| Part 1:Clinical study of dysphagia after radiotherapy for nasopharyngeal carcinomaObjective To investigate the swallowing kinematics of the hyoid bone after radiotherapy by videofluoroscopic swallowing study(VFSS).Preliminarily discuss The mechanical characteristics of dysphagia caused by radiation therapy.Methods 25 Patients with Nasopharyngeal Carcinoma(NPC)have received video-fluoroscopic swallowing exams by X-Ray simulator.All of the swallowing videos have been fast continuously captured through video analysis software.The duration of deglutition,the displacement and the average velocity of the hyoid bone were analyzed.Results The mean duration of swallowing after treatment was significant longer than that before(1.38±0.23s Vs 1.12±0.26s,t=9.53,p=0.00).The maximal anterior displacement of the hyoid bone after treatment was less than that before(0.78±0.24cm Vs 1.01±0.25cm,r=5.82,p=0.00).The maximal vertical displacement of the hyoid bone after treatment was less than before(0.78±0.18cm Vs 1.01±0.25cm,t=2.56,p=0.02).The average velocity of the hyoid bone after treatment was also less than before(0.83±0.19 cm/s Vs 1.31±0.45cm/s,r=6.46,p=0.00).Conclusions The duration of swallowing afterradiotherapy was significant longer than before,while the maximal displacements and the average velocity of the hyoid bone werereduced.The mechanical characteristics of acute dysphagia after radiotherapy are worthy of further study.Part 2:Clinical study on taste changes in patients with locally advanced nasopharyngeal carcinoma after concurrent chemoradiotherapyObjective To observe the dynamic change characteristics of taste of patients with locally advanced nasopharyngeal cancer before,during and after concurrent chemoradiotherapy,and to evaluate the clinical and dosimetry factors causing the taste decline of patientsMethods During 2016.3-2017.1,53 patients with newly diagnosed locally advanced nasopharyngeal carcinoma were enrolled to receive concurrent chemoradiotherapy.Intensity modulated radiotherapy(IMRT)was used in all patients.Using sucrose,sodium chloride,citric acid and quinine sulfate as the four basic taste test reagents for sweet,salty,sour and bitter.Taste tests were performed before,during,and 1 and 3 months after treatment.Logistic regression analysis was used to analyze the clinical and treatment-related factors that might cause severe taste impairment in patients.The ROC curve was used to test the specificity and sensitivity of significant factors.Youden index screening threshold levelResults Two weeks after radiotherapy,the patient's taste began to decline and reached a peak at the sixth week of treatment.The mild,medium,severe and complete disappearance rates were 9.43%,15.10%,41.51%? 33.96%,respectively.Among the four basic tastes,bitter taste decreased the most,followed by salty taste,sweet taste and sour taste.After radiotherapy,sweet and sour taste recovered the most quickly,while bitter taste and salty taste were slower.1 month after the end of radiotherapy,the four basic tastes increased significantly,but still lower than the level before radiotherapy(p<0.05).By the end of radiotherapy 3 months later,the sense of taste had returned to the pre-radiotherapy level(p>0.05).The mean weight loss before and after radiotherapy was 6.20 2.22kg(0.5 kg-10.5 Kg),and the mean decreased taste was 9.62 2.62(3-12)?The degree of taste decline was positively correlated with the change of body weight(F=1 18.97,p<0.001).Multivariate analysis showed that age(p=0.036,OR 1.156,95%ci:1.009-1.324)and tongue root V30(p=0.016,OR 1.319,95%ci:1.053-1.651)were the main factors causing severe taste impairment.Root V30>87%was a predictor of severe taste impairment.Conclusions Patients with locally advanced nasopharyngeal carcinoma showed progressive decline in taste after concurrent chemoradiotherapy and reached the lowest value at week 6 of treatment,and recovered to the pre-radiotherapy level 3 months after the end of radiotherapy?Age and root V30 were the main factors of the patients' taste decline. |
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