Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Radiation Oncology Clinical Medical Research Center of Guangxi, Nanning, Guangxi, China.
Guangxi Clinical Research Center for Digital Medicine and 3D Printing, Guigang City People's Hospital, Guigang, Guangxi, China.
Sci Rep. 2018 Nov 6;8(1):16396. doi: 10.1038/s41598-018-34803-y.
Dysphagia is a side effect of nasopharyngeal carcinoma chemo-radiotherapy (CRT) which greatly influences the quality of life of the patients. We analyzed late dysphagia in 134 patients with nasopharyngeal cancer undergoing radical radiotherapy (RT), and correlated these findings with dose-volume histogram (DVH) parameters of the swallowing organs at risk (SWOARs). DVH parameters of SWOARs were correlated with late dysphagia, and with RTOG/EORTC scale score and the M. D. Anderson dysphagia inventory (MDADI) score. The mean dose (D) to the superior and inferior constrictor muscles (SCM and ICM) and age were associated with grade 2 late dysphagia. Receiver operating characteristic (ROC) curves showed that the threshold values for grade 2 late dysphagia were: D to SCM ≥ 67 Gy, partial volume receiving specified dose of 60 Gy (V) of SCM ≥ 95%, D to ICM ≥ 47 Gy, and V of ICM ≥ 23%. The areas under the ROC curve were 0.681 (p = 0.02), 0.677 (p = 0.002), 0.71 (p < 0.001) and 0.726 (p < 0.001) respectively. Our study demonstrates a significant relationship between late dysphagia and the radiation doses delivered to the SCM and ICM. Our findings suggest that physicians should be cautious in reducing the RT dose to SWOARs in order to avoid severe dysphagia. Further prospective trials are necessary to recommend this as part of routine clinical practice.
吞咽困难是鼻咽癌放化疗（CRT）的副作用，极大地影响了患者的生活质量。我们分析了 134 例接受根治性放疗（RT）的鼻咽癌患者的晚期吞咽困难，并将这些发现与吞咽器官危险（SWOAR）的剂量-体积直方图（DVH）参数相关联。SWOAR 的 DVH 参数与晚期吞咽困难以及 RTOG/EORTC 量表评分和 MD 安德森吞咽障碍量表（MDADI）评分相关。上、下食管括约肌（SCM 和 ICM）的平均剂量（D）和年龄与 2 级晚期吞咽困难相关。受试者工作特征（ROC）曲线显示，2 级晚期吞咽困难的阈值为：SCM 的 D≥67Gy，SCM 接受指定剂量 60Gy（V）的部分体积≥95%，ICM 的 D≥47Gy，ICM 的 V≥23%。ROC 曲线下面积分别为 0.681（p=0.02）、0.677（p=0.002）、0.71（p<0.001）和 0.726（p<0.001）。我们的研究表明，晚期吞咽困难与 SCM 和 ICM 接受的放射剂量之间存在显著关系。我们的发现表明，医生在降低 SWOAR 的放疗剂量时应谨慎，以避免严重的吞咽困难。有必要进行进一步的前瞻性试验，以建议将其作为常规临床实践的一部分。
