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目的:分析立体定向适形放疗颞合关节和咀嚼肌群受照剂量与发生张口困难的关系。方法:61例鼻咽癌患者接受立体定向适形放疗,照射靶区为鼻咽肿瘤、鼻咽区、咽旁间隙和颈部淋巴区,靶区处于95%剂量曲线内,总剂量30-42Gy/10-14次.20-30天。颞合关节和咀嚼肌群处于50%-60%的剂量曲线内。放疗前及放疗后6个月、1年、2年和3年分别用直尺测量患者门齿距。结果:全组1年局控率95.08%(58/61),1、2、3年累积生存率为95.08%(58/61)、93.22%(57/61)、90.16%(55/61)。颞合关节和咀嚼肌群剂量15.79Gy-30.95Gy(19.21±4.56)。Ⅰ-Ⅱ级张口困难发生率4.91%(3/61),未观察到Ⅲ级和Ⅳ级张口困难。相关性检验表明颞合关节和咀嚼肌群剂量与张口困难之间无相关性。结论:立体定向适形放疗技术使颞合关节和咀嚼肌群受照剂量显著下降,放疗后张口困难发生率显著降低。
OBJECTIVE: To analyze the relationship between dose of stereotactic conformal radiotherapy (TEM) joint and chewing muscle group and difficulty in opening the mouth. Methods: Totally 61 patients with nasopharyngeal carcinoma underwent stereotactic radiotherapy. The targets of irradiation were nasopharyngeal tumor, nasopharyngeal area, parapharyngeal space and cervical lymphatic area. The target area was in 95% dose curve with the total dose of 30-42 Gy / 10-14 times. 20-30 days. Temporal joints and masticatory muscles are within a 50% -60% dose curve. Before and after radiotherapy 6 months, 1 year, 2 years and 3 years respectively, with a ruler to measure the patient’s tooth pitch. Results The cumulative rate of one-year, two-year and three-year cumulative survival was 95.08% (58/61), 93.22% (57/61), 90.16% (55/61) . Temporal joint and chewing muscles dose 15.79Gy-30.95Gy (19.21 ± 4.56). Ⅰ-Ⅱ grade mouth opening rate of 4.91% (3/61), did not observe the grade Ⅲ and Ⅳ mouth opening difficulties. Correlation tests showed no correlation between the dose of temporal joint and the masticatory muscles and the difficulty of opening the mouth. Conclusion: Stereotactic conformal radiotherapy significantly reduced the doses of temporal joint and masticatory muscles, and significantly reduced the incidence of mouth-opening difficulties after radiotherapy.