Parliament Matthew B, Scrimger Rufus A, Anderson Stephanie G, Kurien Elizabeth C, Thompson Heather K, Field G Colin, Hanson John
Division of Radiation Oncology, University of Alberta, Edmonton, Alberta, Canada.
Int J Radiat Oncol Biol Phys. 2004 Mar 1;58(3):663-73. doi: 10.1016/S0360-3016(03)01571-2.
To assess whether comprehensive bilateral neck intensity-modulated radiotherapy (IMRT) for head-and-neck cancer results in preserving of oral health-related quality of life and sparing of salivary flow in the first year after therapy.
Twenty-three patients with head-and-neck cancer (primary sites: nasopharynx [5], oral cavity [12], oropharynx [3], and all others [3]) were accrued to a Phase I-II trial. Inverse planning was carried out with the following treatment goals: at least 1 spared parotid gland (defined as the volume of parotid gland outside the planning target volume [PTV]) to receive a median dose of less than 20 Gy; spinal cord, maximum 45 Gy; PTV(1) to receive a median dose of 50 Gy; PTV(2) to receive a median dose of 60 Gy (postoperative setting, n = 15) or 66-70 Gy (definitive radiotherapy setting, n = 8). Treatment was delivered with 6 and 15 MV photons using a "step-and-shoot" technique on a Varian 2300 EX linac with 120-leaf Millenium MLC. Unstimulated and stimulated whole-mouth salivary flow rates were measured, and patients completed the University of Washington instrument (UWQOL) and a separate xerostomia questionnaire (XQOL) in follow-up.
Early functional outcome end point data are available at the 1-, 3-, and 12-month follow-up time points for 22, 22, and 18 patients, respectively. The combined mean parotid dose was 30.0 Gy (95% confidence interval: 26.9-33.1). The differences from baseline in mean overall UWQOL scores at 1, 3, and 12 months postradiotherapy were -0.24, 0.32, and 4.28, not significantly different from zero (p = 0.89, p = 0.87, p = 0.13). None of the UWQOL individual domain scores related to oral health (pain, eating-chewing, eating-swallowing, and speech) at 1, 3, or 12 months were significantly different from baseline. Both unstimulated and stimulated whole-mouth flow was variably preserved. Unstimulated salivary flow at 1 and 12 months was inversely correlated with combined mean parotid dose (p = 0.014, p = 0.0007), whereas stimulated salivary flow rates at 3 and 12 months were also correlated with combined mean parotid dose (p = 0.025, p = 0.0016). Combined maximum parotid dose was correlated with unstimulated flow rate at 12 months (p = 0.02, r = -0.56) and stimulated flow rate at 1 and 12 months (p = 0.036, r = -0.45; p = 0.0042, r = -0.66). The proportion of patients reporting total XQOL scores of 0 or 1 (no or mild xerostomia) did not diminish significantly from baseline at 1, 3, or 12 months (p = 0.72, p = 0.51, p = 1.0). Unstimulated and stimulated flow at 1 month was inversely correlated with total XQOL score at 12 months (p = 0.025, p = 0.029).
Oral health-related quality of life (HRQOL) was highly preserved in the initial 12 months after IMRT, as assessed with separate, validated instruments for xerostomia-specific quality of life and oral HRQOL. In general, patients with better-preserved unstimulated salivary flow rates tended to report lower xerostomia scores. Whole-mouth salivary flow rates post IMRT were inversely correlated with combined mean parotid doses. Longer follow-up is required to assess to what extent HRQOL is favorably maintained.
评估头颈部癌双侧颈部综合调强放射治疗（IMRT）在治疗后第一年是否能保留与口腔健康相关的生活质量并减少唾液分泌。
23名头颈部癌患者（原发部位：鼻咽癌[5例]、口腔癌[12例]、口咽癌[3例]及其他[3例]）纳入一项I-II期试验。采用逆向计划，设定以下治疗目标：至少1个腮腺（定义为计划靶体积[PTV]外的腮腺体积）接受的中位剂量小于20 Gy；脊髓，最大剂量45 Gy；PTV(1)接受的中位剂量为50 Gy；PTV(2)接受的中位剂量为60 Gy（术后情况，n = 15）或66 - 70 Gy（根治性放疗情况，n = 8）。使用“步进式”技术，在配备120叶Millenium MLC的Varian 2300 EX直线加速器上，采用6和15 MV光子进行治疗。测量未刺激和刺激后的全口唾液流速，患者在随访中完成华盛顿大学问卷（UWQOL）和一份单独的口干问卷（XQOL）。
分别在1、3和12个月随访时间点获得了22、22和18例患者的早期功能结局终点数据。腮腺联合平均剂量为30.0 Gy（95%置信区间：26.9 - 33.1）。放疗后1、3和12个月时，UWQOL总体平均得分与基线的差异分别为-0.24、0.32和4.28，与零无显著差异（p = 0.89，p = 0.87，p = 0.13）。放疗后1、3或12个月时，UWQOL中与口腔健康相关的各个领域得分（疼痛、咀嚼、吞咽和言语）与基线相比均无显著差异。未刺激和刺激后的全口唾液流速均有不同程度的保留。1个月和12个月时的未刺激唾液流速与腮腺联合平均剂量呈负相关（p = 0.014，p = 0.0007），而3个月和12个月时的刺激唾液流速也与腮腺联合平均剂量相关（p = 0.025，p = 0.0016）。腮腺最大联合剂量与12个月时的未刺激流速相关（p = 0.02，r = -0.56）以及1个月和12个月时的刺激流速相关（p = 0.036，r = -0.45；p = 0.0042，r = -0.66）。报告XQOL总分为0或1（无或轻度口干）的患者比例在1、3或12个月时与基线相比无显著下降（p = 0.72，p = 0.51，p = 1.0）。1个月时的未刺激和刺激流速与12个月时的XQOL总分呈负相关（p = 0.025，p = 0.029）。
使用针对口干特异性生活质量和口腔健康相关生活质量单独验证的工具评估，IMRT后最初12个月内与口腔健康相关的生活质量（HRQOL）得到高度保留。一般来说，未刺激唾液流速保留较好的患者往往报告的口干得分较低。IMRT后的全口唾液流速与腮腺联合平均剂量呈负相关。需要更长时间的随访来评估HRQOL在多大程度上得到良好维持。
