Department of Radiation Oncology, University of North Carolina at Chapel Hill, USA.
Department of Radiation Oncology, University of North Carolina at Chapel Hill, USA.
Radiother Oncol. 2022 Jul;172:42-49. doi: 10.1016/j.radonc.2022.05.001. Epub 2022 May 7.
To assess the impact of prospectively sparing the parotid ducts via MRI sialography on patient reported xerostomia for those receiving definitive radiotherapy (RT) for oropharyngeal squamous cell carcinoma.
Thirty-eight patients with oropharynx cancer to be treated with definitive RT underwent pre-treatment MRI sialograms to localize their parotid ducts. The parotid ducts were maximally spared during treatment planning. Patients reported symptoms (PRO-CTCAE and QLQ-H&N35) were collected at 6 and 12 months post-RT and compared to a historical cohort who underwent conventional parotid gland mean dose sparing. Regression models were generated using parotid and submandibular gland doses with and without incorporating the dose to the parotid ducts to determine the impact of parotid duct dose on patient reported xerostomia.
At 6 months post-RT, 12/26 (46%) patients reported ≥moderate xerostomia when undergoing parotid ductal sparing compared to 43/61 (70%) in the historical cohort (p = 0.03). At 12 months post-RT, 8/22 (36%) patients reported ≥moderate xerostomia when undergoing parotid ductal sparing compared to 34/68(50%) in the historical cohort (p = 0.08). Using nested logistic regression models, the mean parotid duct dose was found to significantly relate to patient reported xerostomia severity at 6 months post-RT (p = 0.04) and trended towards statistical significance at 12 months post-RT (p = 0.09). At both 6 and 12 months post-RT, the addition of mean parotid duct dose significantly improved model fit (p < 0.05).
MRI sialography guided parotid duct sparing appears to reduce the rates of patient-reported xerostomia. Further, logistic regression analysis found parotid duct dose to be significantly associated with patient reported xerostomia. A significant improvement in model fit was observed when adding mean parotid duct dose compared to models that only contain mean parotid gland dose and mean contralateral submandibular gland dose.
评估通过 MRI 唾液腺造影术前瞻性保护腮腺导管对接受根治性放疗（RT）治疗口咽鳞状细胞癌患者报告的口干症的影响。
38 例接受根治性 RT 治疗的口咽癌患者在治疗前接受 MRI 唾液腺造影术以定位其腮腺导管。在治疗计划中最大限度地保留腮腺导管。在 RT 后 6 个月和 12 个月收集患者报告的症状（PRO-CTCAE 和 QLQ-H&N35），并与接受常规腮腺平均剂量保护的历史队列进行比较。使用腮腺和颌下腺剂量生成回归模型，并在不考虑腮腺导管剂量的情况下，确定腮腺导管剂量对患者报告的口干症的影响。
在 RT 后 6 个月时，26 例中有 12 例（46%）患者在接受腮腺导管保留时报告≥中度口干症，而历史队列中有 61 例中有 43 例（70%）（p=0.03）。在 RT 后 12 个月时，22 例中有 8 例（36%）患者在接受腮腺导管保留时报告≥中度口干症，而历史队列中有 68 例中有 34 例（50%）（p=0.08）。使用嵌套逻辑回归模型，发现平均腮腺导管剂量与 RT 后 6 个月时患者报告的口干症严重程度显著相关（p=0.04），在 RT 后 12 个月时具有统计学意义（p=0.09）。在 RT 后 6 个月和 12 个月时，添加平均腮腺导管剂量均显著改善了模型拟合度（p<0.05）。
MRI 唾液腺造影引导的腮腺导管保护似乎降低了患者报告的口干症发生率。此外，逻辑回归分析发现腮腺导管剂量与患者报告的口干症显著相关。与仅包含平均腮腺剂量和对侧颌下腺平均剂量的模型相比，添加平均腮腺导管剂量可显著提高模型拟合度。
