头颈部癌放疗中患者报告的牙关紧闭及相关开口距离的时间模式：一项前瞻性队列研究。
Temporal patterns of patient-reported trismus and associated mouth-opening distances in radiotherapy for head and neck cancer: A prospective cohort study.
作者信息
Thor M, Olsson C E, Oh J H, Hedström J, Pauli N, Johansson M, Deasy J O, Finizia C
机构信息
Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Radiation Physics, Institute of Clinical Sciences, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
出版信息
Clin Otolaryngol. 2018 Feb;43(1):22-30. doi: 10.1111/coa.12896. Epub 2017 May 29.
OBJECTIVES
To identify temporal patterns of patient-reported trismus during the first year post-radiotherapy, and to study their associations with maximal interincisal opening distances (MIOs).
DESIGN
Single institution case series.
SETTING
University hospital ENT clinic.
PARTICIPANTS
One hundred and ninety-six subjects who received radiotherapy (RT) for head and neck cancer (HNC) with or without chemotherapy in 2007-2012 to a total dose of 64.6/68 Gy in 38/34 fractions, respectively. All subjects were prospectively assessed for mouth-opening ability (Gothenburg Trismus Questionnaire (GTQ), European Organization for Research and Treatment of Cancer quality of life Questionnaire (EORTC QLQ-H&N35), and MIO) pre-RT and at 3, 6 and 12 months after RT.
MAIN OUTCOME MEASURES
Correlations between temporally robust GTQ symptoms and MIO as given by Pearson's correlation coefficients (P ); temporally robust GTQ-symptom domains as given by factor analysis; rates of trismus with respect to baseline by risk ratios (RRs).
RESULTS
Four temporally robust domains were identified: Eating (3-7 symptoms), Jaw (3-7), Pain (2-5) and Quality of Life (QoL, 2-5), and included 2-3 persistent symptoms across all post-RT assessments. The median RR for a moderate/severe (>2/>3) cut-off was the highest for Jaw (3.7/3.6) and QoL (3.2/2.9). The median P between temporally robust symptoms and MIO post-radiotherapy was 0.25-0.35/0.34-0.43/0.24-0.31/0.34-0.50 for Eating/Jaw/Pain/QoL, respectively.
CONCLUSIONS
Mouth-opening distances in patients with HNC post-RT can be understood in terms of associated patient-reported outcomes on trismus-related difficulties. Our data suggest that a reduction in MIO can be expected as patients communicate their mouth-opening status to interfere with private/social life, a clinical warning signal for emerging or worsening trismus as patients are being followed after RT.
目的
确定放疗后第一年患者报告的牙关紧闭的时间模式，并研究其与最大切牙间开口距离（MIO）的关联。
设计
单机构病例系列研究。
地点
大学医院耳鼻喉科诊所。
参与者
196名在2007年至2012年期间接受头颈部癌（HNC）放疗（RT）的患者，部分患者接受了化疗，放疗总剂量分别为64.6/68 Gy，分38/34次进行。所有受试者在放疗前以及放疗后3、6和12个月均接受了张口能力的前瞻性评估（哥德堡牙关紧闭问卷（GTQ）、欧洲癌症研究与治疗组织生活质量问卷（EORTC QLQ-H&N35）以及MIO）。
主要观察指标
通过Pearson相关系数（P）得出的时间上稳定的GTQ症状与MIO之间的相关性；通过因子分析得出的时间上稳定的GTQ症状领域；相对于基线的牙关紧闭发生率，以风险比（RRs）表示。
结果
确定了四个时间上稳定的领域：进食（3 - 7个症状）、颌部（3 - 7个）、疼痛（2 - 5个）和生活质量（QoL，2 - 5个），并且在所有放疗后评估中包括2 - 3个持续症状。对于中度/重度（>2/>3）的临界值，颌部（3.7/3.6）和生活质量（3.2/2.9）的RR中位数最高。放疗后，进食/颌部/疼痛/生活质量在时间上稳定的症状与MIO之间的P中位数分别为0.25 - 0.35/0.34 - 0.43/0.24 - 0.31/0.34 - 0.50。
结论
头颈部癌放疗后患者的张口距离可以根据患者报告的与牙关紧闭相关困难的结果来理解。我们的数据表明，随着患者报告张口状态对私人/社交生活产生干扰，预计MIO会降低，这是放疗后随访患者时出现或恶化的牙关紧闭的临床警示信号。
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