调强放射治疗对鼻咽癌患者口腔黏膜及免疫功能的影响

目的：研究调强放射治疗(intensity modulated radiation therapy，IMRT)对鼻咽癌临床疗效、口腔黏膜反应和 免疫功能的影响，并探讨免疫学改变对临床疗效及口腔黏膜反应的影响。方法：选择2008年10月至2011年11月于佛 山市第一人民医院鼻咽放疗1科治疗的200例鼻咽癌患者，两组均先进行常规化学治疗，再进行放射治疗。根据其放 射治疗方法不同分为观察组与对照组，每组各100例。对照组进行常规二维放射治疗，观察组采用IMRT，随访记录 两组5年生存率和复发率，完成放射治疗后参照美国放射治疗肿瘤协作组织(Radiotherapy Oncology Group，RTOG)急性 放射性黏膜炎的分级标准对患者口腔黏膜进行评价，并检测治疗前后T淋巴细胞亚群。结果：观察组无区域复发生存 率、无瘤生存率、局部复发率与对照组相比，差异均有统计学意义(均P<0.05)；无远处转移生存率两组差异无统计学 意义(P>0.05)。对照组1级、2级、3级、4级口腔黏膜急性反应率分别为8.00%，20.00%，12.00%和7.00%，观察组分别为 7.00%，22.00%，15.00%和1.00%，两组患者1级、2级、3级口腔黏膜急性反应率差异均无统计学意义(均P>0.05)，观察 组4级口腔黏膜急性反应率显著低于对照组，差异有统计学意义(P<0.05)。两组治疗前后CD8+，CD4+/CD8+和CD4+T 细胞亚群差异均有统计学意义(均P<0.01)，且治疗后观察组与对照组之间的差异亦有统计学意义(均P<0.01)。结论： 在鼻咽癌患者治疗过程中，在化学治疗的基础上使用IMRT的效果较常规放射治疗更加显著，可相对减少严重的口腔 黏膜急性反应(4级)，对患者的免疫功能有更好的保护作用。

Effect of intensity modulated radiation therapy on oral mucosa and immune function in patients with nasopharyngeal carcinoma

Objective: To study the potential effects of intensity modulated radiation therapy (IMRT)on clinical efficacy, oral mucosa reaction and immunological foundation; and to explore the effect of immunological changes on clinical efficacy and oral mucosa reaction in patients with nasopharyngeal carcinoma. Methods: A total of 200 patients with nasopharyngeal carcinoma, who came from First Department of Nasopharyngeal Radiotherapy, the First People’s Hospital of Foshan from October 2008 to November 2011, were selected. The patients were treated with nasopharyngeal radiotherapy, and divided into an observation group and a control group (n=100 in each group). The control group underwent common conventional two-dimensional radiotherapy treatment, while the observation group underwent IMRT. The 5-year survival rates and recurrence rates were recorded at follow-up. After the radiotherapy, the oral mucosa in the patients were evaluated by the classification standard of acute radioactive mucositis by American Radiotherapy Oncology Group (RTOG), and the number of T lymphocyte subsets before and after treatment was detected. Results: There were significant difference in non-regional-recurrence survival rate, disease-free survival rate, local recurrence rate between the above 2 groups (all P<0.05), but no significant difference in the distant metastasis-free survival rate (P>0.05). The acute oral mucosa reactions of grade 1, 2, 3, 4 in the control group were 8.00%, 20.00%, 12.00%, 7.00%, respectively, and those were 7.00%, 22.00%, 15.00%, 1.00% respectively. There was no significant difference in the acute response of oral mucosa in grade 1, 2 and 3 in the 2 groups (all P>0.05), but there was significant difference in the grade 4 (P<0.05). There were significantly difference in CD8+, CD4+/ CD8+ and CD4+ T lymphocyte subsets before and after treatment in the above 2 groups (all P<0.01); there were also significantly difference after treatment between the observation group and the control group (all P<0.01). Conclusion: In the process of treatment in patients with nasopharyngeal carcinoma, the use of IMRT on the basis of chemotherapy is more effective than the conventional two-dimensional radiotherapy, which can reduce the proportion of grade 4 (severe) acute oral mucosa reaction. It may be related to the protective effect of IMRT on immune function in the patients.