头颈癌患者放射治疗最常见的并发症的处理

Sonja Rogoleva Gjurovski
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引用次数: 0

摘要

放射治疗是治疗头颈癌的一种广泛的方法,不幸的是,它留下了对患者生活产生负面影响的后果。在电离辐射治疗期间和之后,它不仅影响正在治疗的恶性区域,而且影响目标区域附近的周围组织和器官(口腔黏膜、颌骨、牙齿、唾液腺、周围肌肉和颞下颌关节),使其结构和功能发生变化。许多接受治疗的病人,并没有为放射治疗做好最佳准备,这也影响了他们的组织和器官的术后状况,这些组织和器官位于放射治疗区域附近。本研究的目的是确定头颈癌患者最常见的放疗后并发症,并评估用于管理这些并发症的解决方案的效率。本研究通过NCBI、Cochrane Library、Medline、PubMed和Webmd等数据库进行在线研究。纳入标准为:体内研究;用英语写的研究;头颈癌病例报告;放射治疗后患者调查;放射治疗后口腔内并发症的研究。结果显示头颈部肿瘤患者放射并发症可分为早期、中期和晚期三组。最常见的变化发生在组织(粘膜、皮肤、皮下结缔组织、唾液腺、骨组织和牙齿),导致:唾液分泌不足(口干症)、粘膜炎、机会性感染、放射性龋齿、吞咽困难、味觉改变以及咀嚼和吞咽困难。许多研究表明,口腔黏膜损伤的百分比与患者接受的辐射剂量和电离辐射的类型密切相关。处理包括使用润滑剂;唾液替代品的使用;还有分泌唾液的兴奋剂,比如匹罗卡品和西维米林,还有电刺激。治疗后味觉的丧失可以是部分的,也可以是全部的。最受影响的是酸和苦的味道,很少是甜和咸的味道,很少是所有的味道都失去了。幸运的是,在大多数研究案例中,味觉的变化在一段时间后是可逆的,在一些情况下,几个月,在另一些情况下,甚至可能发生几年,直到完全恢复。实施更多的解决方案并找到新的方法来管理放疗后的并发症是至关重要的,因此可以以任何可能的方式挽救这些患者的生活质量。对这些患者使用IMRT和VMAT等新方法也可以改善治疗后的病情,并且如果可能的话,也可以测试和实施减少照射剂量的方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
MANAGING THE MOST COMMON COMPLICATIONS OF RADIATION THERAPY IN PATIENTS WITH HEAD AND NECK CANCER
Radiation therapy is widely used approach in treatment of head and neck cancer, unfortunately it leaves consequences that are influencing the patients’ life in a negative way. During and after the treatment with ionizing irradiation it affects not only the malignant area that is being treated, but also the surrounding tissues and organs that are located near the region that is targeted (oral mucosa, jaw bones, teeth, salivary glands, surrounding muscles and the temporomandibular joints), leaving changes in their structure and functions. Many of the patients that are treated, have not been prepared optimally for the radiation treatment, what also affects the post operative condition of their tissues and organs that are located nearby to the radiation treated area. The aim of this study was to define the most common postradiation complications in patients with head and neck cancer and to evaluate the efficiency of the solutions that are used to manage them. For this study were analyzed in details 37 published articles on the studied topic, the research was done online using the data bases NCBI, Cochrane Library, Medline, PubMed and Webmd. The inclusion criteria were: studies made in vivo; studies written in English; case reports on head and neck cancer patients; surveys on patients after radiation therapy; studies on patients with intraoral complications from after radiation therapy. Results showed that radiation induced complications in the head and neck cancer patients can be classified in three groups as early, intermediate and late changes. The most common changes were found in the tissues (mucosa, skin, subcutaneous connective tissues, salivary glands, the bone tissues and the teeth), resulting with: hyposalivation (xerostomia), mucositis, opportunistic infections, radiation caries, dysphagia, altered taste and difficulties with the chewing and swallowing. Many studies have shown that the percent of damage on the oral mucosa is strongly related to the radiation dose and the type of ionizing irradiation that patients are being treated with. Treatment consists of application of lubricants; usage of substitutes for saliva; and stimulants for the saliva production, with preparations like pilocarpine and cevimeline, and electro stimulation. The loss of the taste after the treatment can be partial or total. Mostly affected are the sour and bitter tastes, rarely the sweet and the salty taste, and very rare is total loss on all of the flavors. Fortunately in most of the studied cases has been show that the changes in the taste were reversible after a period of time, in some cases a few months and in others it can happen even up to a few years until it reaches total recovery. It is crucial to implement more solutions and to find new ways to manage the complications that follow after the irradiation, so the quality of the life in these patients can be spared in any possible way. Using the new approaches such as IMRT and VMAT on these patients, could also improve their condition after the treatment, and reduced dosage of the irradiation also could be tested and implemented if it is possible.
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