Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden.
PLoS One. 2021 Apr 16;16(4):e0250004. doi: 10.1371/journal.pone.0250004. eCollection 2021.
The study aims to determine possible dose-volume response relationships between the rectum, sigmoid colon and small intestine and the 'excessive mucus discharge' syndrome after pelvic radiotherapy for gynaecological cancer.
From a larger cohort, 98 gynaecological cancer survivors were included in this study. These survivors, who were followed for 2 to 14 years, received external beam radiation therapy but not brachytherapy and not did not have stoma. Thirteen of the 98 developed excessive mucus discharge syndrome. Three self-assessed symptoms were weighted together to produce a score interpreted as 'excessive mucus discharge' syndrome based on the factor loadings from factor analysis. The dose-volume histograms (DVHs) for rectum, sigmoid colon, small intestine for each survivor were exported from the treatment planning systems. The dose-volume response relationships for excessive mucus discharge and each organ at risk were estimated by fitting the data to the Probit, RS, LKB and gEUD models.
The small intestine was found to have steep dose-response curves, having estimated dose-response parameters: γ50: 1.28, 1.23, 1.32, D50: 61.6, 63.1, 60.2 for Probit, RS and LKB respectively. The sigmoid colon (AUC: 0.68) and the small intestine (AUC: 0.65) had the highest AUC values. For the small intestine, the DVHs for survivors with and without excessive mucus discharge were well separated for low to intermediate doses; this was not true for the sigmoid colon. Based on all results, we interpret the results for the small intestine to reflect a relevant link.
An association was found between the mean dose to the small intestine and the occurrence of 'excessive mucus discharge'. When trying to reduce and even eliminate the incidence of 'excessive mucus discharge', it would be useful and important to separately delineate the small intestine and implement the dose-response estimations reported in the study.
本研究旨在确定妇科癌症盆腔放疗后直肠、乙状结肠和小肠与“过度黏液分泌”综合征之间可能的剂量-体积关系。
从一个较大的队列中，纳入了 98 名妇科癌症幸存者。这些接受了外照射放疗但未接受近距离放疗且无造口术的幸存者随访时间为 2 至 14 年。98 名幸存者中有 13 名发生了过度黏液分泌综合征。将 3 个自我评估症状加权在一起，根据因子分析的因子负荷产生一个得分，解释为“过度黏液分泌”综合征。从治疗计划系统导出每个幸存者的直肠、乙状结肠和小肠的剂量-体积直方图（DVH）。通过将数据拟合到 Probit、RS、LKB 和 gEUD 模型，估计过度黏液分泌和每个危及器官的剂量-体积关系。
小肠的剂量-反应曲线较陡峭，估计的剂量-反应参数为：Probit、RS 和 LKB 的 γ50 分别为 1.28、1.23 和 1.32，D50 分别为 61.6、63.1 和 60.2。乙状结肠（AUC：0.68）和小肠（AUC：0.65）具有最高的 AUC 值。对于小肠，有和没有过度黏液分泌的幸存者的 DVH 在低到中等剂量下很好地分开；乙状结肠则不然。基于所有结果，我们认为小肠的结果反映了一个相关的联系。
发现小肠的平均剂量与“过度黏液分泌”的发生之间存在关联。当试图降低甚至消除“过度黏液分泌”的发生率时，分别勾画小肠并实施研究中报告的剂量-反应估计将是有用和重要的。
