Dapper Hendrik, Waltenberger Maria, Pigorsch Steffi U, Combs Stephanie E, Bauermeister Katharina, Bauermeister Wolfgang
Technical University of Munich.
Kharkiv National Medical University.
Res Sq. 2024 Jun 18:rs.3.rs-4516893. doi: 10.21203/rs.3.rs-4516893/v1.
Cervical fibrosis (CF) as a late consequence in patients after radiotherapy significantly impacts the long-term symptoms, functionality, and quality of life of these cancer patients due to a hardening process of different histological tissues. Modern Shear Wave Ultrasound Elastography now enables a differentiated analysis of the changes in various tissue types. In this study, tissue-specific changes in CF induced by radiation therapy in head and neck (ENT) cancer patients were quantified and correlated with cervical range of motion (CROM).
16 patients after radiation of the cervical lymphatic drainage were selected as the observation group (OG). Further, 16 people without radiation in the head and neck region were matched by gender, age, and BMI as the control group (CG). Stiffness measurements in kilopascal (kPa; 1 Pa = 1 N m) were performed using shear wave elastography (SWE) to assess the elasticity of muscle, fascia, and subcutaneous tissue within and surrounding the sternocleidomastoid muscle (SCM). Specific parameters of the OG were compared to the CG and correlated with functional parameters and quality of life (QoL).
The OG exhibited significantly higher stiffness values (Emean, Emax, Emin) across all tissue types than the CG, suggesting a tangible effect of radiation therapy on tissue stiffness. Muscle compartment analysis revealed the most significant stiffness differences. Thickness measurements indicated changes in the muscle and skin but not in the subcutaneous tissue. CROM measurements within the OG fell within normal ranges, suggesting a possible homogenizing effect of radiation treatment on CROM variability. Strong correlations were observed between age and specific stiffness measures, particularly in the OG group, indicating a broader impact of aging or radiation therapy on physiological measures. Significant correlations between tissue stiffness and CROM were found.
CF after radiotherapy occurs primarily in the muscle tissue and its fascia, with the hardening being about twice as pronounced as in the average population and becoming more pronounced with increasing age and correlates with CROM.
颈部纤维化（CF）作为放疗后患者的晚期后果，由于不同组织学组织的硬化过程，会显著影响这些癌症患者的长期症状、功能和生活质量。现代剪切波超声弹性成像技术现在能够对各种组织类型的变化进行差异化分析。在本研究中，对头颈部（耳鼻喉科）癌症患者放疗引起的CF组织特异性变化进行了量化，并与颈部活动范围（CROM）相关联。
选择16例接受颈部淋巴引流放疗的患者作为观察组（OG）。此外，选取16例头颈部未接受放疗的患者，按照性别、年龄和体重指数进行匹配，作为对照组（CG）。使用剪切波弹性成像（SWE）以千帕（kPa；1 Pa = 1 N/m）为单位进行硬度测量，以评估胸锁乳突肌（SCM）内及其周围肌肉、筋膜和皮下组织的弹性。将OG的特定参数与CG进行比较，并与功能参数和生活质量（QoL）相关联。
与CG相比，OG在所有组织类型中均表现出显著更高的硬度值（Emean、Emax、Emin），表明放疗对组织硬度有明显影响。肌肉隔室分析显示硬度差异最为显著。厚度测量表明肌肉和皮肤有变化，但皮下组织无变化。OG内的CROM测量值在正常范围内，表明放疗对CROM变异性可能有均匀化作用。观察到年龄与特定硬度测量值之间存在强相关性，尤其是在OG组中，表明衰老或放疗对生理测量有更广泛的影响。发现组织硬度与CROM之间存在显著相关性。
放疗后CF主要发生在肌肉组织及其筋膜中，硬化程度约为普通人群的两倍，且随着年龄增长而更加明显，并与CROM相关。
