腮腺照射在头颈部癌调强放射治疗后严重唾液分泌减少（口干症）发生中的作用：时间模式、危险因素及对QUANTEC指南的验证
The role of parotid gland irradiation in the development of severe hyposalivation (xerostomia) after intensity-modulated radiation therapy for head and neck cancer: Temporal patterns, risk factors, and testing the QUANTEC guidelines.
作者信息
Owosho Adepitan A, Thor Maria, Oh Jung Hun, Riaz Nadeem, Tsai C Jillian, Rosenberg Haley, Varthis Spyridon, Yom Sae Hee K, Huryn Joseph M, Lee Nancy Y, Deasy Joseph O, Estilo Cherry L
机构信息
Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, New York, USA.
Department of Medical Physics, Memorial Sloan Kettering Cancer Center, NY, New York, USA.
出版信息
J Craniomaxillofac Surg. 2017 Apr;45(4):595-600. doi: 10.1016/j.jcms.2017.01.020. Epub 2017 Jan 31.
BACKGROUND
The aims of this study were to investigate temporal patterns and potential risk factors for severe hyposalivation (xerostomia) after intensity-modulated radiotherapy (IMRT) for head and neck cancer (HNC), and to test the two QUANTEC (Quantitative Analysis of Normal Tissue Effects in the Clinic) guidelines.
PATIENTS AND METHODS
Sixty-three patients treated at the Memorial Sloan Kettering Cancer Center between 2006 and 2015, who had a minimum of three stimulated whole mouth saliva flow measurements (WMSFM) at a median follow-up time of 11 (range: 3-24) months were included. Xerostomia was defined as WMSFM ≤25% compared to relative pre-radiotherapy. Patients were stratified into three follow-up groups: 1: <6 months; 2: 6-11 months; and 3: 12-24 months. Potential risk factors were investigated (Mann-Whitney U test), and relative risks (RRs) assessed for the two QUANTEC guidelines.
RESULTS
The incidence of xerostomia was 27%, 14% and 17% at follow-up time points 1, 2 and 3, respectively. At <6 months, the mean dose to the contralateral and the ipsilateral parotid glands (Dmean, Dmean) was higher among patients with xerostomia (Dmean: 25 Gy vs. 15 Gy; Dmean: 44 Gy vs. 25 Gy). Patients with xerostomia had higher pre-RT WMSFM (3.5 g vs. 2.4 g), and had been treated more frequently with additional chemotherapy (93% vs. 63%; all 4 variables: p < 0.05). At 6-11 months, Dmean among patients with xerostomia was higher compared to patients without (26 Gy vs. 20 Gy). The RR as specified by the one- and two-gland QUANTEC guideline was 2.3 and 1.4 for patients with <6 months follow-up time, and 2.0 and 1.2 for patients with longer follow-up (6-11 + 6-24 months).
CONCLUSION
Xerostomia following IMRT peaks within six months post-radiotherapy and fades with time. Limiting the mean dose to both parotid glands (ipsilateral <25 Gy, contralateral <25 Gy) and reducing the use of chemotherapy will likely decrease the rate of xerostomia. Both QUANTEC guidelines are effective in preventing xerostomia.
背景
本研究旨在调查头颈部癌（HNC）调强放疗（IMRT）后严重唾液分泌减少（口干症）的时间模式和潜在风险因素，并验证两项QUANTEC（临床正常组织效应定量分析）指南。
患者与方法
纳入2006年至2015年在纪念斯隆凯特琳癌症中心接受治疗的63例患者，这些患者在中位随访时间11个月（范围：3 - 24个月）内至少进行了三次刺激全口唾液流量测量（WMSFM）。口干症定义为与放疗前相比WMSFM≤25%。患者被分为三个随访组：1：<6个月；2：6 - 11个月；3：12 - 24个月。研究了潜在风险因素（Mann-Whitney U检验），并评估了两项QUANTEC指南的相对风险（RRs）。
结果
在随访时间点1、2和3时，口干症的发生率分别为27%、14%和17%。在<6个月时，口干症患者双侧和同侧腮腺的平均剂量（Dmean，Dmean）较高（Dmean：25 Gy对15 Gy；Dmean：44 Gy对25 Gy）。口干症患者放疗前的WMSFM较高（3.5 g对2.4 g），且接受额外化疗的频率更高（93%对63%；所有4个变量：p < 0.05）。在6 - 11个月时，口干症患者的Dmean高于无口干症患者（26 Gy对20 Gy）。对于随访时间<6个月的患者，QUANTEC单腺和双腺指南规定的RR分别为2.3和1.4，对于随访时间较长（6 - 11 + 6 - 24个月）的患者，RR分别为2.0和1.2。
结论
IMRT后的口干症在放疗后六个月内达到峰值，并随时间消退。将双侧腮腺的平均剂量限制在（同侧<25 Gy，对侧<25 Gy）并减少化疗的使用可能会降低口干症的发生率。两项QUANTEC指南在预防口干症方面均有效。
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