Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse 18, Bern, CH-3010, Switzerland.
Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
Radiat Oncol. 2024 Aug 2;19(1):104. doi: 10.1186/s13014-024-02495-6.
Radiotherapy (RT) in head and neck squamous cell cancer (HNSCC) often leads to sticky saliva and xerostomia (SSX). Dose sparing of salivary glands (SG) reduces occurrence of SSX but few studies investigated the relationship between RT dose to SG substructures and SSX. We therefore investigated this hypothesis, focusing on the parotid duct (PD).
Retrospective data was collected from 99 HNSCC patients treated at our center with (chemo-)radiotherapy (CRT). PD and other organs-at-risk (OAR) were (re-)contoured and DVHs were generated without re-planning. SSX was graded according to CTCAE v.4.03 and evaluated at acute, subacute, and two late timepoints.
Most patients presented with loco-regionally advanced disease. In 47% of patients, up-front neck dissection preceded CRT. Weighted mean dose was 28.6 Gy for bilateral parotid glands (PG), and 32.0 Gy for PD. Acute SSX presented as grades 0 (35.3%), I (41.4%), II (21.2%) and III (2.0%). There was no association of OARs and SSX ≥ grade 2 in univariable logistic regression (LR). Multivariable LR showed statistically significant relationship of acute SSX with: PG weighted mean dose (OR 0.84, p = 0.004), contralateral PG mean dose (OR 1.14, p = 0.02) and contralateral PD planning OAR (PD PRV) mean dose (OR 1.84, p = 0.03).
There was an association of acute SSX with dose exposure of PD PRV in multivariable regression, only. Due to statistical uncertainties and the retrospective nature of this analysis, further studies are required to confirm or reject the hypothesis.
头颈部鳞状细胞癌（HNSCC）的放射治疗（RT）常导致唾液粘稠和口干（SSX）。唾液腺（SG）剂量节省可减少 SSX 的发生，但很少有研究调查 SG 亚结构与 SSX 之间的关系。因此，我们提出了这一假设，重点研究腮腺导管（PD）。
从我院接受（放）化疗（CRT）治疗的 99 例 HNSCC 患者中收集回顾性数据。不重新计划，对 PD 和其他危及器官（OAR）进行（重新）轮廓和剂量体积直方图（DVH）生成。根据 CTCAE v.4.03 对 SSX 进行分级，并在急性、亚急性和两个晚期进行评估。
大多数患者表现为局部区域晚期疾病。在 47%的患者中，CRT 前进行了颈部清扫术。双侧腮腺的加权平均剂量为 28.6Gy，PD 为 32.0Gy。急性 SSX 表现为 0 级（35.3%）、1 级（41.4%）、2 级（21.2%）和 3 级（2.0%）。单变量逻辑回归（LR）未显示 OAR 与 SSX≥2 级之间存在关联。多变量 LR 显示，急性 SSX 与以下因素存在统计学显著相关性：PG 加权平均剂量（OR 0.84，p=0.004）、对侧 PG 平均剂量（OR 1.14，p=0.02）和对侧 PD 计划 OAR（PD PRV）平均剂量（OR 1.84，p=0.03）。
多变量回归仅显示急性 SSX 与 PD PRV 剂量暴露有关。由于统计不确定性和分析的回顾性，需要进一步的研究来证实或拒绝这一假设。
