早晚期鼻咽癌病患經放射治療後與時間相關之生活品質分析

Analysis of the Time-related Quality of Life for Patients with Early and Late Stages of the Nasopharyngeal Carcinoma after Radiotherapy

許維中(Wei-Chung Hsu) ； 詹淑卿(Sue-Ching Chan) ； 陳宇嘉(Yu-Chia Chen) ； 丁禮莉(Lai-Lei Ting) ； 鍾娜娜(Na-Na Chung) ； 陳斯榮(Szu-Jung Chen) ； 王博民(Po-Ming Wang) ； 劉博仁(Po-Jen Liu) ； 林高德(Gau-De Lin)

《中華放射線醫學雜誌》 29卷3期 (2004/06) Pp. 129-136

摘要

本研究之目的是評估早晚期鼻咽癌病患隨放射治療後時間間隔的生活品質。
總共有兩機構符合鼻咽部放射劑量不少於70 Gy、頸部淋巴區放射劑量不少於50 Gy的332位鼻咽癌病患被邀請參與研究。病患均於放射治療結束後三個月以上，一次填寫EORTC QLQ C-30及EORTC QLQ H&N35的生活品質量表，以此作為評估之依據。（歐洲癌症研究與治療組織European Organization for Research and Treatment of Cancer, EORTC）。
將治療後時間間隔（治療後三至六個月、治療後六至十二個月、治療後一至五年及治療後五年以上）與期別（早、晚期）加以分類，利用單因子變異數分析後，可區分為三大類型，即「X/XX型」、「X/YX型」與「其他類型」。進一步使用治療後時間間隔與期別之雙因子變異數分析，可發現「說話問題」（F=5.028**）、「社交接觸問題」（F=4.090**）、「感覺問題」（F=7.109***）「咳嗽」（F=9.852***）、「病態感」（F=4.783**）、「使用止痛藥」（F=2.938*）、「疼痛」（F=6.192***）及「體重增加」（F=3.357）八項呈現顯著意義，表示這些生活品質指標在治療後時間間隔上隨期別之不同而有差異。
整體來說，早期期別病患的生活品質受急性放射線副作用影響較為明顯，生活品質隨放射治療後時間之增長而逐漸改善；晚期期別病患的生活品質則受到急性及遲發性放射線副作用的影響，一度改善的生活品質可能隨放射治療後時間之增長而再度轉壞或呈波浪型的變化。因此，改善放療技術對鼻咽癌早期篩檢與偵檢不僅在治療存活率上十分重要，對於病患治療後之生活品質亦有所提昇。

關鍵字

EORTC ； 鼻咽癌 ； 生活品質 ； 放射治療

並列摘要

The purpose of this study is to evaluate the quality of life (QoL) for patients with nasopharyngeal carcinoma after radiotherapy according to early and late stages.
Three hundred and thirty-two nasopharyngeal cancer patients in two institutions were invited to participate; all were received not less than 70 Gy to nasopharynx and not less than 50 Gy to neck. Health- related quality of life was assessed 3 months or later after the completion of the radiotherapy by means of the European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire (QLQ C-30) and the EORTC head and neck cancer-specific questionnaire (QLQ H&N-35).
After completion of radiotherapy, the periods to patients filling in the questionnaire were divided into 4 groups: 3-6 months, 6-12 months, 1-5 years and more than 5 years. In addition, tumor stages were divided into early and late stages. By one-way ANOVA analysis, all items and symptoms changing over time were divided into three types: X/XX type, X/YX type and other types. The eight items: speech problems (F = 5.028**), trouble with social contact (F = 4.090**), senses problems (F = 7.109***), coughing (F = 9.852***), felt ill (F = 4.783**), using pain-killers (F = 2.938*), pain (F = 6.192***), and weight gain (F = 3.357*) showed statistical significance by two-way ANOVA analysis. These indicated that the quality of life items were difference after radiotherapy according to tumor stages and time intervals.
The quality of life for nasopharyngeal cancer patients with early tumor stage was influenced by acute radiation effect significantly. The quality of life was improved over time after the completion of radiotherapy. Nasopharyngeal cancer patients with late tumor stage were influenced by both acute and late radiation effects. The quality of life may be getting worse or up and down after initial improvement during the later periods after completion of radiotherapy. Hence, improvement of the treatment technique, early screen and detection of nasopharyngeal cancer are important not only to increase patient’s survival but also to improve the quality of life after completion of the treatment.

並列關鍵字

EORTC ； Nasopharyngeal carcinoma ； Quality of life ； Radiotherapy