Gandhi Om H, Lee Andrew E, Gujral Jaskeerat, Ismoilov Miraziz, Singh Shashi B, Ghonim Mohanad, Ghonim Mohamad, Kim Min-Young, Raynor William Y, Case Matthew J, Siddiqi Asad, Yazdanpanah Fereshteh, Werner Thomas J, Saboury Babak, Revheim Mona-Elisabeth, Chang Yu-Cheng, Alavi Abass
Department of Radiology, University of Pennsylvania Philadelphia, PA 19104, USA.
Current Affiliation: Stanford University School of Medicine Stanford, CA 94305, USA.
Am J Nucl Med Mol Imaging. 2025 Jun 25;15(3):97-104. doi: 10.62347/GLDL6616. eCollection 2025.
Head and neck cancer (HNC) patients frequently develop post-radiation maxillary sinusitis. This study investigated how different radiation therapy (RT) modalities, photon, proton, and mixed photon/proton RT, affect maxillary sinus inflammation, using 2-[F]-fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography (FDG-PET/CT).
Seventy-seven HNC patients treated with RT (30 with photon, 20 with proton, and 27 with mixed photon/proton RT) underwent FDG-PET/CT imaging before and 3 months after treatment. Demographic information, tumor location, chemotherapy details, radiation dose (cGy), and post-radiation sinusitis ratings (scale 0-2) were collected. The mean standardized uptake value (SUVmean) of the maxillary sinus was measured by a radiologist with two years of experience using manually delineated regions of interest. Parametric paired t-tests were used to compare pre- and post-treatment SUVmeans for each RT modality. Pre-minus-post-treatment changes in SUVmean (ΔSUVmean) between RT modalities were compared using independent t-tests. Correlation between radiation dose and ΔSUVmean and correlation between ΔSUVmean and clinical sinusitis scores were assessed using Pearson correlation analysis.
Photon RT was associated with a statistically significant increase in maxillary sinus SUVmean post-treatment (+14.32%, P = 0.0324), while proton RT and mixed photon/proton RT did not result in significant changes (-3.39%, P = 0.6549 and -5.33%, P = 0.4541, respectively). A significant difference was found between photon and mixed photon/proton RT (P = 0.0444), whereas the difference between photon and proton RT approached significance (P = 0.0790). Clinical inflammation ratings were highest for photon therapy (average 0.97), followed by mixed therapy (0.78), then proton therapy (0.65), though these differences were not statistically significant.
Our findings demonstrate that photon RT leads to significant increases in maxillary sinus SUVmean as measured by FDG-PET/CT, while proton and mixed photon/proton RT do not show statistically significant changes. These preliminary results suggest that proton-based radiation modalities may be associated with reduced maxillary sinus inflammatory activity compared to photon RT alone, though larger studies with longer follow-up are needed to establish clinical significance and patient outcomes.
头颈癌（HNC）患者常发生放疗后上颌窦炎。本研究使用2-[F]-氟-2-脱氧-D-葡萄糖-正电子发射断层扫描/计算机断层扫描（FDG-PET/CT），调查不同的放射治疗（RT）方式，即光子放疗、质子放疗和光子/质子混合放疗，如何影响上颌窦炎症。
77例接受放疗的HNC患者（30例接受光子放疗，20例接受质子放疗，27例接受光子/质子混合放疗）在治疗前和治疗后3个月接受FDG-PET/CT成像。收集人口统计学信息、肿瘤位置、化疗细节、放射剂量（cGy）和放疗后鼻窦炎评分（0-2级）。由一位有两年经验的放射科医生使用手动绘制的感兴趣区域测量上颌窦的平均标准化摄取值（SUVmean）。采用参数配对t检验比较每种放疗方式治疗前后的SUVmean。使用独立t检验比较不同放疗方式之间治疗前减去治疗后的SUVmean变化（ΔSUVmean）。使用Pearson相关分析评估放射剂量与ΔSUVmean之间的相关性以及ΔSUVmean与临床鼻窦炎评分之间的相关性。
光子放疗与治疗后上颌窦SUVmean的统计学显著增加相关（+14.32%，P = 0.0324），而质子放疗和光子/质子混合放疗未导致显著变化（分别为-3.39%，P = 0.6549和-5.33%，P = 0.4541）。在光子放疗和光子/质子混合放疗之间发现了显著差异（P = 0.0444），而光子放疗和质子放疗之间的差异接近显著（P = 0.0790）。光子治疗的临床炎症评分最高（平均0.97），其次是混合治疗（0.78），然后是质子治疗（0.65），尽管这些差异无统计学意义。
我们的研究结果表明，通过FDG-PET/CT测量，光子放疗导致上颌窦SUVmean显著增加，而质子放疗和光子/质子混合放疗未显示出统计学显著变化。这些初步结果表明，与单独的光子放疗相比，基于质子的放疗方式可能与上颌窦炎症活动减少有关，不过需要更大规模、更长随访时间的研究来确定临床意义和患者预后。
