- 期刊
Correlation between Sternocleidomastoid Muscle Stiffness after Radiation Therapy and Quality of Life in Patients with Head and Neck Cancer
頭頸癌患者放射治療後胸鎖乳突肌硬化與生活品質之關係
摘要
研究目的：頭頸癌患者接受放射治療後之軟組織纖維化經常造成疼痛、口乾、進食障礙及肩頸功能障礙及肌肉硬化等。本研究希望了解肌肉硬化程度與生活品質之關係，及復健治療是否可改善肌肉硬化程度及生活品質。研究方法：頭頸癌患者接受放射治療後，以彈力超音波(real-time sonoelastography)檢測胸鎖乳突肌硬化程度，以EORTC QLQ-35 及EORTCQLQ H&N35 來評估患者之健康相關生活品質(health-related quality of life)。6 個月後再次比較胸鎖乳突肌硬化程度及生活品質之改變，並同時比較患者有、無接受復健治療對胸鎖乳突肌硬化程度及生活品質的影響。結果：本研究共有25 位頭頸癌患者參與，最後共有17 位患者完成追蹤。放射治療區域胸鎖乳突肌硬化程度明顯高於對照區域(54.3 ± 23.0 % vs. 40.5 ±19.7 %, p=0.036)，但6 個月後兩者則無顯著差異。當胸鎖乳突肌硬化程度改善時，身體功能、情緒功能、噁心/嘔吐、呼吸困難、失眠及感覺障礙等生活品質也隨之改善。而患者有無接受復健治療則與胸鎖乳突肌硬化程度及生活品質之改變無顯著相關，可能是因受試人數太少及個案接受復健治療次數差異較大所致。結論：頭頸癌患者放射治療部位之胸鎖乳突肌硬化程度改善後，生活品質也會隨之改善；而胸鎖乳突肌硬化程度及生活品質之改變程度則與復健治療無顯著相關，可能是因受試人數不足及復健治療次數差異所致，日後仍需收集更多患者以再次分析復健之成效。
並列摘要
Objective: Radiation-induced fibrosis after radiation treatment frequently results in neck and shoulder pain/dysfunction, trismus, dysphagia, muscle stiffness and lower health-related quality of life (HRQOL) in patients with head and neck (H&N) cancer. Here, we access the correlation between neck muscle stiffness after radiation therapy and HRQOL, and the effect of rehabilitation on muscle stiffness and HRQOL. Method: We used real-time sonoelastography to evaluate sternocleidomastoid muscle (SCM) stiffness after radiation therapy. We used the EORTC QLQ-30 and EORTCQLQ H&N35 to evaluate the HRQOL of H&N cancer patients. Each participant received real-time sonoelastography and an HRQOL evaluation twice with the course of 6 months to compare changes in soft-tissue stiffness and HRQOL. The participants were subdivided into two groups with and without rehabilitation treatment to compare the effect of rehabilitation on changes in SCM stiffness and HRQOL. Results: Twenty-five patients with H&N cancers were included in the study. Seventeen of the patients completed both evaluations 6 months later. The SCM stiffness area of the radiation site was significantly larger than the non-radiation site at the initial evaluation (54.3 ± 23.0 % vs. 40.5 ± 19.7 %, p=0.036), but the SCM stiffness area of both sites showed no significant difference 6 months after the initial evaluation. Some of the HRQOL subscales (physical functioning, emotion functioning, nausea/ vomiting, dyspnea, insomnia and senses problems) improved when the SCM stiffness area decreased at follow up. The SCM stiffness area and HRQOL changes were not significantly different for patients with or without the rehabilitation treatment, which may be due to the small number of participants in our study. Conclusions: The HRQOL of H&N cancer patients revealed a negative correlation with the SCM stiffness area change. Rehabilitation treatment showed no significant effect on the SCM stiffness area change and HRQOL, which may be due to the small number of participants and variations in compliance with rehabilitation treatment in our cohort.