頭頸癌放射線治療後產生慢性鼻竇炎的風險

Chronic rhinosinusitis after radiotherapy in patients with head and neck cancer

盧彥廷(Yen-Ting Lu)

指導教授 ： 王博輝

中山醫學大學/醫學院/醫學研究所/博士(2021年)

https://doi.org/10.6834/csmu202100222

摘要

放射線治療為頭頸部惡性腫瘤的重要治療方式。然而，放射線治療也會帶來其他的後遺症。過去的研究發現，放射線治療後的鼻咽癌患者發生慢性鼻竇炎的風險較高。但是，對於其他頭頸部惡性腫瘤經放射線治療後發生慢性鼻竇炎的風險目前仍未有相關研究。本研究的目的即為探討放射線治療後其他頭頸部惡性腫瘤患者罹患慢性鼻竇炎的風險。此研究為回溯性世代研究，主要是利用全民健康保險研究資料庫進行資料蒐集及分析。研究族群為介於2005年1月1 日至2008年12月31日區間內新診斷的頭頸惡性腫瘤患者。追蹤時間為2005年1月1 日至2013年12月31日。研究族群依治療的方式被分成三個族群：無接受放射線治療(No radiotherapy; No RT)、只接受放射線治療(RT alone)及任何有接受放射線治療(Any RT)的族群。主要的研究標的是慢性鼻竇炎的發生率及發生的時間。本研究總共納入701位新診斷頭頸部惡性腫瘤的患者。研究族群全體五年追蹤的慢性鼻竇炎發生率為7%。若依照治療方法分組，五年追蹤慢性鼻竇炎的發生率分別如下：無接受放射治療(4.5%)、只接受放射線治療(12%)及任何有接受放射線治療(9.3%)的族群。經過存活分析，發現不論是只接受放射線治療的族群或是任何接受放射線治療的族群，比起無接受放射線治療族群的慢性鼻竇炎風險都有顯著提高的現象。風險比值各為6.76 (95%信賴區間為2.60-17.5)及2.91 (95%信賴區間為1.60-5.31)。本研究為第一個使用國家人口世代研究方法分析頭頸部惡性腫瘤放射線治療後慢性鼻竇炎的相關研究。結論為在頭頸部惡性腫瘤族群中，放射線治療與否跟慢性鼻竇炎有顯著的相關性。希望藉由這個研究結果呼籲未來治療頭頸部惡性腫瘤的醫師們，留心放射線治療後慢性鼻竇炎的發生，期待能給患者更好的生活品質。

關鍵字

頭頸部惡性腫瘤 ； 鼻咽癌 ； 放射線治療 ； 慢性鼻竇炎 ； 風險

並列摘要

Radiotherapy played an important role in head and neck cancer treatment. Chronic rhinosinusitis (CRS) is a common post-radiotherapy (RT) side effect in patients with nasopharyngeal cancer (NPC). However, whether RT is a risk factor for CRS in patients with other types of head and neck cancer remains unclear. This study investigated the association, if any, between CRS and RT in patients with head and neck cancer. This is a retrospective cohort study. The patients who were newly diagnosed as having head and neck cancer between January 1, 2005, and December 31, 2008, from the 2005 Longitudinal Health Insurance Database were included. Patients were categorized into the following groups according to the treatment regimens received: RT alone (RT-alone), RT combined with other treatments (any-RT), and treatments without RT (no-RT). The major outcome was the occurrence of CRS after treatment. 701 patients with head and neck cancer were included in this study. 7% patients experienced CRS within 5 years after initial treatment. Patients were divided into subgroups according to different treatment policies, and the RT-alone group, any-RT group, and no-RT group had 5-year incidence of CRS of 12%, 9.3%, and 4.5%, respectively. Patients in the RT-alone and any-RT groups exhibited an increased risk of CRS compared with patients in the no-RT group (hazard ratio: 6.76 and 2.91; 95% confidence interval: 2.60 to 17.5 and 1.60 to 5.31, respectively). In conclusion, this is the first nationwide population-based cohort study to evaluate the risk of post-treatment CRS in patients with head and neck cancer. Our findings indicate that RT is a major risk factor for CRS. Thus, physicians should consider this potential risk in patients with head and neck cancer after RT.

並列關鍵字

head and neck cancer ； nasopharyngeal cancer ； radiotherapy ； chronic rhinosinusitis ； risk

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