Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Pract Radiat Oncol. 2022 May-Jun;12(3):e193-e200. doi: 10.1016/j.prro.2021.12.006. Epub 2021 Dec 24.
This study aimed to prospectively assess dosimetric and clinical effects of treatment planners having a priori knowledge of the maximum achievable dose sparing for organs at risk (OARs) for patients with oropharynx cancer receiving intensity modulated radiation therapy (RT).
We examined patients with oropharynx cancer who were treated in prospective clinical trials between February 2012 and April 2019 at our institution. A tool generating estimates of maximum achievable dose sparing for OARs (feasibility dose-volume histogram [FDVH]) was used clinically starting July 2016. Patients were divided into 2 cohorts: Before (ie, baseline) and after (ie, FDVH-guided) FDVH. Doses received by various OARs were compared with those estimated to be achievable per FDVH, and that difference was defined as the excess of feasible dose (EFD). Patient-reported outcome (PRO) questionnaires were completed at 3, 6, and 12 months after treatment. The baseline and FDVH-guided cohorts were compared in terms of EFD, plan quality metrics, and post-RT PRO assessments.
A total of 139 patients were included in the analysis (60 in the baseline cohort, 79 in the FDVH-guided cohort). The FDVH-guided cohort had lower EFD to the contralateral parotid by 4.1 Gy, the ipsilateral parotid by 10.6 Gy, the larynx by 4.3 Gy, the oral cavity by 1.5 Gy, and the contralateral submandibular gland by 0.4 Gy. Plan quality metrics were similar between the cohorts. Less variation of EFD was seen in the FDVH-guided cohort for the parotid glands and contralateral submandibular gland (P < .05). The average post-RT PROs were better in the FVHD cohort versus baseline (particularly at the 6-month timepoint for dry mouth frequency, sticky saliva, meal enjoyment, severity of pain, and Eating Assessment Tool 10 composite [swallowing]; P < .05).
Use of FDVH was associated with improved and less variable OAR sparing for clinically delivered plans. FDVH-guided patients had improved PROs compared with baseline with a variety of outcomes significantly improved at 6 months after treatment.
本研究旨在前瞻性评估治疗计划者在接受调强放疗（RT）的口咽癌患者中，预先了解危及器官（OAR）的最大可实现剂量节省时，剂量学和临床效果。
我们检查了 2012 年 2 月至 2019 年 4 月期间在我们机构接受前瞻性临床试验治疗的口咽癌患者。自 2016 年 7 月起，临床使用了一种生成 OAR 最大可实现剂量节省估计值的工具（可行性剂量-体积直方图 [FDVH]）。患者分为 2 个队列：前（即基线）和后（即 FDVH 指导）FDVH。比较了 OAR 实际接受的剂量与根据 FDVH 估计的可实现剂量，该差异定义为可行剂量的过量（EFD）。患者在治疗后 3、6 和 12 个月完成了患者报告的结局（PRO）问卷。在 EFD、计划质量指标和 RT 后 PRO 评估方面比较了基线和 FDVH 指导队列。
共有 139 例患者纳入分析（基线队列 60 例，FDVH 指导队列 79 例）。FDVH 指导队列的对侧腮腺、同侧腮腺、喉、口腔和对侧颌下腺的 EFD 分别降低了 4.1 Gy、10.6 Gy、4.3 Gy、1.5 Gy 和 0.4 Gy。两个队列的计划质量指标相似。在 FDVH 指导队列中，腮腺和对侧颌下腺的 EFD 变化较小（P <.05）。FDVHD 队列的平均 RT 后 PRO 较基线更好（特别是在口干频率、粘性唾液、进餐享受、疼痛严重程度和 Eating Assessment Tool 10 综合评分 [吞咽]方面，在治疗后 6 个月时更显著，P <.05）。
FDVH 的使用与临床提供的计划中 OAR 更好和更一致的保护相关。与基线相比，FDVH 指导的患者的 PRO 得到改善，治疗后 6 个月时多种结局显著改善。
