Tuo Anney, Moon Dominic H, Avkshtol Vladimir, Shah Jennifer Lobo, Pham Nhat-Long, Sher David J
Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, USA.
Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
Radiother Oncol. 2025 Aug;209:110933. doi: 10.1016/j.radonc.2025.110933. Epub 2025 May 11.
When using IMRT for oropharyngeal squamous cell carcinoma (OPSCC), the extent to which patient-reported outcomes (PRO) improve at progressively lower dose distributions is unclear. In this study, we evaluated the relationship between PROs and dosimetry in OPSCC patients on two elective neck irradiation (ENI) de-escalation trials.
Eligible patients in this analysis had a diagnosis of OPSCC and were treated on two ENI de-escalation trials. Contoured OARs included oral cavity (OC), floor of mouth (FoM), superior/middle constrictors (SMC), parotid glands (PG), submandibular glands (SMG), and tubarial glands (TG). OAR metrics were dichotomized at the median and in tertiles. The primary endpoints were 3- and 12-month PROs: the overall MD Anderson Dysphagia Inventory (MDADI) and Dry Mouth (DM) and Sticky Saliva (SS) scores from the EORTC HN35.
The analysis includes 86 patients. The median mean doses were contralateral (CL, 15.7 Gy) and ipsilateral PG (26.3 Gy), contralateral SMG (35.3 Gy), OC (29.3 Gy), and SMC (47 Gy). OC, SMC and TG were significant predictors of 12-month MDADI, with a dose-response below the lowest tertile. Three-month DM scores were associated with OC doses, CL PG V15 and CL SMG V30, but only FoM and CL SMG V30 were predictors of 12 month DM. Oral cavity, FOM, and SMG doses were associated with 12 month SS outcomes.
In a cohort of patients treated with de-escalated IMRT, the critical impact of OC and SMG doses became evident. More work is needed to understand both dosimetric and non-dosimetric predictors of long-term PROs.
在对头颈部鳞状细胞癌（OPSCC）使用调强放射治疗（IMRT）时，尚不清楚在剂量分布逐渐降低的情况下患者报告结局（PRO）改善的程度。在本研究中，我们在两项选择性颈部照射（ENI）剂量递减试验中评估了OPSCC患者的PRO与剂量测定之间的关系。
本分析中的符合条件的患者被诊断为OPSCC，并接受了两项ENI剂量递减试验治疗。勾画的危及器官（OAR）包括口腔（OC）、口底（FoM）、上/中咽缩肌（SMC）、腮腺（PG）、下颌下腺（SMG）和咽鼓管腺（TG）。OAR指标在中位数和三分位数处进行二分法划分。主要终点是3个月和12个月的PRO：MD安德森吞咽困难量表（MDADI）总分以及欧洲癌症研究与治疗组织（EORTC）HN35问卷中的口干（DM）和唾液黏稠（SS）评分。
分析纳入了86例患者。对侧（CL）和同侧PG的中位平均剂量分别为15.7 Gy和26.3 Gy，对侧SMG为35.3 Gy，OC为29.3 Gy，SMC为47 Gy。OC、SMC和TG是12个月MDADI的显著预测因素，在最低三分位数以下呈剂量反应关系。3个月的DM评分与OC剂量、CL PG的V15以及CL SMG的V30相关，但只有FoM和CL SMG的V30是12个月DM的预测因素。口腔、FoM和SMG的剂量与12个月的SS结局相关。
在接受剂量递减IMRT治疗的患者队列中，OC和SMG剂量的关键影响变得明显。需要开展更多工作以了解长期PRO的剂量测定和非剂量测定预测因素。
