Department of Radiation Oncology, Centre Clinique de la Porte de Saint Cloud, Boulogne-Billancourt, France; Department of Radiation Oncology, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.
Department of Radiation Oncology, Gustave Roussy, Université Paris-Sud XI, Villejuif, France.
Int J Radiat Oncol Biol Phys. 2014 Mar 1;88(3):589-95. doi: 10.1016/j.ijrobp.2013.11.230. Epub 2014 Jan 7.
This study aimed to evaluate the efficiency and the tolerance of radiation therapy (RT) on salivary glands in a large series of amyotrophic lateral sclerosis (ALS) patients with hypersalivation.
Fifty ALS patients that had medically failure pretreatment were included in this prospective study. RT was delivered through a conventional linear accelerator with 6-MV photons and 2 opposed beams fields including both submandibular glands and two-thirds of both parotid glands. Total RT dose was 10 Gy in 2 fractions (n=30) or 20 Gy in 4 fractions (n=20). RT efficacy was assessed with the 9-grade Sialorrhea Scoring Scale (SSS), recently prospectively validated as the most effective and sensitive tool to measure sialorrhea in ALS patients.
At the end of RT, all patients had improved: 46 had a complete response (92% CR, SSS 1-3) and 4 had a partial response (8% PR, SSS 4-5). A significant lasting salivary reduction was observed 6 months after RT completion: there was 71% CR and 26% PR, and there was a significant SSS reduction versus baseline (P<10(-6)). There was no grade 3 to 4 toxicity, and most side effects (34%) occurred during RT. Nine patients (18%) underwent a second salivary gland RT course, with a 3-months mean delay from the first RT, resulting in a SSS decrease (-77%). Both RT dose regimens induced a significant SSS decrease with no significant toxicity. There were, however, more patients with CR/PR in the 20-Gy protocol (P=.02), and 8 of 9 patients (89%) receiving a second RT course had previously been treated within the 10-Gy protocol.
Radiation therapy of 20 Gy in 4 fractions is an efficient and safe treatment for ALS patients with sialorrhea. A shorter RT course (10 Gy in 2 fractions) may be proposed in patients in poor medical condition.
本研究旨在评估放射治疗(RT)对大系列伴有唾液分泌过多的肌萎缩侧索硬化症(ALS)患者唾液腺的疗效和耐受性。
本前瞻性研究纳入了 50 例经预处理后药物治疗失败的 ALS 患者。RT 采用 6-MV 光子常规直线加速器进行,使用 2 个对向野,包括双侧下颌下腺和双侧腮腺的 2/3。总 RT 剂量为 10 Gy 分 2 次(n=30)或 20 Gy 分 4 次(n=20)。采用 9 级唾液流率评分量表(SSS)评估 RT 疗效,该量表最近前瞻性验证为评估 ALS 患者唾液流率的最有效和最敏感的工具。
RT 结束时,所有患者均得到改善:46 例完全缓解(92%CR,SSS 1-3),4 例部分缓解(8%PR,SSS 4-5)。RT 完成后 6 个月观察到唾液持续减少:71%CR 和 26%PR,与基线相比 SSS 显著降低(P<10(-6))。无 3-4 级毒性,大多数不良反应(34%)发生在 RT 期间。9 例(18%)患者接受了第二次唾液腺 RT 治疗,两次治疗的平均间隔时间为 3 个月,SSS 降低(-77%)。两种 RT 剂量方案均能显著降低 SSS,且无明显毒性。然而,20-Gy 方案的 CR/PR 患者更多(P=.02),9 例接受第二次 RT 治疗的患者中有 8 例(89%)之前接受过 10-Gy 方案的治疗。
对于伴有唾液分泌过多的 ALS 患者,20 Gy 分 4 次的 RT 是一种有效且安全的治疗方法。对于身体状况较差的患者,可能需要更短的 RT 疗程(10 Gy 分 2 次)。