数字化口腔定位支架在头颈部肿瘤放射治疗中的应用现状

doi:10.7518/gjkq.2024018

摘要/Abstract

摘要：

在放射治疗中，由于射线不可避免地对正常细胞产生辐射作用，头颈部肿瘤患者常会发生严重的口腔并发症，例如：放射治疗诱发性口腔黏膜炎、张口困难、吞咽困难、放射性颌骨坏死和放射性龋病等。这些并发症会影响甚至中断放射治疗的进行，对放射治疗后患者的生活质量造成难以估量的影响。为减小放射治疗带来不利影响，近年来，国内外学者对口腔定位支架（OPS）开展了广泛的研究，其中传统型OPS对一些口腔并发症的预防起到明显的作用，但其在设计制作以及推广应用上存在一些不足，数字化OPS的研究应运而生。本文主要对数字化OPS的设计制作方法、口腔并发症的预防以及放射治疗摆位的影响进行总结分析，对其应用前景进行了展望。

关键词: 口腔支架, 头颈部肿瘤, 放射治疗, 计算机辅助设计, 放射性口腔黏膜炎, 摆位误差

Abstract:

In radiotherapy, normal tissues are inevitably damaged by radiation. Thus, patients suffering from head and neck tumor often develop serious oral complications, such as radiotherapy-induced oral mucositis, trismus, dysphagia, radiation osteonecrosis of the jaws, and radiation caries. These complications can affect or interrupt the delivery of radiation therapy. Accordingly, they have an immeasurable impact on the quality of patients’ lives after radiotherapy. To reduce the adverse effects of radiotherapy, domestic and foreign scholars have conducted extensive research on oral positioning stents (OPS). Conventional OPS plays a significant role in the prevention of those oral complications, but they have any disadvantages in design, fabrication, promotion, and application. Research on digital OPS has emerged. This work summarizes and analyzes the fabrication process, prevention of oral complications, and radiotherapy setup with digital OPS to improve the research direction and application prospects.

Key words: oral stents, head and neck cancer, radiation therapy, computer aided design, radiotherapy-induced oral mucositis, setup errors

中图分类号:

R782

和子慕, 李风兰. 数字化口腔定位支架在头颈部肿瘤放射治疗中的应用现状[J]. 国际口腔医学杂志, 2024, 51(1): 28-35.

He Zimu, Li Fenglan. Present application of digital oral positioning stents in radiotherapy of head and neck tumor[J]. Int J Stomatol, 2024, 51(1): 28-35.

图/表 2

表 1

OPS对HNT放疗患者口腔并发症的影响研究总结"

口腔并发症		肿瘤临床分类	放疗方式	OPS	主要发现	参考文献
RIOM	黏膜炎	鼻咽癌	IMRT	传统型	佩戴OPS者的口腔平均剂量降低至（32.98±1.91）Gy，将Ⅲ级黏膜炎并发症的发生率降至22.83%，比不佩戴者降低了2.52%；佩戴OPS者的腮腺平均剂量降低至（29.42±2.25）Gy，比不佩戴者的平均剂量降低了8.78%~15.39%	[25]
		鼻腔鼻窦癌、口腔癌、口咽癌	3D-适形治疗和IMRT	传统型	佩戴OPS者Ⅲ级RIOM的发生时间推迟1周，Ⅲ级RIOM发病率比不佩戴者降低了19.4%	[26]
		舌癌	IMRT	数字化	佩戴OPS者的上唇、上颊以及腭部的平均剂量分别减少了56%、53%、40%~72%	[29]
	味觉损害	鼻咽癌	常规放疗	传统型	佩戴OPS者味觉损害发生率为21.05%，较不佩戴者减少了58.12%	[13]
	口干症	舌癌	常规放疗	传统型	放疗开始30 d，佩戴OPS者较不佩戴者的口干不良事件评分降低40%	[14]
		舌癌	常规放疗	传统型	放疗后3个月，佩戴OPS者的未刺激唾液流率和刺激唾液流率分别为0.29 mL/min和0.64 mL/min，较不佩戴者分别增加38.1%、25.49% 放疗后6个月，佩戴OPS者的未刺激唾液流率和刺激唾液流率分别为0.13 mL/min和0.48 mL/min，较不佩戴者分别增加62.5%、29.73%	[28]
		口咽癌	IMRT	传统型	单侧放疗佩戴OPS者和不佩戴OPS者MDASI-HN口干症的平均得分为3.08±2.91、3.38±3.19，不具有统计学意义（P=0.707）双侧放疗佩戴OPS者和不佩戴OPS者MDASI-HN口干症的平均得分为4.20±2.97、4.04±2.99，不具有统计学意义（P=0.604）；佩戴者味觉损害发生率为2%，较不佩戴者减少了13%；佩戴者吞咽困难发生率为21%，较不佩戴者减少了10%	[27]
放射性颌骨坏死		鼻咽癌	IMRT	数字化	佩戴OPS者下颌骨接受的平均辐射剂量为（35.34±3.98）Gy，较不佩戴者减少了10.12%；佩戴OPS者舌接受的平均辐射剂量降为（35.96±4.98）Gy，较不佩戴者减少13.32%	[17]
放射相关龋病		口腔癌	IMRT	传统型	佩戴OPS者上颌骨牙齿接受的平均剂量为（20.9±13.1）Gy，较不佩戴者减少了41.62%；佩戴OPS者腮腺接受的平均剂量降低至（35.0±9.7）Gy，较不佩戴者降低了16.27%	[15]

表 1

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