鼻咽癌面颈联合野放疗对唾液腺功能影响的临床分析

目的 :利用放射性核素99mTcO4-动态显像唾液腺定量测定鼻咽癌面颈联合野放疗前、中、后唾液腺功能的变化并探讨与放疗剂量之间的关系。方法 :2 0 0 3年 2月 1日～ 2 0 0 3年 10月 3 1日 ,分别对 2 0例鼻咽癌面颈联合野放疗患者于放疗前、放疗至 10、3 6～ 40、70Gy时进行99mTcO4-动态显像定量测定其唾液腺(腮腺、颌下腺 )摄锝率 (UR)、泌锝率 (ER)变化 ,同时观察其口干程度进行临床分级。结果 :2 0例鼻咽癌面颈联合野放疗剂量为 10和3 6～ 40Gy时 ,其泌锝率明显低于放疗前 ,P <0 0 5 ,在放疗 70Gy时降到最低 ,P <0 0 1。与临床观察到的口干严重程度一致 ,而其摄锝率在 3 6～ 40Gy照射以前变化不明显 ,无统计学意义。结论 :鼻咽癌面颈联合野照射患者放疗前无明显唾液腺功能障碍 ,随着放疗剂量的增加 ,唾液腺功能明显下降 ,其ER较UR下降明显 ,在确保患者放疗疗效的同时 ,应尽可能提高放疗技术 ,减少唾液腺照射剂量和放疗体积 ,保护唾液腺功能 ,以提高患者的生活质量。

Clinical analysis of salivary function prior to and after faciocervical fields radiotherapy for patients with nasopharyngeal carcinoma

OBJECTIVE:To study the salivary function with quantitative 99m TcO 4 - pertechnetate salivary scintigraphy before,during and after radiotherapy for patients with nasopharyngeal carcinoma (NPC) who treated with faciocervical fields and further to analyze irradiation-induced injury in relation to radiation dose and field size.METHODS: From February to October 2003,20 NPC patients were treated with faciocervical fields radiotherapy.Uptake (UR) and excretion rate (ER) of parotid and submandibular gland were performed prior to radiotherapy,at dose of 10 Gy/5Fx,36-40 Gy/18-20Fx,and 70 Gy/35Fx.Oral dryness was observed in clinic.RESULTS: ER of parotid and submandibular gland decreased significanfly after the radiotherapy at dose of 10 Gy/5Fx and 36-40 Gy/18-20Fx as compared to that of pretherapy, and to the lowest level at dose of 70 Gy/35Fx.Oral dryness was the same.No change of UR were observed before the radiotherapy at doses of 36-40Gy/ 18-20 Fx.CONCLUSIONS: With the radiotherapy dose increasing,function of parotid and submandibular gland decreases.With the guarantee of radiotherapy quality,we should improve radiation technology to reduce the volume and dose of salivary irradiation.