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目的:初步探讨应用调强放疗的鼻咽癌患者中,腮腺功能的恢复与剂量体积之间的关系。方法:初程接受调强适形放射治疗(IMRT)的鼻咽癌患者34例,处方剂量70.6～76.6Gy。根据DVH图得出双侧腮腺的平均剂量,30%和60%体积的受照射剂量;在治疗前、治疗后6个月及12个月用99mTcO4-检测腮腺功能,测定其分泌指数(EI);放疗结束时、放疗后6个月、12个月分别评价患者的口干程度。结果:左侧腮腺的平均受照射剂量为(27.5±2.67)Gy,≤26Gy者占35.3%(12例)、≤30Gy者占82.4%(28例)、30%体积的平均受照射剂量为(31.1±3.48)Gy、60%体积的为(20.7±2.68)Gy;右侧腮腺的平均受照射剂量为(28.3±2.95)Gy,≤26Gy的患者占23.5%(8例)、≤30Gy的患者占73.5%(25例)、30%体积的平均受照射剂量为(31.4±3.80)Gy、60%体积的为(20.8±3.91)Gy。EI值放疗前平均为0.62±0.11,放疗后6个月为0.28±0.06,12个月为0.48±0.07,放疗后6个月与放疗前及放疗后12个月比较差异有统计学意义,t值分别为2.71和2.17,P值分别为0.009和0.03;放疗后12个月与放疗前比较EI差异无统计学意义,t=1.07,P=0.29。放疗后6个月、12个月患者的中重度口干的发生率分别为64.7%(22例)、11.8%(4例)。结论:鼻咽癌调强放疗中腮腺的平均受照射剂量控制在≤30Gy,放疗后12个月患者口干可明显好转。
OBJECTIVE: To investigate the relationship between the restoration of parotid function and dose volume in patients with nasopharyngeal carcinoma treated by intensity modulated radiotherapy. METHODS: Thirty-four patients with nasopharyngeal carcinoma undergoing initial intensity modulated radiation therapy (IMRT) received a prescription dose of 70.6-76.6 Gy. According to the DVH map, the mean parotid gland volume, 30% and 60% of the irradiated dose were obtained. The parotid gland function was detected by 99mTcO4-test before treatment, 6 months and 12 months after treatment. The secretion index (EI) At the end of radiotherapy, the degree of dry mouth of the patients was evaluated respectively at 6 months and 12 months after radiotherapy. Results: The mean parotid gland in the left parotidectomy group was (27.5 ± 2.67) Gy, ≤26 Gy was in 35.3% (12 cases) and ≤30 Gy was in 82.4% (28 cases). The average dose of 30% 31.1 ± 3.48 Gy, 20.7 ± 2.68 Gy in 60% of the volume. The average dose of parotid gland in the right side was (28.3 ± 2.95) Gy and in 23.5% (≤26Gy) patients, ≤30 Gy Accounting for 73.5% (25 cases). The average radiation dose at 30% volume was (31.4 ± 3.80) Gy and that at 60% volume was (20.8 ± 3.91) Gy. EI before radiotherapy was 0.62 ± 0.11, 6 months after radiotherapy was 0.28 ± 0.06, 12 months was 0.48 ± 0.07, 6 months after radiotherapy and before radiotherapy and 12 months after radiotherapy, the difference was statistically significant, t The values were 2.71 and 2.17, P values were 0.009 and 0.03 respectively. There was no significant difference in EI between 12 and 12 months after radiotherapy, t = 1.07 and P = 0.29. The incidence of moderate-severe dry mouth at 6 months and 12 months after radiotherapy were 64.7% (22 cases) and 11.8% (4 cases), respectively. CONCLUSIONS: The mean parotid gland in patients with nasopharyngeal carcinoma undergoing IMRT control is ≤30 Gy, and the dry mouth can be significantly improved at 12 months after radiotherapy.