Ozkaya Akagunduz Ozlem, Eyigor Sibel, Kirakli Esra, Tavlayan Emin, Erdogan Cetin Zeynep, Kara Gulsen, Esassolak Mustafa
1 Faculty of Medicine, Department of Radiation Oncology, Ege University, Ankara Street, Izmir, Turkey.
2 Faculty of Medicine, Department of Physical Therapy and Rehabilitation, Ege University, Izmir, Turkey.
Ann Otol Rhinol Laryngol. 2019 Feb;128(2):73-84. doi: 10.1177/0003489418804260. Epub 2018 Oct 20.
We aimed to restore dose-volume parameters of swallowing-related structures (SRSs) by evaluating long-term swallowing dysfunctions after radiotherapy (RT) in head and neck cancer patients (HNCPs).
Head and neck cancer patients whose pharyngeal region was involved in RT portal and treated with definitive RT/chemoradiotherapy (CRT) were included in the analyses. Patients underwent objective swallowing assessment by flexible endoscopic evaluation of swallowing (FEES). Volumes of SRSs that received 55 Gy (V) (mean dose [D]) were evaluated according to the dose-volume histograms of each patient. For every SRS, optimal dose-volume cut-off values were determined by receiver operating characteristic curve analysis.
Fifty-five patients at a median 20 months (range, 12-26 months) after their treatments were evaluated. There was a strong negative correlation between FEES scores and dose-volume parameters of SRS ( r ⩽ -0.5, P < .0001). According to our results, middle pharyngeal constrictor (MPC) and inferior pharyngeal constrictor (IPC) had a D > 57 Gy, base of tongue (BOT) D > 50 Gy, supraglottic larynx (SGL) and glottic larynx (GL) D > 55 Gy, and cervical esophagus (CE) D > 45 Gy. MPC V > 70%, IPC V > 50%, BOT V > 65%, CE V > 40%, and SGL and GL V > 50% were significant predictors for dysphagia.
It was found that dysphagia correlates strongly with dose-volume parameters of SRSs. IPC, SGL, and CE were found to be structures significantly associated with dysphagia.
我们旨在通过评估头颈部癌患者（HNCPs）放疗（RT）后的长期吞咽功能障碍，恢复吞咽相关结构（SRSs）的剂量-体积参数。
分析纳入咽区受RT射野累及并接受根治性RT/同步放化疗（CRT）的头颈部癌患者。患者通过吞咽功能的软性内镜评估（FEES）进行客观吞咽评估。根据每位患者的剂量-体积直方图，评估接受55 Gy（V）（平均剂量[D]）的SRSs体积。对于每个SRS，通过受试者操作特征曲线分析确定最佳剂量-体积截止值。
对55例患者在治疗后中位20个月（范围12 - 26个月）进行了评估。FEES评分与SRS的剂量-体积参数之间存在强烈的负相关（r⩽ -0.5，P <.0001）。根据我们的结果，下咽缩肌（MPC）和咽下缩肌（IPC）的D > 57 Gy，舌根（BOT）的D > 50 Gy，声门上喉（SGL）和声门喉（GL）的D > 55 Gy，以及颈段食管（CE）的D > 45 Gy。MPC的V > 70%，IPC的V > 50%，BOT的V > 65%，CE的V > 40%，以及SGL和GL的V > 50%是吞咽困难的显著预测因素。
发现吞咽困难与SRSs的剂量-体积参数密切相关。发现IPC、SGL和CE是与吞咽困难显著相关的结构。
