Anderson Nigel J, Wada Morikatsu, Schneider-Kolsky Michal, Rolfo Maureen, Joon Daryl Lim, Khoo Vincent
Department of Radiation Oncology, Austin Health, Heidelberg Heights , Victoria , Australia.
Acta Oncol. 2014 Oct;53(10):1305-11. doi: 10.3109/0284186X.2014.933874. Epub 2014 Jul 1.
To determine the validity of QUANTEC recommendations in predicting acute dysphagia using intensity-modulated head and neck radiotherapy.
Seventy-six consecutive patients with locally advanced squamous cell carcinoma (SCC) of the head and neck +/- systemic therapy were analyzed. Multiple dose parameters for the larynx (V50Gy, Dmean and Dmax) were recorded. Acute dysphagia toxicity was prospectively scored in all treatment weeks (week 1-6 or 1-7) using CTCAEv3 by three blinded investigators. QUANTEC larynx recommendations (V50Gy < 27%, Dmean < 44 Gy, Dmean < 40 Gy, Dmax < 66 Gy) were used to group the cohort (i.e. V50Gy < 27% vs. V50Gy > 27%). The proportion of patients with Grade 3 dysphagia was compared within each group.
There was a significant reduction in the incidence of grade 3 toxicity in the V50Gy < or > 27% group at week 5 (14.3% vs. 45.2%, p = 0.01) and 6 (25.9% vs. 65.9%, p < 0.01). A significant reduction at week 5 (14.7% vs. 50.0, p = 0.02) and 6 (32.4% vs. 67.6%, p = 0.01) was seen in Dmean < 44 Gy when compared to Dmean > 44 Gy. Dmean < 40 Gy also delivered a significant reduction at week 5 (5.6% vs. 42.3%, p < 0.01) and week 6 (23.5% vs. 59.3%, p = 0.01). A significant toxicity reduction at treatment week 6 (28.0% vs. 63.0%, p = 0 < 01) was seen from Dmax < 66 Gy to Dmax > 66 Gy. V50Gy > 27% (p < 0.01), Dmean > 40 Gy (p = 0.01) and Dmax > 66 Gy (p < 0.01) were also predictors of Grade 3 dysphagia when analyzed with multiple clinical risk factors.
QUANTEC late toxicity recommendations for dose to larynx during IMRT are a useful predictor for acute dysphagia toxicity in this patient cohort. Furthermore, this included chemoradiotherapy regimes and post-operative radiotherapy patients, allowing for prophylactic implementation of supportive care measures.
确定QUANTEC建议在预测调强头颈放疗所致急性吞咽困难方面的有效性。
分析了76例连续的局部晚期头颈鳞状细胞癌患者（±全身治疗）。记录了喉部的多个剂量参数（V50Gy、平均剂量[Dmean]和最大剂量[Dmax]）。由三名盲法研究者在所有治疗周（第1 - 6周或第1 - 7周）使用CTCAEv3对急性吞咽困难毒性进行前瞻性评分。采用QUANTEC喉部建议（V50Gy < 27%、Dmean < 44 Gy、Dmean < 40 Gy、Dmax < 66 Gy）对队列进行分组（即V50Gy < 27%与V50Gy > 27%）。比较每组中3级吞咽困难患者的比例。
在第5周（14.3%对45.2%，p = 0.01）和第6周（25.9%对65.9%，p < 0.01），V50Gy < 或> 27%组中3级毒性的发生率显著降低。与Dmean > 44 Gy相比，Dmean < 44 Gy在第5周（14.7%对50.0，p = 0.02）和第6周（32.4%对67.6%，p = 0.01）时也出现显著降低。Dmean < 40 Gy在第5周（5.6%对42.3%，p < 0.01）和第6周（23.5%对59.3%，p = 0.01）时同样有显著降低。从Dmax < 66 Gy到Dmax > 66 Gy，在治疗第6周时毒性显著降低（28.0%对63.0%，p = 0 < 01）。当与多个临床风险因素一起分析时，V50Gy > 27%（p < 0.01）、Dmean > 40 Gy（p = 0.01）和Dmax > 66 Gy（p < 0.01）也是3级吞咽困难的预测因素。
QUANTEC关于调强放疗期间喉部剂量的晚期毒性建议是该患者队列中急性吞咽困难毒性的有用预测指标。此外，这包括了放化疗方案和术后放疗患者，有助于预防性实施支持性护理措施。
