| Backgrounds and ObjectivesAs the i enhancement of social economy and the enhancement of medical care,the malignant tumor treatment goal is not only focusing on survival or disease-free survival rate,improving patient's quality of life has become one of the important subject of modern medicine.Radiotherapy plays an important role in the treatment of head and neck cancer,especially in the treatment of nasopharyngeal carcinoma.Nasopharyngeal carcinoma is one of high incidence of malignant tumors in our country,and the growth of tumor cells is very active,sensitive to radiation and chemotherapy.At present,radiation therapy is the accepted and preferred method of radical treatment,radiotherapy induced damage,such as dry mouth,pain,swallowing,such as eating,mouth problem,has attracted more and more attention.In recent years,concurrent chemoradiotherapy has been gradually applied to the clinical treatment of nasopharyngeal carcinoma,and has obtained certain curative effect.Commonly used concurrent chemoradiotherapy regimens include cisplatin + docetaxel or platinum-based single drug combined radiotherapy,such as Carboplatin.With the development of radiotherapy technology,Intensive modulated radiotherapy(IMRT)has become the main method for nasopharyngeal carcinoma,compared with Two dimensional conventional radiotherapy(2D-CRT),and the intensity modulated radiotherapy has a good conformability,which can increase the dose of the target area and reduce the normal tissue dose of the surrounding tissue.2D-CRT is mainly based on the neck and neck joint field and the ear front field,and the bilateral field wears on and has a great influence on the surrounding normal tissues.Due to the good curative effect of radiotherapy,the survival period is prolonged,and the patient's requirements for the quality of life are constantly improved,preserving and improving the quality of life of patients is particularly important.ObjectiveThe purpose of the research:(1)To compare the effects of IMRT and 2D-CRT on the survival quality of patients with nasopharyngeal carcinoma.(2)Salivary gland scintigraphy(SGS)was used to quantitatively compare the changes of glandular uptake and secretion in the two radiotherapy modes,and the salivary gland secretion quality was measured by Phadeba method at different time.Differences in the degree of salivary gland dysfunction provide some clinical guidance for limiting the dose of the parotid gland in the target area.Methods48 cases which were newly diagnosed of nasopharyngeal carcinoma treated by radiotherapy of Qilu hospital of Shandong university from 2005 to 2014 were selected,and the quality of life questionnaire after radiotherapy was conducted.According to the different treatment methods which were divided into IMRT group(25 cases)and 2D-CRT group(31 cases),EORTC developed the core quality of life questionnaire(EORTC QLQ-C30)and head and neck cancer disease special table(EORTC QLQ-H&N35)as evaluation tools for quality of life of patients with nasopharyngeal carcinoma radiotherapy,to analyze the quality of life of 48 patients with NPC after radiotherapy.The changes of gland uptake and secretion function were compared by using SGS.Meanwhile,Phadeba method was used to determine the secretion quality of salivary glands in patients at different time periodsResultsThe field of quality of life in long-term survivors of NPC after radiotherapy of the total score was 66.32 + 19.25.Symptoms:the highest score for the sticky saliva 55.42+31.05.The highest incidence was 45(95.83%)cases of sticky saliva.IMRT group and 2D-CRT group were statistically significant in pain,swallowing,feeling,eating,sex,dry mouth,mouth opening,sticky saliva,morbid sense of differences(P<0.05).The contralateral parotid mean dose and D50 of the patients were lower than ipsilateral parotid in IMRT group,and the difference was significant.Patients in the 2D-CRT group received the same dose on both sides of the parotid gland.The dynamic imaging of SGS showed that after 12 months of radiotherapy,bilateral parotid uptake and excretion function were restored to normal.Bilateral parotid uptake and excretion decreased in 2D-CRT group.The comparison of salivary flow rate and amylase secretion rate between the two groups of patients with radiation dose of 20Gy,40Gy,60Gy and 12 months after radiotherapy was also statistically significant(P<0.01).ConclusionsIMRT is superior to the 2D-CRT in improving the survival quality of patients with NPC.IMRT was significantly reduced the dose in the parotid gland and less reaction in the later stage.To develop an appropriate treatment plan for clinical,provide the basis for improving the quality of life of patients. |
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