RÉSUMÉ
Objective To analyze the effects of target volume optimization on oral mucosal reaction and salivary gland function in oropharyngeal cancer patients receiving intensity-modulated radiotherapy(IMRT).Methods A total of 120 patients with oropharyngeal cancer admitted to Affiliated Hospital of Jiangsu University from April 2020 to August 2022 were selected and randomly grouped into control group(n=60,conventional IMRT)and treatment group(n=60,cervical region Ⅱ and the oral target region were optimized during IMRT).The therapeutic efficacy,parotid gland dose,incidence of acute oral mucosal reaction,dry mouth and oral pain at 3 months after IMRT were compared between two groups.The resting-state apparent diffusion coefficient(ADC)values of parotid and submandibular glands at different time points(before radiotherapy,the 4th week of radiotherapy,the end of radiotherapy and 3 months after radiotherapy)were recorded.Results The difference in the objective reaction rate between two groups was trivial[80.00％(48/60)vs 75.00％(45/60),P>0.05].The mean dose(Dmean)and V34 of the unaffected parotid gland and the Dmean and V30 of the oral cavity in treatment group were lower than those in control group(P<0.05).The incidences of acute oral mucosal reaction,dry mouth and oral pain at 3 months after radiotherapy in treatment group were 41.67％,50.00％,and 58.33％,lower than those in control group(75.00％,78.33％,and 85.00％)(P<0.05).The resting-state ADC values of parotid and submandibular glands at the 4th week of radiotherapy,the end of radiotherapy,and 3 months after radiotherapy in both two groups were higher than those before radiotherapy(P<0.05).At the 4th week of radiotherapy,the end of radiotherapy,and 3 months after radiotherapy,the resting-state ADC values of parotid and submandibular glands in treatment group were lower than those in control group(P<0.05).Conclusion Optimizing target volume during oropharyngeal IMRT can effectively prevent the occurrence of radiation-induced mucositis,alleviate oral mucosal reaction,oral pain and dry mouth,reduce parotid gland dose,and diminish the effects of IMRT on salivary gland function in patients.
RÉSUMÉ
Malignant tumors are important diseases that threaten human health. Although targeting and immunotherapy have been gradually applied in the treatment of malignant tumors in recent years， which can alleviate the suffering of patients to a certain extent， there are still problems of large adverse reactions and easy drug resistance. At present， chemotherapy is still the main method for the treatment of malignant tumors. While killing tumor cells， chemotherapy also damages normal cells， which often leads to drug toxicity， such as bone marrow suppression， gastrointestinal adverse reactions， liver and kidney function damage， and oral mucosal reactions. Although modern medicines have a certain effect on the toxicity of chemotherapy drugs， there are still limitations. Traditional Chinese medicine（TCM） has a long history of treating malignant tumors， and considers that chemotherapy is a drug with toxin invading the body， exacerbating the "deficiency"， "toxin" and "stasis" of the body， causing damage to Qi， blood and organs， especially in spleen， stomach， liver and kidney， and leading to bone marrow suppression， liver and kidney function injury and other adverse reactions. Studies have confirmed that the use of TCM treatment has a better clinical efficacy. Therefore， new therapies shall be explored based on the basic theory of traditional Chinese medicine. As the core part of the theoretical system of TCM， Viscera-state doctrine is closely related to looking， listening， questioning and feeling the pulse of TCM， and has constantly developed and improved. It has important significance in guiding diagnosis and treatment of diseases. This study is guided by viscera-state doctrine of TCM and based on the etiology and pathogenesis of TCM. It starts with the clinical manifestations of common drug toxicity of chemotherapy drugs， such as bone marrow suppression， gastrointestinal adverse reactions， liver and kidney function damage， oral mucosal reactions， which are external signs of the toxicity of chemotherapeutic drugs， and associates pathological manifestations of viscera to physiological functions. From elephants and Tibetans， it systematically summarizes the viscera characteristics of various common chemotherapeutic drugs and provides new ideas and methods for clinical use of TCM in treating the toxicity of chemotherapeutic drugs， so as to promote the application of viscera-state doctrine in diagnosis and treatment of diseases.
RÉSUMÉ
Objective To explore an effective method for preventing and treating oral mucosal complications of radiotherapy for head and neck cancer. Methods Fifty head and neck cancer patients who were receiving radiotherapy were enrolled between March, 2008 and March, 2010. These patients were randomly assigned to the treatment group and the control group. During the radiotherapy, patients in the treatment group were given IL-11 in the form of atomization inhalation,whereas patients in the control group were not. Results IL-1 1 was well tolerated by the patients. It significantly decreased the level of oral mucosal complications and pains and improved patients' appetites ( P < 0.05 ). In addition, the duration of pain was significantly ( P <0.05 ) reduced from 4.5 ± 1.3 days ( in control group) to 2.3 ± 1.0 ( in treatment group), and the healing period was also significantly ( P < 0.05) reduced from 7.3 ± 1.5 days ( in control group) to 4.1 ± 1.7 ( in treatment group). Conclusion IL-11 is effective in preventing and treating oral mucosal complications of radiotherapy for head and neck cancer,relieving associated pains, and therefore improving patients' quality of life.