Laval University Cancer Research Center, Centre Hospitalier Universitaire de Québec - L'Hôtel-Dieu de Québec, Quebec, Canada.
Int J Radiat Oncol Biol Phys. 2012 Mar 15;82(4):1454-62. doi: 10.1016/j.ijrobp.2011.04.022. Epub 2011 Jun 2.
Radiation therapy (RT) causes acute and late toxicities that affect various organs and functions. In a large cohort of patients treated with RT for localized head and neck cancer (HNC), we prospectively assessed the occurrence of RT-induced acute and late toxicities and identified characteristics that predicted these toxicities.
We conducted a randomized trial among 540 patients treated with RT for localized HNC to assess whether vitamin E supplementation could improve disease outcomes. Adverse effects of RT were assessed using the Radiation Therapy Oncology Group Acute Radiation Morbidity Criteria during RT and one month after RT, and the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer Late Radiation Morbidity Scoring Scheme at six and 12 months after RT. The most severe adverse effect among the organs/tissues was selected as an overall measure of either acute or late toxicity. Grade 3 and 4 toxicities were considered as severe. Stepwise multivariate logistic regression models were used to identify all independent predictors (p < 0.05) of acute or late toxicity and to estimate odds ratios (OR) for severe toxicity with their 95% confidence intervals (CI).
Grade 3 or 4 toxicity was observed in 23% and 4% of patients, respectively, for acute and late toxicity. Four independent predictors of severe acute toxicity were identified: sex (female vs. male: OR = 1.72, 95% confidence interval [CI]: 1.06-2.80), Karnofsky Performance Status (OR = 0.67 for a 10-point increment, 95% CI: 0.52-0.88), body mass index (above 25 vs. below: OR = 1.88, 95% CI: 1.22-2.90), TNM stage (Stage II vs. I: OR = 1.91, 95% CI: 1.25-2.92). Two independent predictors were found for severe late toxicity: female sex (OR = 3.96, 95% CI: 1.41-11.08) and weight loss during RT (OR = 1.26 for a 1 kg increment, 95% CI: 1.12-1.41).
Knowledge of these predictors easily collected in a clinical setting could help tailoring therapies to reduce toxicities among patients treated with RT for HNC.
放射治疗（RT）会导致急性和迟发性毒性，影响各种器官和功能。在接受局部头颈部癌症（HNC）RT 治疗的大量患者中，我们前瞻性评估了 RT 引起的急性和迟发性毒性的发生情况，并确定了预测这些毒性的特征。
我们对 540 名接受 RT 治疗的局部 HNC 患者进行了一项随机试验，以评估维生素 E 补充是否可以改善疾病结局。在 RT 期间和 RT 后一个月使用放射治疗肿瘤学组急性放射发病率标准评估 RT 不良影响，并在 RT 后 6 个月和 12 个月使用放射治疗肿瘤学组/欧洲癌症研究与治疗组织迟发性放射发病率评分方案进行评估。选择器官/组织中最严重的不良反应作为急性或迟发性毒性的整体衡量标准。3 级和 4 级毒性被认为是严重的。采用逐步多变量逻辑回归模型确定急性或迟发性毒性的所有独立预测因素（p<0.05），并估计严重毒性的优势比（OR）及其 95%置信区间（CI）。
急性和迟发性毒性的发生率分别为 23%和 4%。确定了 4 个严重急性毒性的独立预测因素：性别（女性 vs. 男性：OR=1.72，95%CI：1.06-2.80）、卡氏功能状态（每增加 10 分，OR=0.67，95%CI：0.52-0.88）、体质指数（BMI）（高于 25 与低于：OR=1.88，95%CI：1.22-2.90）、TNM 分期（II 期与 I 期：OR=1.91，95%CI：1.25-2.92）。严重迟发性毒性的两个独立预测因素为：女性（OR=3.96，95%CI：1.41-11.08）和 RT 期间体重减轻（OR=1.26，每增加 1 公斤，95%CI：1.12-1.41）。
在临床环境中很容易收集这些预测因素的知识，可以帮助针对接受 HNC RT 治疗的患者量身定制治疗方案，以降低毒性。
