Abstract:Objective: To study the effects of three-dimensional conformal radiation therapy (3D-CRT) and volume modulated arc therapy (VMAT) on thyroid function in patients with head and neck cancers. Methods: 140 patients with head and neck tumors from January 2011 to June 2014 underwent radiotherapeutics in Nuclear Medicine Department of Central Hospital of Chongqing Three Gorges Tumour Branch were randomly divided into group 3D-CRT and group VMAT, with 70 cases in each group, group 3D-CRT was treated with 3D-CRT, group VMAT was treated with VMAT, all patients were treated for 2 months and followed up for 24 months. The clinical efficacy at 2 months after radiotherapy was observed, the levels of serum thyroid stimulating hormone (TSH), free triiodothyronine (FT3) and free thyroxine (FT4) were measured before radiotherapy, at the end of radiotherapy, and at 3, 6, 12, 18 and 24 months after radiotherapy, QLQ-H&N35 scale score was used to evaluate the quality of life of patients before radiotherapy, 1 months for radiotherapy, after radiotherapy and 6 months after radiotherapy, the occurrence of hypothyrea during follow-up was recorded. Results: There was no significant difference in the total effective rate between the two groups at 2 months after radiotherapy (P>0.05); at 6, 12, 18 and 24 months after radiotherapy, the TSH in group VMAT was significantly lower than that in group 3D-CRT (P<0.05);at 12,18 and 24 months after radiotherapy, the FT3 and FT4 in group VMAT were significantly higher than those in group 3D-CRT (P<0.05); at 6 months after radiotherapy, the score of QLQ-H&N35 scale in group VMAT was significantly lower than that in group 3D-CRT (P<0.05); there was no significant difference in the incidence rate of hypothyrea between the two groups during the 24 months follow-up (P>0.05). Conclusion: 3D-CRT and VMAT are effective radiotherapy methods for head and neck cancers, but VMAT is superior to 3D-CRT in protecting thyroid function and improving quality of life after treatment.
张军, 李刚, 任必勇, 彭东, 张力. 3D-CRT和VMAT对头颈部肿瘤患者甲状腺功能的影响[J]. 河北医学, 2018, 24(9): 1463-1466.
ZHANG Jun, LI Gang, REN Biyong, et al. The Effect of 3D-CRT and VMAT on Thyroid Function in Patients with Head and Neck Cancers. HeBei Med, 2018, 24(9): 1463-1466.
[1] 冀叶,李磊,杨洁,等.云南省头颈部肿瘤住院患者13649例构成分析[J].中华肿瘤防治杂志,2013,20(15):1142~1144. [2] Cabrera A R, Yoo D S, Brizel D M. Contemporary radiotherapy in head and neck cancer: balancing chance for cure with risk for complication[J]. Surg Oncol Clin N Am, 2013, 22(3):579~598. [3] 杨学宁,吴一龙.实体瘤治疗疗效评价标准-RECIST[J].循证医学,2004,4(2):85~90. [4] Chie W C, Hong R L, Lai C C, et al. Quality of life in patients of nasopharyngeal carcinoma: Validation of the Taiwan Chinese version of the EORTC QLQ-C30 and the EORTC QLQ-H&N35[J]. Quality of Life Research, 2003, 12(1):93~98. [5] Ronjom M F. Radiation-induced hypothyroidism after treatment of head and neck cancer[J]. Dan Med J., 2016, 63(3):1~18. [6] 王冬青,翟利民,高敏,等.头颈部肿瘤调强放射治疗后甲状腺功能减退的临床参数和剂量影响因素[J].中华放射医学与防护杂志,2014,34(3):201~205. [7] 杨剑波,梁全琨,韦正波,等.头颈部非甲状腺肿瘤放射治疗对甲状腺功能的影响研究[J].现代诊断与治疗,2016,27(23):4528~4529. [8] Jin-An M A, Xuezhen L I, Wen Z, et al. Grave's disease induced by radiotherapy for nasopharyngeal carcinoma: A case report and review of the literature[J]. Oncology Letters, 2013, 6(1):144~146. [9] 吴仁瑞,钟琼,欧阳玉茗.头颈部肿瘤患者调强放射治疗后发生甲状腺功能减退的影响因素分析[J].临床合理用药杂志,2017,10(27):123~124. [10] 孙华茂,王剑锋,卢彦达,等.头颈部肿瘤患者放射治疗早期甲状腺功能减退发生率及其影响因素[J].中国老年学杂志,2014,34(16):4487~4489.