Huang Wei, Tan Peixin, Zhang Hongdan, Li Zhen, Lin Hui, Wu Youxing, Du Qinwen, Wu Qidi, Cheng Jun, Liang Yu, Pan Yi
Department of Radiation Oncology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Department of Nutrition, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Front Oncol. 2022 Jun 28;12:902966. doi: 10.3389/fonc.2022.902966. eCollection 2022.
Head and neck cancer (HNC) patients usually present with malnutrition during radiotherapy, leading to loss of skeletal muscle mass (SMM) and poor clinical outcomes. CT has been used in clinical practice for measuring SMM in cancer patients. However, its clinical application for monitoring SMM is limited by the expensive price and high radiation exposure. This study aimed to investigate the feasibility of cone-beam computed tomography (CBCT) for assessing SMM and its changes in HNC patients undergoing radiotherapy.
This study was divided into two parts. In part 1 (n = 32), the cross-sectional of skeletal muscle area (SMA) at the third cervical vertebra (C3) based on CBCT and computed tomography (CT) was assessed. In part 2 (n = 30), CT and CBCT were performed, and patients' weight was measured before and at four different time points during radiotherapy. SMAs at C3 were independently identified by three senior radiation oncologists. The interobserver agreement of SMA on CBCT (SMA) findings was analyzed using the intraclass correlation coefficient (ICC). One-way analysis of variance was used to evaluate the interobserver variability and statistical significance for SMA measurements. CBCT and CT measurement differences and correlations were analyzed using paired sample -test and Pearson correlation analysis, respectively. The Krouwer variant of the Bland-Altman plot was used to analyze the agreement of SMA measurements between CBCT and CT. A simple linear regression model was used to analyze the relationship of SMA measurements between the two imaging techniques, and the equation was established. A repeated-measures ANOVA was performed to evaluate the effects and interactions between weight loss, SMA loss, and time.
SMA demonstrated excellent interobserver reliability; no significant difference between SMA and SMA on CT (SMA) at C3 was observed in all patients. The SMA and SMA were highly correlated ( = 0.966; 95% confidence interval = 0.955-0.975; < 0.001). Bland-Altman analysis revealed that SMA was generally higher than SMA. The predicted SMA value at C3 on CT using CBCT was similar to the actual value. Moreover, significant differences between SMA and weight loss ( =10.99, = 0.002), groups (weight loss and SMA loss) and times (4 time points) ( = 3.93, = 0.013), and mean percent loss over time ( = 7.618, < 0.001) were noted.
CBCT may be used as an alternative for CT to measure SMA in HNC patients during radiotherapy.
头颈癌（HNC）患者在放疗期间常出现营养不良，导致骨骼肌质量（SMM）丢失及临床预后不佳。CT已在临床实践中用于测量癌症患者的SMM。然而，其在监测SMM方面的临床应用受到高成本和高辐射暴露的限制。本研究旨在探讨锥形束计算机断层扫描（CBCT）评估HNC放疗患者SMM及其变化的可行性。
本研究分为两部分。在第1部分（n = 32）中，基于CBCT和计算机断层扫描（CT）评估第三颈椎（C3）水平的骨骼肌面积（SMA）横断面。在第2部分（n = 30）中，进行CT和CBCT检查，并在放疗前及放疗期间四个不同时间点测量患者体重。由三位资深放射肿瘤学家独立确定C3水平的SMA。使用组内相关系数（ICC）分析CBCT上SMA（SMA）结果的观察者间一致性。采用单因素方差分析评估SMA测量的观察者间变异性和统计学意义。分别使用配对样本t检验和Pearson相关分析分析CBCT与CT测量差异及相关性。使用Bland-Altman图的Krouwer变体分析CBCT与CT之间SMA测量的一致性。采用简单线性回归模型分析两种成像技术之间SMA测量的关系，并建立方程。进行重复测量方差分析以评估体重减轻、SMA丢失和时间之间的效应及相互作用。
SMA显示出极好的观察者间可靠性；所有患者中，C3水平的SMA与CT上的SMA（SMA）之间未观察到显著差异。SMA与SMA高度相关（r = 0.966；95%置信区间 = 0.955 - 0.975；P < 0.001）。Bland-Altman分析显示SMA总体上高于SMA。使用CBCT预测的CT上C3水平的SMA值与实际值相似。此外，注意到SMA与体重减轻之间存在显著差异（F = 10.99，P = 0.002），组（体重减轻和SMA丢失）与时间（4个时间点）之间存在显著差异（F = 3.93，P = 0.013），以及随时间的平均百分比丢失存在显著差异（F = 7.618，P < 0.001）。
CBCT可作为CT的替代方法，用于测量HNC放疗患者的SMA。
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