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目的头颈部肿瘤放疗患者常出现口腔黏膜炎、口干、疼痛吞咽困难等口腔并发症。文中旨在探讨鼻咽癌放疗患者应用个性化口腔定位支架,对于将正常组织推离高剂量靶区并保持精确可重复的稳定位置,进而达到保护肿瘤周围口腔正常组织的作用。方法收集2016年3月至同年8月期间于南京总医院放疗科接受治疗的初治鼻咽癌患者15例,并随机分为试验组和对照组。2组患者均采用调强放疗(IMRT)。试验组患者制作个性化口腔定位支架,并在放疗期间佩戴;对照组无处理。待放疗结束后比较两组患者临床靶区(CTV)和口腔正常组织的受照剂量。结果试验组与对照组左侧腮腺平均受照剂量分别为(2 223.56±294.55)和(2 900.56±374.66)cGy,差异有统计学意义(t=3.847,P=0.002);右侧腮腺平均受照剂量分别为(2 284.96±256.67)和(2 994.67±339.26)cGy,差异有统计学意义(t=4.512,P=0.001)。2组患者CTV平均受照剂量差异无统计学意义[(6142.83±135.99)cGy vs(6221.83±173.31)cGy,t=0.971,P=0.349]。结论佩戴个性化口腔定位支架的鼻咽癌放疗患者在调强放疗时可保持上下颌处于精确可重复的稳定位置,并在不影响临床靶区放疗效果的同时减少双侧腮腺的受照剂量。
Objective Head and neck cancer radiotherapy patients often appear oral mucositis, dry mouth, pain and swallowing difficulties such as oral complications. The purpose of this paper is to explore the application of personalized oral positioning stent in patients with nasopharyngeal carcinoma radiotherapy for the normal tissue pushed away from the high dose target and maintain precise and repeatable stable position, and thus to protect the normal oral tissue around the role of the tumor. Methods Fifteen newly diagnosed nasopharyngeal carcinoma patients treated in Department of Radiation Oncology, Nanjing General Hospital from March 2016 to August of the same year were collected and randomly divided into experimental group and control group. Both groups received IMRT. Patients in the test group were given personalized oral positioning brackets and were worn during radiotherapy; no treatment in the control group. After the end of radiotherapy, the dose of clinical target area (CTV) and oral normal tissue in both groups were compared. Results The average doses of parotid gland in experimental group and control group were (2223.56 ± 294.55) and (2900.56 ± 374.66) cGy respectively, the difference was statistically significant (t = 3.847, P = 0.002) The doses were (2 284.96 ± 256.67) and (2 994.67 ± 339.26) cGy respectively, the difference was statistically significant (t = 4.512, P = 0.001). There were no significant differences in the average dose of CTV between the two groups ([6142.83 ± 135.99] cGy vs (6221.83 ± 173.31) cGy, t = 0.971, P = 0.349]. Conclusion Patients with NPC radiotherapy undergoing oral radiosurgery can keep the upper and lower jaws in a precise and repeatable stable position during IMRI and reduce the dose of bilateral parotid gland without affecting the radiotherapy effect in clinical target area.