Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Outpatient Center of the UKE GmbH, Martinistr. 52, 20246, Hamburg, Germany.
Department of Oncology, Hematology and Bone Marrow Transplantation with the Section Pneumology, Center for Oncology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
Strahlenther Onkol. 2022 Nov;198(11):1016-1024. doi: 10.1007/s00066-022-01992-5. Epub 2022 Aug 25.
PURPOSE/OBJECTIVE: To analyze dose-volume histogram (DVH)-derived data on the exposure of organs at risk with impact on long-term percutaneous enteral gastrostomy (PEG) tube dependence in head and neck cancer patients at 6 and 12 months after definitive or adjuvant (chemo)radiotherapy.
Sixty-one patients were prospectively treated with (chemo)radiotherapy. Prophylactic or reactive gastrostomy tube placement was performed in 41 (67.2%) patients. Dose-volume histogram parameters were obtained for the swallowing apparatus.
Median follow-up time was 25 (2-34) months. Overall survival was shorter in patients with inlying PEG tubes at 6 and 12 months (log rank p = 0.038 and p = 0.017) after therapy completion. The estimated median time of tube dependency was 6 (95% confidence interval: 2-14) months. After 6 months, 46.5% of patients were tube dependent. After 12 months, this estimated proportion fell to 31.5%. For both time points, the volume to the larynx (in %) receiving at least 50 Gy (larynx V50Gy) exceeding 53% was predictive for long-term tube feeding (6 months: p = 0.041 and 12 months: p = 0.042) being an independent predictor during multivariable analysis. There was no clinical feature influencing tube dependence after 12 months.
Long-term gastrostomy dependence was found to be strongly associated with an exposure of laryngeal structures (specifically, V50Gy ≥ 53%) during radiotherapy. Consequently, the avoidance of supraglottic as well as glottic structures is warranted.
分析头颈部癌症患者接受根治性或辅助（放）化疗 6 个月和 12 个月后，危及器官的剂量-体积直方图（DVH）衍生数据与长期经皮内镜下胃造瘘（PEG）管依赖的关系。
61 例患者前瞻性接受（放）化疗。41 例（67.2%）患者预防性或反应性放置胃造瘘管。获取吞咽器官的剂量-体积直方图参数。
中位随访时间为 25 个月（2-34 个月）。治疗完成后 6 个月和 12 个月，带管患者的总生存率更短（对数秩检验，p=0.038 和 p=0.017）。估计的带管依赖中位时间为 6 个月（95%置信区间：2-14 个月）。6 个月后，46.5%的患者依赖于带管进食。12 个月后，这一估计比例降至 31.5%。对于这两个时间点，喉（%）接受至少 50 Gy（喉 V50Gy）的体积超过 53%是长期管饲的预测因素（6 个月：p=0.041；12 个月：p=0.042），在多变量分析中是独立的预测因素。在 12 个月后，没有临床特征影响带管依赖。
长期胃造瘘依赖与放疗期间喉结构（特别是 V50Gy≥53%）的暴露密切相关。因此，有必要避免累及声门上区和声带结构。
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