Dornfeld Ken, Simmons Joel R, Karnell Lucy, Karnell Michael, Funk Gerry, Yao Min, Wacha Judith, Zimmerman Bridget, Buatti John M
Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA.
Int J Radiat Oncol Biol Phys. 2007 Jul 1;68(3):750-7. doi: 10.1016/j.ijrobp.2007.01.047. Epub 2007 Apr 6.
To test the hypothesis that radiation dose to key sites in the upper aerodigestive tract is associated with long-term functional outcome after (chemo)radiotherapy for head-and-neck cancers.
This study examined the outcome for 27 patients treated with intensity-modulated radiotherapy for definitive management of their head-and-neck cancer who were disease free for at least 1 year after treatment. Head-and-neck cancer-specific quality of life (QoL) was assessed before treatment and at 1 year after treatment. Type of diet tolerated, presence of a feeding tube, and degree of weight loss 1 year after treatment were also used as outcome measures. Radiation doses delivered to various points along the upper aerodigestive tract, including base of tongue, lateral pharyngeal walls, and laryngeal structures, were determined from each treatment plan. Radiation doses for each of these points were tested for correlation with outcome measures.
Higher doses delivered to the aryepiglottic folds, false vocal cords, and lateral pharyngeal walls near the false cords correlated with a more restrictive diet, and higher doses to the aryepiglottic folds correlated with greater weight loss (p < 0.05) 1 year after therapy. Better posttreatment speech QoL scores were associated with lower doses delivered to structures within and surrounding the larynx.
Our data show an inverse relationship between radiation dose delivered to laryngeal structures and speech and diet and QoL outcomes after definitive (chemo)radiation treatment. These findings suggest that efforts to deliver lower doses to laryngeal structures may improve outcomes after definitive (chemo)radiation therapy.
检验以下假设，即头颈部癌（化疗）放疗后，上呼吸道消化道关键部位的辐射剂量与长期功能预后相关。
本研究考察了27名头颈部癌患者的预后情况，这些患者接受调强放疗以明确治疗头颈部癌，治疗后至少1年无疾病。在治疗前和治疗后1年对头颈部癌特异性生活质量（QoL）进行评估。还将耐受的饮食类型、饲管的存在情况以及治疗后1年的体重减轻程度用作预后指标。从每个治疗计划中确定输送到上呼吸道消化道各个点（包括舌根、咽侧壁和喉部结构）的辐射剂量。测试这些点中每个点的辐射剂量与预后指标的相关性。
输送到杓会厌襞、假声带以及假声带附近咽侧壁的较高剂量与更严格的饮食相关，输送到杓会厌襞的较高剂量与治疗后1年更大的体重减轻相关（p < 0.05）。治疗后更好的言语生活质量评分与输送到喉内及喉周围结构的较低剂量相关。
我们的数据显示，在确定性（化疗）放疗后，输送到喉部结构的辐射剂量与言语、饮食和生活质量预后之间存在负相关关系。这些发现表明，努力降低输送到喉部结构的剂量可能会改善确定性（化疗）放疗后的预后。
