鼻咽癌患者放射治療後鼻竇變化之觀察; The Paranasal Sinuses Change in Post-irradiation Patients with Nasopharyngeal Carcinoma

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Title:	鼻咽癌患者放射治療後鼻竇變化之觀察;The Paranasal Sinuses Change in Post-irradiation Patients with Nasopharyngeal Carcinoma
Authors:	梁凱莉;Kai-Li Liang
Contributors:	中國醫藥大學：醫學研究所碩士班
Keywords:	併發症;鼻咽癌;鼻腔沖洗;放射治療;鼻及鼻竇炎;complication;nasopharyngeal carcinoma;nasal irrigation;radiotherapy;rhinosinusitis
Date:	2007-07-17
Issue Date:	2009-08-13 14:50:40 (UTC+8)
Abstract:	背景：鼻咽癌是台灣第二常見的頭頸癌。放射治療是目前對鼻咽癌治療的主要方式。放射治療後的患者常產生鼻及鼻竇炎的併發症，臨床上醫師常建議病患以鼻腔沖洗來緩解症狀。但至今關於鼻腔沖洗對放射治療後引發之鼻及鼻竇炎的療效尚無報告。本研究的目的在希望瞭解放射治療引起的鼻及鼻竇炎之發生率及病程進展。同時嘗試研究鼻腔沖洗對放射治療引起的鼻及鼻竇炎的治療效果。材料與方法：首先進行回溯性的觀察，以瞭解電腦斷層診斷之鼻及鼻竇炎在放射治療後鼻咽癌患者的發生率。收案自2002年1月至2004年6月間在本院診斷為鼻咽癌且接受全程放射治療的患者，觀察其放射治療後一年內的電腦斷層鼻竇變化。自2004年10月至2006年5月間開始收案在本院新診斷鼻咽癌的患者，排除未接受完整放射治療、沒有治療後追蹤及追蹤期間診斷有局部復發者。將收案患者隨機分為接受鼻沖洗或沒有接受鼻沖洗兩組，接受鼻腔沖洗者於放射治療開始即接受每日鼻腔沖洗至治療後第6個月，在放射治療開始前、放射治療第4週、放射治療完成以及放射治療後的1個月、2個月、3個月、6個月和12個月患者接受鼻內視鏡檢查和鼻及鼻竇炎問卷訪視。結果：回溯性的觀察50名患者在一年內連續的鼻竇電腦斷層變化，發現在放射治療後電腦斷層的評分即爬升，但在6個月時已漸下降，至治療後12個月時電腦斷層分數仍略高於治療前，但已接近治療前。後續進行的前瞻性研究共收案107名患者。接受鼻腔沖洗的患者在接受沖洗期內的鼻內視鏡及鼻及鼻竇炎症狀分數較低，兩組在沖洗治療期間的內視鏡及問卷呈有意義的差別(p=0.0001及0.0012)。若就各觀察點而言，在放射治療後的2個月及3個月兩組的內視鏡或問卷分數達最明顯的差異。但無論患者是否接受鼻沖洗，治療後12個月時患者的平均症狀及內視鏡檢查都減緩至接近治療前。結論：本研究的結果發現鼻及鼻竇炎是鼻咽癌患者放射治療後常見的併發症。以目前的放射治療技術，多數患者的鼻及鼻竇炎症狀在治療後6個月漸趨緩解。而鼻腔沖洗有助於減少患者在治療初期的鼻腔不適。 Background: Nasopharyngeal carcinoma (NPC) is the second common head and neck cancer in Taiwan. Radiotherapy (RT) is the standard treatment for NPC. RT-induced rhinosinusitis is a common side effect in post-irradiated NPC patients. Nasal irrigation is frequently recommended for treatment of post-RT rhinosinusitis. To our knowledge, there was no study related to this subject till now. The purpose of this study was to find the RT effect on the paranasal sinuses in patients with NPC, including the incidence and the timing course. And we try to evaluate the efficacy of nasal irrigation for RT-induced rhinosinusitis. Materials and Methods: A retrospective study was preformed first for estimate the incidence of IMRT-induced rhinosinusitis in our institute and the timing course of sinus mucosal change in the first post-treatment year. Patients who received full course RT for NPC and had 4 times CT scans at baseline, post RT 3months, 6 months and 12 months in our hospital were retrospectively recruited from January 2002 to June 2004. From October 2004 to May 2006, patients with NPC were consecutively recruited. Patients who did not complete RT, who had residual or recurrent nasopharyngeal tumor during the study period, and who lost to follow-up after RT were excluded. All patients were randomly allocated to irrigation or non-irrigation groups. Patients in irrigation group received daily nasal irrigation till 6 months after RT. The endoscopy and questionnaire scores were recorded at baseline (the week before radiotherapy), at 4th week of RT, at the week RT completed and at post-RT 1, 2, and 3, 6 and 12months. Results: Fifty patients with NPC were enrolled for the retrospective study. The CT scores rose after RT and gradually decreased at post-RT 6 months. The CT scores at post-RT 12 months remained slightly higher than the baseline. It seemed the RT effect on paranasal sinuses had acute and late phases. The prospective study designed under this hypothesis enrolled 107 patients with NPC: When patients were grouped as irrigation or non-irrigation, patients in the irrigation group had lowered endoscopic and questionnaire scores than patients in non-irrigation group. Significant differences between two groups were observed when including all follow-up points till post-RT 6 months both in endoscopic and questionnaire scores (p=0.0001 and 0.0012, respectively). The between-group differences were most obvious at post-RT 2 and 3 months. However, the mean endoscopic and questionnaire scores decreased to near the baseline level at post-RT 12 months, both in irrigation and non-irrigation groups. Conclusions: The results of this study confirmed that rhinosinusitis was a common RT side effect in patients with NPC. With the advances of radiotherapy technique, most IMRT-induced rhinosinusitis improved after 6 months. Nasal irrigation was proved as a safe and effective management for relief the acute post-RT nasal symptoms.
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