全程营养支持治疗对鼻咽癌急性放疗反应及治疗依从性的影响

摘要

Objective To explore the effect of whole course nutrition support on the response and treatment compliance of na-sopharyngeal carcinoma ( NPC) patients. Methods A total of 87 patients with NPC from January 2013 to December 2014 were en-rolled in this study, with 26 patients as observation group and 61 as control group. Oral nutritional preparations or nasal feeding were defined for full nutritional support during radiotherapy procedure in observation group. Intensity modulated radiotherapy was treated with 6MV X-ray. The prescription dose was 66-74 Gy/30-33 f and 66-70 Gy/30-33 f for nasopharynx and neck lymph node metastasis. Dur-ing radiotherapy, the quality of life ( KPS score) , the body weight and the acute response ( RTOG) were recorded, and the nutritional status was evaluated by using body mass index ( BMI) . Treatment compliance was evaluated at the 30 fraction of radiation. Results All the patients in observation group completed radiotherapy, but treatment disruption was found in 7 cases in control group, among whom 5 cases failed to complete radiotherapy. KPS score and nutritional status of observation group were better than those in control group at the 4th week and the end of radiotherapy ( P<0. 05) . The scores of radiodermatitis, mucositis, odynophagia and myelosuppres-sion were obviously lower in observation group compared with control group ( P<0. 05) , but the scores of dry mouth in the two groups had no difference(P>0. 05). The treatment compliance in observation group was 88. 5%(23/26), significantly better than 37. 7%(23/61) in control group (P<0. 05). Conclusion Total nutrition support can significantly reduce the acute radiation response of NPC, improve quality of life and treatment compliance of patients.%目的：探讨全程营养支持治疗对鼻咽癌急性放射反应及治疗依从性的影响。方法回顾性分析2013年1月至2014年12月收治的鼻咽癌放疗患者87例。自放疗开始至放疗结束始终采用口服营养制剂或鼻饲者定义为全程营养支持，共有患者26例，设为观察组；其余61例设为对照组。放疗采用6MV X线调强放疗，鼻咽部DT 66～74 Gy／30～33 f，颈部淋巴结转移灶DT 66～70 Gy／30～33 f。放疗期间记录生活质量（ KPS评分）和体质量，同时采用RTOG急性放射反应评分标准评价毒副反应，用体质量指数（ BMI）评价营养状况，在放疗30次时评价放疗依从性。结果观察组所有患者均按计划完成治疗；对照组中有7例中断放疗，其中有5例未能按计划完成放疗。观察组放疗第4周和放疗结束时的KPS评分、BMI均明显优于对照组（ P＜0．05）；放疗结束时，两组口干症状的评分差异无统计学意义（ P＞0．05），观察组放射性皮炎、黏膜炎、吞咽痛和骨髓抑制的评分均低于对照组（P＜0．05）；观察组放疗依从率为88．5％（23／26），高于对照组的37．7％（23／61），差异有统计学意义（ P＜0．05）。结论全程营养支持治疗能显著降低鼻咽癌急性放射反应，提高患者生活质量及治疗依从性。