不同方式放射線照射法對鼻咽癌病人唾液腺功能之影響

Effects of Different Radiation Therapy Schemes on the Salivary Flow Rate of NPC Patients

任益民(Yee-Min Jen) ； 林玉清(Yu-Ching Lin) ； 王宜斌(Yi-Bing Wang) ； 許文林(Wen-Lin Hsu) ； 吳錦榕(Ching-Jung Wu) ； 黃經民(Jing-Min Hwang) ； 熊佩韋(Pei-Wei Shueng) ； 張立平(Li-Ping Chang) ； 陳昌明(Chang-Ming Chen)

《放射治療與腫瘤學》 5卷2期 (1998/06) Pp. 65-71

https://doi.org/10.6316/TRO/199805(2)65

摘要

目的：研究鼻咽癌病人放射治療前後全唾液流量之變化，及檢驗多分次放射線照射法，是否如理論所預期，可以降低放射治療對於唾液腺之傷害。
材料與方法：本研究一共對30例接受傳統照射與17例多分次照射之病人，定量地測量鼻咽癌病人治療前、接受不同劑量照射後、及治療結束後一、三及六個月時，靜止態與刺激態時唾液總流量的變化。
結果：發現正常未照射之唾液流量個別差異極大，靜止狀態範圍：0.01-0.83 ml/min；刺激狀態0.08-2.83 ml/min。而且唾液腺對於放射線極度敏感，照射僅360-720 cGy之後，靜止狀態總唾液流量已減少50％，少數病人更已減少至原來之10％以下；而刺激狀態下的總流量，也急劇降至原來的30-50％。而且在照射3600 cGy之後，大部份病人唾液流量已達最低點。至於使用多分次照射法是否較傳統照射法能減輕唾液腺之放射傷害，經以GEE之統計學分析，發現基本上兩種照射法對於全唾液流量並無顯著差異，不過不論是靜止態或刺激態時，在照射結束至半年期間，多分次照射法有較好創頃向（p值分別為0.039及0.04）。此外，分析發現女性、未照射前之唾液流量高、以及年齡越大者，唾液腺經照射後其流量減少越明顯。
結論：本研究首度就國人唾液流量之正常值提出具體數據，發現個別差異極大。唾液腺對於放射線極度敏感，照射僅360-720 cGy之後，靜止與刺激狀態總唾液流量已減少30-50%。照射3600 cGy之後，大部份病人唾液流量已達最低點，且直到照射結束後六個月均不見恢復。使用多分次照射法，在唾液腺傷害方面，似未比傳統照射法好。

關鍵字

放射治療 ； 唾液 ； 鼻咽癌

並列摘要

Purpose: To evaluate the change of whole salivary flow rates of nasopharyngeal carcinoma patients before and after radiotherapy, and to examine whether hyperfractionated regimen may induce less damage to the salivary glands than conventional technique.
Materials and Methods: This study included 30 and 17 patients irradiated using conventional and hyperfractionated radiotherapy. Whole salivary flow rates were measured both at resting and stimulated status before, during, 1, 3 and 6 months after radiotherapy.
Results: A large variation in unirradiated salivary flow rate was noted with the range for resting and stimulated rates of 0.01-0.83 ml/min and 0.08-2.83 ml/min, respectively. After 360-720 cGy, the resting and stimulated salivary flow rate had already decreased by 30-50%. The nadir was reached in many patients after 3600 cGy. Statistical analysis did not show significant difference between the hyperfractionated and conventional groups. However, after completing radiotherapy and up to 6 months' follow-up, a marginal difference favoring hyperfractionated group was noted both for resting and stimulated flow (p=0.039 & 0.04, respectively). In addition, female, high initial salivary flow rate, and older age might predict more salivary flow rate reduction after radiotherapy.
Conclusions: Salivary glands were highly radiosensitive, and saliva excretion dropped by 30-50% after 360-720 cGy. The present study did not show a significant reduction of damage to the salivary glands using hyperfractionated radiotherapy.

並列關鍵字

Radiotherapy ； Saliva ； Nasopharyngeal carcinoma