Beddok Arnaud, Maynadier Xavier, Krhili Samar, Ala Eddine Catherine, Champion Laurence, Chilles Anne, Goudjil Farid, Zefkili Sofia, Amessis Malika, Choussy Olivier, Le Tourneau Christophe, Buvat Irene, Créhange Gilles, Carton Matthieu, Calugaru Valentin
Radiation Oncology Department, Institut Curie, PSL Research University, 25 rue d'Ulm, 75005, Paris/Orsay, France.
Institut Curie, PSL Research University, University Paris Saclay, Inserm LITO, 91898, Orsay, France.
Strahlenther Onkol. 2023 Oct;199(10):901-909. doi: 10.1007/s00066-023-02080-y. Epub 2023 May 31.
Our study aims to identify predictive factors of moderate to severe (grade ≥ 2) late toxicity after reirradiation (reRT) of recurrent head and neck carcinoma (HNC) and explore the correlations between dose organs at risk (OAR) and grade ≥ 2 toxicity.
Between 09/2007 and 09/2019, 55 patients were re-irradiated with IMRT or proton therapy with curative intent for advanced HNC. Our study included all patients for whom data from the first and second irradiations were available. Co-variables, including interval to reRT, size of re-irradiated PTV, and dose to OAR, were analyzed as potential predictors for developing moderate to severe long-term toxicity with death as a competing risk. Receiver-operator characteristics (ROC) analysis assessed the association between dose/volume parameters and the risk of toxicity.
Twenty-three patients participated in our study. After a median follow-up of 41 months, 65% of the patients experienced grade ≥ 2 late toxicity. The average dose to pharyngeal constrictor muscles (PCM) at the time of reRT showed an association with the risk of grade ≥ 2 dysphagia: AUC = 0.78 (95% CI: 0.53-1), optimal cut-off value = 36.7 Gy (sensitivity 62%/specificity 100%). The average dose to the oral cavity at the time of reRT showed an association with the risk of grade ≥ 2 dysgeusia: AUC = 0.96 (0.89-1), optimal cut-off value = 20.5 Gy (sensitivity 100%/specificity 88%).
Our analysis depicted an association between the dose to OAR and the risk of developing moderate to severe dysphagia and dysgeusia and proposed new dose constraints for PCM (36.7 Gy) and oral cavity (20.5 Gy).
我们的研究旨在确定复发性头颈癌（HNC）再程放疗（reRT）后中重度（≥2级）晚期毒性的预测因素，并探讨危及器官（OAR）剂量与≥2级毒性之间的相关性。
2007年9月至2019年9月期间，55例晚期HNC患者接受了以治愈为目的的IMRT或质子再程放疗。我们的研究纳入了所有可获得首次和第二次放疗数据的患者。将包括再程放疗间隔、再程放疗计划靶体积（PTV）大小和OAR剂量在内的协变量作为发生中重度长期毒性的潜在预测因素进行分析，将死亡作为竞争风险。受试者工作特征（ROC）分析评估剂量/体积参数与毒性风险之间的关联。
23例患者参与了我们的研究。中位随访41个月后，65%的患者出现≥2级晚期毒性。再程放疗时咽缩肌（PCM）的平均剂量与≥2级吞咽困难风险相关：曲线下面积（AUC）=0.78（95%置信区间：0.53 - 1），最佳截断值=36.7 Gy（敏感性62%/特异性100%）。再程放疗时口腔的平均剂量与≥2级味觉障碍风险相关：AUC = 0.96（0.89 - 1），最佳截断值=20.5 Gy（敏感性100%/特异性88%）。
我们的分析表明OAR剂量与发生中重度吞咽困难和味觉障碍的风险之间存在关联，并提出了PCM（36.7 Gy）和口腔（20.5 Gy）的新剂量限制。
