Muzumder Sandeep, Srikantia Nirmala, Udayashankar Avinash H, Kainthaje Prashanth Bhat, Sebastian M G John, Raj John Michael
Department of Radiation Oncology, St. John's Medical College and Hospital, Bengaluru, Karnataka, India.
Department of Biostatistics, St John's Medical College, Bengaluru, Karnataka, India.
Radiat Oncol J. 2021 Sep;39(3):184-192. doi: 10.3857/roj.2020.00913. Epub 2021 Sep 13.
The study aims to report late toxicities in locally advanced head-and-neck squamous cell carcinoma (LAHNSCC) treated with intensity-modulated radiation therapy (IMRT).
A retrospective study was conducted on 103 patients of LAHNSCC treated with IMRT. We analyzed the cumulative incidence of late xerostomia, dysphagia, and aspiration at an interval of 6-month, 1-year, 2-year, and 3-year from the start of IMRT.
At a median follow up of 4.2 years (interquartile range, 3.5 to 6 years), the cumulative incidence of grade ≥2 late xerostomia was 5.5%, dysphagia was 6.9%, and aspiration was 11.1%. Logistic regression showed that Dmean of ≥26 Gy to parotids had higher risk of xerostomia (hazard ratio [HR] = 5.19; 95% confidence interval [CI], 1.90-14.22; p = 0.001). Late dysphagia was associated with Dmean of ≥45 Gy to pharyngeal constrictors (PC) (HR = 7; 95% CI, 1.84-26.61; p =0.004), ≥55 Gy to larynx (HR = 3.25; 95% CI, 1.15-9.11; p = 0.025), and adjuvant RT (HR = 5.26; 95% CI, 1.85-14.87; p = 0.002). Aspiration was associated with Dmean of ≥45 Gy to larynx (HR = 6.5; 95% CI, 1.93-21.88; p = 0.003), Dmean of ≥55 Gy to PC (HR = 3.54; 95% CI, 1.25-9.98; p = 0.017), and patients having late dysphagia (HR = 4.37; 95% CI, 1.55-12.31; p = 0.005).
IMRT is a feasible radiation delivery technique in LAHNSCC with a decreased late toxicity profile.
本研究旨在报告接受调强放射治疗（IMRT）的局部晚期头颈部鳞状细胞癌（LAHNSCC）的晚期毒性反应。
对103例接受IMRT治疗的LAHNSCC患者进行回顾性研究。我们分析了从IMRT开始后6个月、1年、2年和3年时晚期口干、吞咽困难和误吸的累积发生率。
中位随访4.2年（四分位间距，3.5至6年），≥2级晚期口干的累积发生率为5.5%，吞咽困难为6.9%，误吸为11.1%。逻辑回归显示，腮腺平均剂量（Dmean）≥26 Gy时口干风险更高（风险比[HR]=5.19；95%置信区间[CI]，1.90 - 14.22；p = 0.001）。晚期吞咽困难与咽缩肌（PC）平均剂量≥45 Gy（HR = 7；95% CI，1.84 - 26.61；p = 0.004）、喉平均剂量≥55 Gy（HR = 3.25；95% CI，1.15 - 9.11；p = 0.025）及辅助放疗（HR = 5.26；95% CI，1.85 - 14.87；p = 0.002）有关。误吸与喉平均剂量≥45 Gy（HR = 6.5；95% CI，1.93 - 21.88；p = 0.003）、PC平均剂量≥55 Gy（HR = 3.54；95% CI，1.25 - 9.98；p = 0.017）及有晚期吞咽困难的患者（HR = 4.37；95% CI，1.55 - 12.31；p = 0.005）有关。
IMRT是LAHNSCC一种可行的放疗技术，可降低晚期毒性反应。
