咽癌患者调强适形放射治疗期间咽缩肌放射剂量对吞咽功能的影响

目的:观察咽癌患者调强适形放射治疗期间咽缩肌放射剂量与吞咽功能的关系。方法:选取80例咽癌患者作为研究对象，均实施调强适形放射治疗6个月，根据患者治疗需求选取咽缩肌放射剂量，分别于放疗1、3及6个月，记录患者吞咽功能评分，分析咽缩肌放射剂量与吞咽功能评分的相关性。并于放疗结束时，评估患者吞咽功能，将患者分为吞咽功能正常、吞咽障碍轻度、中度及重度障碍，比较无-轻度吞咽障碍组与中-重度吞咽障碍组咽缩肌放射剂量，采用回归分析检验咽缩肌放射剂量对吞咽功能的影响。结果:各时点中，放疗1个月时MDADI总分及各维度评分最高，后由高到低依次为放疗3个月时、放疗6个月时，不同时点MDADI评分比较差异均有统计学意义（P<0.05）；80例咽癌患者咽上缩肌放射剂量为（44.72±5.58） Gy，中咽缩肌放射剂量为（48.94±6.17） Gy，咽下缩肌放射剂量为（38.95±4.74） Gy，咽缩肌放射总剂量为（132.61±28.52） Gy；经一般线性双变量Pearson相关性分析结果显示，不同时点MDADI总分与咽缩肌总放射剂量呈负相关；80例咽癌患者放疗结束时，29例吞咽功能正常，18例轻度吞咽障碍，21例中度吞咽障碍，12例重度吞咽障碍；初步比较中-重度吞咽障碍组与无-轻度吞咽障碍组咽缩肌放射剂量后，经多元Logistic回归分析显示，咽缩肌放射剂量高是患者放疗结束时发生中-重度吞咽障碍的危险因素（OR>1, P<0.05）。结论:咽癌患者调强适形放射治疗期间咽缩肌放射剂量可影响吞咽功能，随剂量增加，患者吞咽功能降低，吞咽障碍发生风险增加。

Effects of radiation dose to pharyngeal constrictor muscle on swallowing function in patients receiving intensity-modulated radiotherapy for pharyngeal cancer

Abstract: Objective To observe the relationship between radiation dose to pharyngeal constrictor muscle and swallowing function in patients receiving intensity-modulated radiotherapy (IMRT) for pharyngeal cancer. Methods A total of 80 patients with pharyngeal cancer were enrolled in the study, and all patients were treated by IMRT for 6 months. The radiation dose to pharyngeal constrictor muscle was determined according to the treatment needs of patients. The swallowing function scores of patients were recorded at the 1st month, 3rd months and 6th months after IMRT, and the correlation between radiation dose to pharyngeal constrictor muscle and swallowing function score was analyzed. After the swallowing function of patients was evaluated at the end of radiotherapy, the patients were divided into normal swallowing function, mild, moderate and severe dysphagia. The radiation dose to pharyngeal constrictor muscle was compared between mild or no dysphagia group and moderate-to-severe dysphagia group, and regression analysis was used to examine the effects of radiation dose to pharyngeal constrictor muscle on swallowing function. Results The each dimensional and total scores of MDADI reached the highest at the 1st month after radiotherapy, followed by the 3rd month and the 6th month after radiotherapy. The differences in MDADI scores at different time points were statistically significant (P<0.05). The radiation doses to superior, middle and inferior pharyngeal constrictor muscles in 80 patients with pharyngeal cancer were (44.72±5.58), (48.94±6.17) and (38.95±4.74) Gy, respectively, and the total radiation dose to pharyngeal constrictor muscle was (132.61±28.52) Gy. The results of general linear bivariate Pearson correlation analysis showed that the total score of MDADI at different time points was negatively correlated with the total radiation dose to pharyngeal constrictor muscle. At the end of radiotherapy, there were 29 cases with normal swallowing function, 18 cases with mild dysphagia, 21 cases with moderate dysphagia and 12 cases with severe dysphagia. After preliminary comparison of radiation dose to pharyngeal constrictor muscle between moderate-to-severe dysphagia group and mild or no dysphagia group, the result of multiple Logistic regression analysis revealed that high radiation dose to pharyngeal constrictor muscle was a risk factor for moderate-to-severe dysphagia occurring at the end of radiotherapy (OR>1, P<0.05). Conclusion The radiation dose to pharyngeal constrictor muscle can affect the swallowing function in patients receiving IMRT for pharyngeal cancer. With the increase of radiation dose, the swallowing function in patients is decreased, and the risk of dysphagia is increased.