调强放疗对鼻咽癌患者甲状腺功能及体积的影响

详细信息    查看全文 | 推荐本文 |

英文篇名：Influence of Intensity Modulated Radiotherapy on Thyroid Function and Volume in Patients with Nasopharyngeal Carcinoma 作者：刘晓清 ; 张飞燕 ; 曹燕清 ; 王建好 ; 杨帆 ; 王希成 英文作者：LIU Xiaoqing;ZHANG Feiyan;CAO Yanqing;WANG Jianhao;YANG Fan;WANG Xicheng;Department of Radiotherapy, the First Affiliated Hospital of Guangdong Pharmaceutical University; 关键词：鼻咽癌 ; 调强放射治疗 ; 甲状腺激素 ; 甲状腺功能减退 英文关键词：Nasopharyngeal carcinoma;;Intensity-modulated radiotherapy;;Thyroid hormone;;Hypothyroidism 中文刊名：YBQJ 英文刊名：Clinical Medicine & Engineering 机构：广东药科大学附属第一医院放疗科; 出版日期：2019-07-15 出版单位：临床医学工程 年：2019 期：v.26;No.245 基金：广东省医学科研基金项目(项目编号:A2012311) 语种：中文; 页：YBQJ201907015 页数：2 CN：07 ISSN：44-1655/R 分类号：35-36

摘要

目的探讨调强放疗(IMRT)对鼻咽癌患者甲状腺功能及体积的影响。方法选取2013年10月至2016年8月期间行IMRT的初治鼻咽癌患者108例,于放疗前及放疗后1年检测FT3、 FT4、 TSH,并行鼻咽及颈部MR,将MR图像与定位CT图像融合,勾画甲状腺体积,比较其FT3、 FT4、 TSH水平及甲状腺体积变化。结果放疗后1年, 26例(24.1%)患者发生亚临床或临床甲减。放疗前后患者的甲状腺体积分别为(18.6±3.37) cm3和(14.8±2.98) cm3(P=0.000)。放疗前,患者的FT3、 FT4、 TSH水平分别为(4.66±0.63) pmol/L、(15.47±2.74) pmol/L、(2.16±1.56)μIU/m L,与放疗后的(3.28±0.98) pmol/L、(12.56±2.32) pmol/L、(3.78±2.03)μIU/m L比较,差异均有统计学意义(P <0.05),尤其是N2、 N3的病例。结论 IMRT模式下,鼻咽癌放疗后1年甲状腺体积缩小, FT3、 FT4降低, TSH升高, IMRT计划应注意保护甲状腺。
        Objective To explore the influence of intensity modulated radiation therapy(IMRT) on thyroid function and volume in patients with nasopharynx carcinoma. Methods 108 cases of patients newly diagnosed as nasopharyngeal carcinoma undergoing IMRT from October 2013 to August 2016 were selected. The FT3, FT4, TSH, and nasopharynx and neck MR were examined before radiotherapy and 1 year after radiotherapy. MR images were fused with CT-sim images to delineate the thyroid volume. The FT3, FT4 and TSH levels, and thyroid volume were compared. Results 1 year after radiotherapy, subclinical or clinical hypothyroidism occurred in 26 patients(24.1%).The thyroid volume before and after radiotherapy were(18.6 ± 3.37) cm3 and(14.8 ± 2.98) cm3 respectively(P = 0.000). Before radiotherapy, the FT3, FT4 and TSH levles were(4.66 ± 0.63) pmol/L,(15.47 ± 2.74) pmol/L and(2.16 ± 1.56) μIU/m L, had statistical difference with(3.28 ± 0.98) pmol/L,(12.56 ± 2.32) pmol/L and(3.78 ± 2.03) μIU/m L after radiotherapy(P <0.05), especially in the cases of N2 and N3. Conclusions In IMRT mode, thyroid volume of patients with nasopharynx carcinoma decreases 1 year after radiotherapy, FT3 and FT4 decrease, and TSH increases. Thyroid gland should be protected during IMRT.

引文

[1]赵充,肖巍巍,韩非,等. 419例鼻咽癌患者调强放疗疗效和影响[J].中华放射肿瘤学杂志, 2010, 19(3):191-196.
    [2]徐靖,夏云飞.头颈肿瘤放射治疗后甲状腺功能减退的研究进展[J].中华肿瘤防治杂志, 2006, 13(13):1026-1030.
    [3] Zheng Y, Han F, Xiao W, et al. Analysis of late toxicity in nasopharyngeal carcinoma patients treated with intensity modulated radiation therapy[J]. Radiat Oncol, 2015, 10:17.
    [4]许昀,陈碧娟,郭巧娟,等.调强放疗对鼻咽癌患者甲状腺功能的影响[J].实用癌症杂志, 2016, 31(11):1799-1802.
    [5] Shuang H, Wang X, Hu C, et al. Hypothalamic-pituitary-thyroid dysfunction induced by intensity-modulated radiotherapy(IMRT)for adult patients with nasopharyngeal carcinoma[J]. Med Oncol, 2013,30(4):710.
    [6] Lin Z, Wang X, Xie W, et al. Evaluation of clinical hypothyroidism risk due to irradiation of thyroid and pituitary glands in radiotherapy of nasopharyngeal cancer patients[J]. J Wed Imaging Radiat Oncol,2013, 57(6):713-718.
    [7] Wu YH, Wang HM, Chen HH, et al. Hypothyroidism after radiotherapy for nasopharyngeal cancer patients[J]. Int J Radiat Oncol Biol Phys, 2010, 76(4):1133-1139.
    [8]戚正君,吴伟莉,金凤,等.鼻咽癌调强放疗对甲状腺血流动力学改变及功能影响的研究[J].中国癌症杂志, 2016, 26(5):447-451.
    [9] Wang LJ, Xia H, Huang SF, et al. Evaluation of thyroid function status in nasopharyngeal cancer patients with long-term survival agter intensity-modulated radiation therapy[J]. J Ahin Oncol, 2014, 10(20):7.
    [10]皮国良,何汉平,毕建平,等.头颈肿瘤放疗后甲状腺损伤危险因素分析[J].中国现代医学杂志, 2018, 28(9):70-75.