头颈部鳞状细胞癌患者颌骨放射性骨坏死的危险因素。
Risk factors for osteoradionecrosis of the jaw in patients with head and neck squamous cell carcinoma.
机构信息
Division of Radiation Oncology, Kobe University Hospital, Kobe, Hyogo, Japan.
Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
出版信息
Radiat Oncol. 2021 Jan 5;16(1):1. doi: 10.1186/s13014-020-01701-5.
BACKGROUND
To evaluate factors associated with osteoradionecrosis of the jaw (ORNJ) in patients with head and neck squamous cell carcinoma (HNSCC), focusing on jaw-related dose-volume histogram (DVH) parameters.
METHODS
We retrospectively reviewed the medical records of 616 patients with HNSCC treated with curative-intent or postoperative radiation therapy (RT) during 2008-2018. Patient-related (age, sex, history of smoking or alcohol use, diabetes mellitus, performance status, pre-RT dental evaluation, pre- or post-RT tooth extraction), tumor-related (primary tumor site, T-stage, nodal status), and treatment-related (pre-RT surgery, pre-RT mandible surgery, induction or concurrent chemotherapy, RT technique) variables and DVH parameters (relative volumes of the jaw exposed to doses of 10 Gy-70 Gy [V10-70]) were investigated and compared between patients with and without ORNJ. The Mann-Whitney U test was used to compare RT dose parameters. Univariate and multivariate Cox regression analyses were used to assess factors associated with ORNJ development. Kaplan-Meier analyses were performed for cumulative ORNJ incidence estimation.
RESULTS
Forty-six patients (7.5%) developed ORNJ. The median follow-up duration was 40 (range 3-145) months. The median time to ORNJ development was 27 (range 2-127) months. DVH analysis revealed that V30-V70 values were significantly higher in patients with than in those without ORNJ. In univariate analyses, primary tumor site, pre-RT mandible surgery, post-RT tooth extraction, and V60 > 14% were identified as important factors. In multivariate analyses, V60 > 14% (p = 0.0065) and primary tumor site (p = 0.0059) remained significant. The 3-year cumulative ORNJ incidence rates were 2.5% and 8.6% in patients with V60 ≤ 14% and > 14%, respectively (p < 0.0001), and 9.3% and 1.4% in patients with oropharyngeal or oral cancer and other cancers, respectively (p < 0.0001).
CONCLUSIONS
V60 > 14% and oropharyngeal or oral cancer were found to be independent risk factors for ORNJ. These findings might be useful to minimize ORNJ incidence in HNSCC treated with curative RT.
背景
本研究旨在评估头颈部鳞癌（HNSCC）患者发生颌骨放射性骨坏死（ORNJ）的相关因素，重点关注与颌骨相关的剂量-体积直方图（DVH）参数。
方法
我们回顾性分析了 2008 年至 2018 年间 616 例接受根治性或术后放疗（RT）治疗的 HNSCC 患者的病历资料。患者相关因素（年龄、性别、吸烟或饮酒史、糖尿病、体能状态、放疗前口腔评估、放疗前或放疗后拔牙）、肿瘤相关因素（原发肿瘤部位、T 分期、淋巴结状态）和治疗相关因素（放疗前手术、放疗前下颌骨手术、诱导或同步化疗、放疗技术）以及 DVH 参数（10Gy-70Gy 剂量下暴露的颌骨相对体积[V10-70]），并比较了 ORNJ 患者和非 ORNJ 患者之间的差异。采用 Mann-Whitney U 检验比较 RT 剂量参数。采用单因素和多因素 Cox 回归分析评估 ORNJ 发生的相关因素。采用 Kaplan-Meier 分析评估累积 ORNJ 发生率。
结果
46 例（7.5%）患者发生 ORNJ。中位随访时间为 40 个月（范围 3-145 个月）。ORNJ 发生的中位时间为 27 个月（范围 2-127 个月）。DVH 分析显示，ORNJ 患者的 V30-V70 值明显高于非 ORNJ 患者。单因素分析显示，原发肿瘤部位、放疗前下颌骨手术、放疗后拔牙以及 V60>14%是重要因素。多因素分析显示，V60>14%（p=0.0065）和原发肿瘤部位（p=0.0059）仍然是显著因素。V60≤14%和>V60>14%的患者 3 年累积 ORNJ 发生率分别为 2.5%和 8.6%（p<0.0001），口咽或口腔癌和其他癌症患者的发生率分别为 9.3%和 1.4%（p<0.0001）。
结论
V60>14%和口咽或口腔癌是 ORNJ 的独立危险因素。这些发现可能有助于减少接受根治性 RT 治疗的 HNSCC 患者 ORNJ 的发生率。
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