Zukauskaite Ruta, Eriksen Jesper Grau, Johansen Jørgen, Samsøe Eva, Kristensen Morten Horsholt, Johnsen Lars, Lonkvist Camilla Kjaer, Grau Cai, Overgaard Jens, Hansen Christian Rønn
Department of Oncology, Odense University Hospital, Odense, Denmark.
Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark.
Acta Oncol. 2025 Sep 18;64:1262-1268. doi: 10.2340/1651-226X.2025.43924.
One of the factors influencing disease control and toxicity risk after radiotherapy is selection of treatment volume margin. This study evaluates whether different gross tumour volume (GTV) to high-dose clinical target volume (CTV1) margins impact dysphagia in a cohort of head and neck squamous cell carcinoma (SCC) patients. Patient/material and methods: Data of patients receiving primary IMRT-based radiotherapy for SCC for the oropharynx, hypopharynx, and larynx at three treatment centres between 2010 and 2015 were retrospectively collected. Treatment planning followed two DAHANCA guideline periods: pre-2013 (varying GTV-CTV1 margins), and post-2013 (isotropic 5 mm margin). Treatment plans were collected for 1,913 patients. GTV-CTV1 margins were calculated as median surface distance from GTV to CTV1. Dysphagia was graded using modified DAHANCA ordinal scale. For each patient, the highest score of dysphagia during 5-year follow-up period was chosen for analysis.
Dysphagia data were available for 1,706 patients (89%). The median GTV-CTV1 margin was 9.0 mm in 2010-2012 and 4.7 mm in 2013-2015. The severity of dysphagia was more pronounced in patients treated during 2010-2012 (p = 0.003). Predictors of grade ≥ 2 dysphagia included larger GTV (odds ratio [OR]: 1.7; p < 0.001), larger GTV-CTV1 margin (odds ratio [OR] of 1.3 per cm; p = 0.04), and tumour localisation other than oropharyngeal p16+carcinomas (p = 0.002). Male sex, non/previous smoking status, and application of chemotherapy were associated with less severe dysphagia.
Tumour volume and GTV-CTV1 margin are dominant geometric parameters influencing dysphagia risk following curative radiotherapy.
影响放疗后疾病控制和毒性风险的因素之一是治疗体积边缘的选择。本研究评估了不同的大体肿瘤体积（GTV）至高剂量临床靶区体积（CTV1）边缘对一组头颈部鳞状细胞癌（SCC）患者吞咽困难的影响。患者/材料与方法：回顾性收集了2010年至2015年间在三个治疗中心接受基于调强放疗（IMRT）的口咽、下咽和喉SCC原发性放疗患者的数据。治疗计划遵循两个丹麦头颈癌协作组（DAHANCA）指南时期：2013年前（GTV至CTV1边缘不同），以及2013年后（各向同性5毫米边缘）。收集了1913例患者的治疗计划。GTV至CTV1边缘计算为从GTV到CTV1的中位表面距离。吞咽困难采用改良的DAHANCA序贯量表进行分级。对于每位患者，选择5年随访期内吞咽困难的最高评分进行分析。
1706例患者（89%）有吞咽困难数据。2010 - 2012年GTV至CTV1边缘的中位数为9.0毫米，2013 - 2015年为4.7毫米。2010 - 2012年接受治疗的患者吞咽困难的严重程度更明显（p = 0.003）。≥2级吞咽困难的预测因素包括更大的GTV（比值比[OR]：1.7；p < 0.001）、更大的GTV至CTV1边缘（每厘米比值比[OR]为1.3；p = 0.04），以及口咽p16 + 癌以外的肿瘤定位（p = 0.002）。男性、非/既往吸烟状态以及化疗的应用与吞咽困难较轻相关。
肿瘤体积和GTV至CTV1边缘是影响根治性放疗后吞咽困难风险的主要几何参数。
