头颈部癌症患者接受调强放疗后味觉功能的前瞻性评估。
Prospective Evaluation of Taste Function in Patients With Head and Neck Cancer Receiving Intensity-Modulated Radiotherapy.
机构信息
Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan.
College of Medicine, Chang Gung University, Tao-yuan, Taiwan.
出版信息
JAMA Otolaryngol Head Neck Surg. 2022 Jul 1;148(7):604-611. doi: 10.1001/jamaoto.2022.0850.
IMPORTANCE
The majority of the patients with head and neck cancer (HNC) experience taste dysfunction (TD) during or after radiotherapy (RT). However, prospectively collected data for taste dysfunction have been limited, especially in the era of intensity-modulated RT (IMRT).
OBJECTIVE
To evaluate the taste function in patients with HNC receiving IMRT by investigating the association between time course and recovery of TD in both acute and late phases.
DESIGN, SETTING, AND PARTICIPANTS: From August 2017 to November 2020, patients treated at the Chang Gung Memorial Hospital with curative or postoperative IMRT for HNC were enrolled in this prospective cohort study. The data analysis was performed from March 2021 to January 2022.
EXPOSURES
IMRT with and without concurrent chemotherapy.
MAIN OUTCOMES AND MEASURES
Taste function was measured using the whole-mouth solution method for 4 tastes (salt, sweet, sour, and bitter). Subjective evaluations (National Cancer Institute Common Terminology Criteria for Adverse Events [version 4.03] and Subjective Total Taste Acuity scale) were used. Patient self-reported quality of life was evaluated using European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Module (EORTC QLQ-H&N35).
RESULTS
A total of 87 patients (78 [90%] men and 9 [10%] women; mean [range] age, 58 [31-80] years) were enrolled. Overall TD rates were 79 of 86 (91.9%), 63 of 83 (75.9%), 27 of 81 (33.3%), 5 of 56 (8.9%), and 2 of 30 (6.7%) during RT, and 1 week, 3 months, 6 months, and 1 year after RT, respectively. Positive correlation occurred between objectively measured taste loss for the 4 taste qualities and subjective perception of taste loss. Only oral cavity mean dose 4000 cGy or greater predicted TD 3 months after RT. The mean oral cavity doses to the predicted 15% (D15), 25% (D25), and 50% (D50) probabilities were 25, 38, and 60 Gy at 3 months and 57, 60, and 64 Gy at 6 months, respectively.
CONCLUSIONS AND RELEVANCE
In this cohort study, most patients still experienced TD during and at 3 months after RT. Only a few patients experienced long-term TD. A high oral cavity dose was associated with TD in patients with HNC receiving IMRT. Reducing oral cavity dose may promote early recovery of taste function after IMRT.
重要性
大多数头颈部癌症（HNC）患者在放疗（RT）期间或之后会出现味觉功能障碍（TD）。然而，前瞻性收集的 TD 数据有限，尤其是在调强放疗（IMRT）时代。
目的
通过研究急性和晚期 TD 的时间过程和恢复之间的关系，评估接受 IMRT 的 HNC 患者的味觉功能。
设计、地点和参与者：本前瞻性队列研究纳入了 2017 年 8 月至 2020 年 11 月期间在长庚纪念医院接受根治性或术后 IMRT 治疗的 HNC 患者。数据分析于 2021 年 3 月至 2022 年 1 月进行。
暴露
接受 IMRT 联合或不联合同期化疗。
主要结果和测量
使用全口溶液法测量味觉（盐、甜、酸和苦）4 种味觉。采用主观评价（国家癌症研究所不良事件通用术语标准[版本 4.03]和主观总味觉敏锐度量表）。使用欧洲癌症研究与治疗组织头颈部模块（EORTC QLQ-H&N35）评估患者的自我报告生活质量。
结果
共纳入 87 例患者（78 例[90%]男性和 9 例[10%]女性；平均[范围]年龄为 58[31-80]岁）。在 RT 期间以及 RT 后 1 周、3 个月、6 个月和 1 年，分别有 86 例中的 79 例（91.9%）、83 例中的 63 例（75.9%）、81 例中的 27 例（33.3%）、56 例中的 5 例（8.9%）和 30 例中的 2 例（6.7%）发生 TD。4 种味觉的客观测量味觉丧失与主观感知味觉丧失呈正相关。仅口腔平均剂量 4000 cGy 或更高预测 RT 后 3 个月 TD。在 RT 后 3 个月和 6 个月时，口腔 15%（D15）、25%（D25）和 50%（D50）概率的口腔平均剂量预计分别为 25、38 和 60 Gy，60 和 64 Gy。
结论和相关性
在这项队列研究中，大多数患者在 RT 期间和 RT 后 3 个月仍有 TD。只有少数患者出现长期 TD。HNC 患者接受 IMRT 后，口腔高剂量与 TD 相关。降低口腔剂量可能会促进 IMRT 后味觉功能的早期恢复。
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