Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands.
Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands.
Radiother Oncol. 2015 Apr;115(1):56-62. doi: 10.1016/j.radonc.2015.01.019. Epub 2015 Mar 16.
To determine if acute symptoms during definitive radiotherapy (RT) or chemoradiation (CHRT) are prognostic factors for late dysphagia in head and neck cancer (HNC).
This prospective cohort study consisted of 260 HNC patients who received definitive RT or CHRT. The primary endpoint was grade 2-4 swallowing dysfunction at 6 months after completing RT (SWALM6). During treatment, acute symptoms, including oral mucositis, xerostomia and dysphagia, were scored, and the scores were accumulated weekly and entered into an existing reference model for SWALM6 that consisted of dose-volume variables only.
Both acute xerostomia and dysphagia were strong prognostic factors for SWALM6. When acute scores were added as variables to the reference model, model performance increased as the course of treatment progressed: the AUC rose from 0.78 at the baseline to 0.85 in week 6. New models built for weeks 3-6 were significantly better able to identify patients with and without late dysphagia.
Acute xerostomia and dysphagia during the course of RT are strong prognostic factors for late dysphagia. Including accumulated acute symptom scores on a weekly basis in prediction models for late dysphagia significantly improves the identification of high-risk and low-risk patients at an early stage during treatment and might facilitate individualized treatment adaptation.
确定头颈部癌症（HNC）患者在接受根治性放疗（RT）或放化疗（CHRT）期间出现的急性症状是否是晚期吞咽困难的预后因素。
这项前瞻性队列研究纳入了 260 例接受根治性 RT 或 CHRT 的 HNC 患者。主要终点为 RT 结束后 6 个月时的 2-4 级吞咽功能障碍（SWALM6）。在治疗过程中，对口腔黏膜炎、口干和吞咽困难等急性症状进行评分，并每周累计评分，将评分输入仅包含剂量-体积变量的现有 SWALM6 参考模型中。
急性口干和吞咽困难均是 SWALM6 的强烈预后因素。当将急性评分作为变量添加到参考模型中时，随着治疗的进行，模型性能逐渐提高：AUC 从基线时的 0.78 上升至第 6 周的 0.85。为第 3-6 周建立的新模型能够更准确地识别出有和无晚期吞咽困难的患者。
RT 过程中出现的急性口干和吞咽困难是晚期吞咽困难的强烈预后因素。在预测晚期吞咽困难的模型中每周累计急性症状评分可显著提高在治疗早期识别高危和低危患者的能力，并可能有助于个体化治疗方案的调整。
