自适应放疗在鼻咽癌患者涎腺功能保护中的应用

目的:探讨自适应放疗对鼻咽癌患者涎腺功能的保护作用。方法:选择2013年6月至2015年6月在我院接受治疗的80例初治鼻咽癌患者，按照放疗方式不同随机分为2组:观察组(40例)采用自适应放疗，对照组（40例）采用调强放疗。结果:观察组患者PTVnx、PTVnd、PTV1、PTV2的Dmax、Dmin、Dmean均高于对照组,差异均具有统计学意义（P＜0.05）；观察组患侧颌下腺、患侧腮腺平均照射剂量明显低于对照组，体积高于对照组，差异具有统计学意义（P＜0.05）；观察组患者脑干、颞叶及视神经等正常组织放射剂量明显低于对照组，差异具有统计学意义（P＜0.05）；两组患者经治疗随访2年后，采取Log-rank检验，两组患者随访累积复发率比较，差异无统计学意义［（3/40,7.5%） vs （5/40,12.5%），Log-rank χ2=0.563 1,P=0.453 0］；观察组患者放疗后3个月、放疗后12个月、放疗后24个月唾液分泌量明显高于对照组，随访2年后口干症发生率低于对照组，差异均具有统计学意义（P＜0.05）。结论:自适应放疗提高了鼻咽癌患者肿瘤靶区的照射剂量，维持与改善涎腺分泌功能，对其它危及器官也具有一定的保护作用。

Application of adaptive radiotherapy in the protection of salivary gland function in patients with nasopharyngeal carcinoma

Objective:To investigate the protective effect of adaptive radiotherapy（ART） on salivary gland function in nasopharyngeal carcinoma(NPC) patients.Methods:The clinical data of 80 patients with nasopharyngeal carcinoma treated in our hospital from June 2013 to June 2015 were analyzed.The observation group(40 cases) received adaptive radiotherapy,while the control group(40 cases) received IMRT.Results:The Dmax,Dmin and Dmean dose of PTVnx,PTVnd,PTV1,PTV2 in the observation group were higher than those in the control group,the difference was statistically significant(P＜0.05).The average radiation dose of the affected submandibular gland and the affected parotid gland in the observation group were significantly lower than the control group,the volume were significantly higher than the control group,the difference was statistically significant(P＜0.05).The radiation dose of brainstem,temporal lobe,and optic nerve in the observation group were lower than those in the control group,the difference was statistically significant(P＜0.05).Two groups of patients were followed up for 2 years after treatment.The Log-rank test was used to compare the cumulative recurrence rate between the two groups.The cumulative recurrence rate between the observation group and the control group,the difference was not statistically significant［（3/40,7.5%） vs （5/40,12.5%），Log-rank χ2=0.563 1,P=0.453 0］.The salivary secretion of the observation group 3 months after radiotherapy,12 months after radiotherapy and 24 months after radiotherapy was significantly higher than that of the control group,the difference was statistically significant(P＜0.05).The incidence of xerostomia after 2 years in the observation group was lower than that in the control group,the difference was statistically significant(P＜0.05).Conclusion:ART treatment can effectively increase the radiation dose of target area,and have a protective effect on the risk organ,and can improve and maintain salivary gland salivary secretion function.