months after radiotherapy were 32.9%, 43.2%, 61.3%, 68.4%, 73.5%, 69.7%, and 61.3%, respectively (P=0.000). The univariate analysis showed that T stage, invasion into the nasal cavity, rhinopharynx flush, and radiation dose to the nasopharynx were associated with the incidence of sinusitis in NPC patients after IMRT (P=0.003, 0.006, 0.002, and 0.020). The multivariate analysis showed that T stage, invasion into the nasal cavity, and rhinopharynx flush were the influential factors for incidence of sinusitis in NPC patients after IMRT (P=0.002, 0.002, and 0.000). Conclusions There is a higher incidence of sinusitis with higher T stage among NPC patients before radiotherapy. The incidence of sinusitis grows rapidly within 3 months after IMRT, reaches the peak level at 9 months, and tends to be stable at one year. T stage, invasion into the nasal cavity, and rhinopharynx flush are the influential factors for incidence of sinusitis in NPC patients after IMRT.