Department of Otolaryngology-Head and Neck Surgery, Max Rady College of Medicine, University of Manitoba, GB421 - 820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada.
Speech Language Pathology, Department of Psychosocial Oncology, CancerCare Manitoba, Room ON1018, 675 McDermot Ave, Winnipeg, MB, R3E 0V9, Canada.
J Otolaryngol Head Neck Surg. 2022 Nov 8;51(1):41. doi: 10.1186/s40463-022-00593-7.
The study objectives were: provide longitudinal data on upper aerodigestive tract function and late complications following IMRT for nasopharyngeal carcinoma, and elucidate factors that might predict a worse outcome. The hypotheses were: (1) Despite advances such as IMRT, radiation will cause significant functional decline and late complications that often progress or arise years after treatment. (2) Larger radiation volume will be associated with poorer outcomes.
Longitudinal, observational cohort study of nasopharyngeal carcinoma patients with retrospective analysis of prospectively collected, population-based data. Late sequelae and validated measures of overall performance, speech, and swallowing were documented pre-treatment and 3,6,12, 24, 36 and ≥ 60-months post-treatment.
Forty-two patients treated curatively with radiation (N = 9) or chemoradiation (N = 33) were followed for a median 74 months. Functional outcomes showed an initial nadir at 3 months associated with acute effects of treatment, followed by initial recovery. There was subsequent functional decline years post-treatment with advancing dysphagia/aspiration, trismus, muscle spasm, and hypoglossal nerve palsy. Univariable regression analysis revealed that increasing high-dose radiation volumes (PTV 70 Gy) were associated with increased likelihood of less than solid diet (Performance Status Scale (PSS)-Normalcy of Diet score < 50; p = 0.04), and reduced PSS-Understandability of Speech (p = 0.005). The probability of poor outcome increased with time. Eleven percent of patients were tube feed dependent at ≥ 5 years.
Despite improvements in radiation delivery, late effects of radiation remain common. Higher radiation volumes are associated with poorer outcomes that worsen over time.
本研究的目的是：提供鼻咽癌调强放疗后上呼吸道功能和晚期并发症的纵向数据，并阐明可能预测不良结局的因素。假设如下：（1）尽管有调强放疗等进展，放射线仍会导致显著的功能下降和晚期并发症，这些并发症通常在治疗后数年进展或出现。（2）较大的放射体积与较差的结果相关。
对接受根治性放疗（N=9）或放化疗（N=33）的鼻咽癌患者进行纵向、观察性队列研究，并对前瞻性收集的基于人群的数据进行回顾性分析。在治疗前和治疗后 3、6、12、24、36 和≥60 个月时，记录晚期后遗症和整体表现、言语和吞咽的验证测量结果。
42 例患者接受了放疗（N=9）或放化疗（N=33）根治性治疗，中位随访时间为 74 个月。功能结果在 3 个月时出现初始低谷，与治疗的急性效应相关，随后出现初始恢复。多年后，出现吞咽/呛咳、牙关紧闭、肌肉痉挛和舌下神经麻痹等进行性功能下降。单变量回归分析显示，高剂量放射体积（PTV70Gy）增加与固体饮食摄入量减少的可能性增加相关（功能状态量表（PSS）-饮食正常评分<50；p=0.04），言语理解能力降低（p=0.005）。随着时间的推移，不良结局的概率增加。11%的患者在≥5 年内需要管饲。
尽管放射治疗有了改进，但放射的晚期效应仍然很常见。较高的放射体积与随着时间推移而恶化的较差结局相关。
