Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands.
Radiother Oncol. 2012 Apr;103(1):76-81. doi: 10.1016/j.radonc.2011.11.001. Epub 2011 Nov 21.
To apply recently developed predictive models for swallowing dysfunction to compare the predicted probabilities of swallowing dysfunction for standard intensity modulated radiotherapy (ST-IMRT) and swallowing sparing IMRT (SW-IMRT).
Thirty head and neck cancer patients who previously underwent radiotherapy for the bilateral neck were selected for this study. For each patient, ST-IMRT and SW-IMRT simultaneous integrated boost treatment plans were created. ST-IMRT treatment plan optimisation aimed at obtaining adequate target volume coverage and sparing of the parotid and submandibular glands as much as possible. Objectives for SW-IMRT were similar, with additional objectives to spare the organs at risk related to swallowing dysfunction (SWOARs). Dose-volume data with ST-IMRT and SW-IMRT and normal tissue complication probabilities for physician-rated and patient-rated swallowing dysfunction were calculated with recently developed predictive models.
All plans had adequate target volume coverage and dose to critical organs was within accepted limits. Sparing of parotid glands was similar for ST-IMRT and SW-IMRT. With SW-IMRT, the mean dose to the various SWOARs was reduced. Absolute dose values and dose reductions with SW-IMRT differed per patient and per SWOAR and depended on N stage and tumour location. The mean reduction in predicted physician-rated Radiation Therapy Oncology Group (RTOG) grade 2-4 swallowing dysfunction was 9% (range, 3-20%). Mean reductions of the probability of patient-rated moderate to severe complaints with regard to the swallowing of solid food, soft food, liquid food and choking when swallowing were 8%, 2%, 1% and 1%, respectively.
New predictive models for swallowing dysfunction were applied to show potential reductions in physician and patient-rated swallowing dysfunction with IMRT that was specifically optimised to spare SWOARs.
应用最近开发的吞咽功能障碍预测模型，比较标准调强放疗（ST-IMRT）和吞咽保护调强放疗（SW-IMRT）的吞咽功能障碍预测概率。
本研究选择了 30 例双侧颈部接受放疗的头颈部癌症患者。为每位患者创建了 ST-IMRT 和 SW-IMRT 同步整合增强治疗计划。ST-IMRT 治疗计划优化旨在获得足够的靶区覆盖，并尽可能保护腮腺和颌下腺。SW-IMRT 的目标相似，额外的目标是保护与吞咽功能障碍相关的危及器官（SWOARs）。使用最近开发的预测模型计算了 ST-IMRT 和 SW-IMRT 的剂量-体积数据以及医师评价和患者评价吞咽功能障碍的正常组织并发症概率。
所有计划都有足够的靶区覆盖，关键器官的剂量都在可接受的范围内。ST-IMRT 和 SW-IMRT 对腮腺的保护相似。SW-IMRT 可降低各种 SWOAR 的平均剂量。SW-IMRT 的绝对剂量值和剂量降低因患者和 SWOAR 而异，取决于 N 分期和肿瘤位置。预测的医师评价放射治疗肿瘤学组（RTOG）2-4 级吞咽功能障碍的平均降低率为 9%（范围，3-20%）。患者评价吞咽固体食物、软食、液体食物和吞咽时呛咳的中度至重度抱怨的概率平均降低 8%、2%、1%和 1%。
应用新的吞咽功能障碍预测模型显示，针对 SWOAR 进行专门优化的 IMRT 可降低医师和患者评价的吞咽功能障碍的发生率。
