Since most nasopharyngeal carcinomas are hypofractionated phosphorous carcinomas with high sensitivity to radiation, radiotherapy is still the main treatment for nasopharyngeal carcinoma. Radiotherapy or radiotherapy + chemotherapy is generally preferred for first-time patients, and chemotherapy can be used for metastases in the late stage, but local palliative radiotherapy can still be used for pain relief, hemostasis and obstruction relief.
Mucosal reaction: It is the most significant radiation reaction in nasopharyngeal cancer radiotherapy. It is manifested as congestion and edema of mucous membrane in nasopharynx and oropharynx, loss of taste, ulceration, bleeding, necrosis and severe pain in severe cases, inability to eat and forced to stop radiotherapy. Preventive measures: pay attention to oral hygiene and add some surface anesthetics to the mouthwash for severe oral mucosal pain to reduce pain and improve the quality of life. Mucosal reactions are usually relieved gradually after the end of radiotherapy. You can also use the Chinese herbal medicine licorice 6 grams, maidenhair 6 grams, genistein 6 grams, double flower 6 grams, chrysanthemum 6 grams, steep in boiling water, cool and drink.
2, dry mouth: because the parotid gland is irradiated after its secretion function is inhibited, saliva secretion is reduced. Preventive measures: ① If you have difficulty in eating, you need to use soup to send down or into semi-liquid food. ②Take appropriate Chinese herbal medicine to promote the flow of fluid, some patients contain mint tablets to achieve better results. ③Let the patient contain sour dried fruits such as strawberry and fructan peel, and instruct the patient to cooperate with imagination therapy to stimulate salivary gland secretion, which can better relieve dry mouth. ④It has been reported that “artificial saliva” made of methylcellulose, sorbitol and mineral salts can be sprayed repeatedly to keep the mouth moist. ⑤ Saliva pH value decreases after radiotherapy for nasopharyngeal carcinoma, and oral infection is easy to occur, so saline can be used for oral rinsing. Drink water as soon as possible after radiotherapy, and it is better to add half a spoon of baking soda to each glass of water. (6) In addition, patients should drink a small amount of water from time to time to help keep the mouth moist.
3, nasal congestion: caused by swelling and obstruction of nasolacrimal duct and nasal mucous membrane edema, especially obvious when lying down, affecting sleep, 1% of nasal drops can be used to relieve symptoms, and eye drops can also be used to prevent nasolacrimal duct infection. Generally, the nasal congestion can be relieved by itself after the end of radiotherapy.
4.Nasopharyngeal and nasal bleeding: During radiotherapy, the tumor fades too fast, the normal tissues are too late to repair after the tumor tissue necrosis and shedding, the mucosal blood vessels become more brittle after irradiation, and bleeding can be caused by dry climate, forceful coughing, nose blowing or sneezing. In mild cases, blood will be oozing, in severe cases, it may cause hemorrhage. Preventive measures: ① Flush nasal cavity and nasopharyngeal cavity daily to remove necrotic tumor tissue, improve local blood flow and enhance sensitivity of radiotherapy. The flushing solution can be 0.3% hydrogen peroxide, and the pressure should not be too high to avoid bleeding; it can also be flushed with cool boiled water for 1~2 times and then with saline. ②Check the nasopharynx at least once a week. If the tumor is found to be fading too fast, the radiation dose can be appropriately reduced or suspended so that the normal tissue can be repaired. ③Eat a diet that is easy to be cool, and eat more fresh vegetables and fruits. ④Keep the bowel movement smooth and keep enema if necessary to relieve constipation. ⑤ Avoid blowing the nose or sneezing hard, and do not pick your nose with your hands. ⑥Control blood pressure, especially for those with a history of hypertension, keep the nasopharyngeal cavity clean and moist, do not drink alcohol, and avoid eating overheated and spicy food. Once nasopharyngeal bleeding occurs, the patient should immediately lie on his back and remove the pillow, keep quiet, use a cold water bag on the nose and forehead, and give sedative medicine to stop the bleeding. If there is a lot of bleeding, let the patient spit out as much as possible to prevent the blood swallowed from stimulating the gastric mucosa and aggravating the nasopharyngeal bleeding by vomiting.
3.The complications of radiotherapy mainly include temporomandibular joint dysfunction and soft tissue atrophy fibrosis, radioactive dental caries and radioactive osteomyelitis of jaw and radioactive encephalomyelopathy.
(1) Radioactive otitis media: manifested as swelling and pain in the ear, . When the eardrum is perforated and the exudate flows out, the pain can be relieved or alleviated by itself. Treatment: manual drainage, and drug drops to prevent infection.
(2) Difficulty in opening the mouth: due to atrophy and fibrosis of the masticatory muscles caused by radiotherapy. Prevention: let the patient insist on opening and closing mouth exercise or use wooden wedge triangle to insert the incisors for expansion, with hyperbaric oxygen therapy if possible.
(3) Radioactive gingivitis and radioactive caries: after radiotherapy of nasopharyngeal cancer, the secretion of salivary gland is inhibited and the self-cleaning effect of the mouth is reduced, which is manifested as gingival congestion, edema and even ulceration, and the continued development of gingival atrophy leads to the exposure of the tooth neck and the formation of radioactive caries. If radiotherapy is started before the traumatic surface is healed after tooth extraction, radioactive osteitis is likely to occur. Prevention: Quit smoking before radiotherapy, keep the mouth clean, 1~2 degree caries can be filled, remove all diseased teeth, start radiotherapy after 2 weeks, brush the teeth in the morning and evening during radiotherapy, rinse the mouth frequently, keep the mouth clean.