鼻咽癌螺旋断层治疗中口腔黏膜勾画方法探索

doi:10.3760/cma.j.issn.1004-4221.2020.01.003

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摘要目的评价两种口腔黏膜勾画方法在鼻咽癌患者中预测急性放射性口腔黏膜炎(A-ROM)价值。方法前瞻性观察分析2017-2019年间浙江省肿瘤医院收治的局部中晚期鼻咽癌150例,所有患者均接受根治性螺旋断层治疗并采用全口腔勾画法(OCC法)和表面黏膜勾画法(MSC法)勾画口腔黏膜。根据RTOG急性放射损伤分级标准每周评估并记录患者的A-ROM分级,比较两种方法对A-ROM的价值。结果所有患者≥3级A-ROM发生率为33.3%。单因素分析≥3级A-ROM发生的相关剂量学参数包括OCC法的V5、V10、V15、V45、V50、V55、V60、V65、V70和MSC法的V5、V10、V50、V55、V60、V65、V70、Dmean(P均<0.05)。二分类Logistic回归分析发现OCC法的性别、吸烟是≥3级A-ROM的危险因素(男/女:OR=0.141,95%CI为0.037~0.538,P=0.004;吸烟/不吸烟:OR=5.109,95%CI为1.413~18.470,P=0.013)。MSC法的性别、吸烟、N分期、V55是≥3级A-ROM的危险因素(男/女:OR=0.129,95%CI为0.032~0.519,P=0.004;吸烟/不吸烟:OR=4.448,95%CI为1.224~16.164,P=0.023;N分期:OR=2.291,95%CI为1.268~4.137,P=0.006;V55:OR=1.432,95%CI为1.008~2.033,P=0.045)。MSC的V55阈值为7.70%,曲线下面积为0.754,敏感性为0.680,特异性为0.740(P<0.001)。结论采用螺旋断层治疗鼻咽癌时,MSC法相比OCC法可以更加准确地预测A-ROM的严重程度。

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	陈媛媛
	李佩静
	杨双燕
	方佳本
	张将
	胡巧英
	陈明
	陈晓钟
	田野

关键词 ：鼻咽肿瘤/螺旋断层治疗, 急性放射性口腔黏膜炎, 剂量学参数

Abstract：Objective To evaluate the value of two oral mucosal contouring methods for predicting acute radiation-induced oral mucositis (A-ROM) in nasopharyngeal carcinoma (NPC) patients. Methods A total of 150 AJCC 7^th stage Ⅱ-IVB NPCs receiving radical tomotherapy (TOMO) in Zhejiang Cancer Hospital from 2017 to 2019 were included in this prospective observational study. Oral cavity contour (OCC) and mucosal surface contour (MSC) were applied to delineate the oral mucosal structure. A-ROM grade was prospectively assessed and recorded weekly according to RTOG scoring criteria. The prediction value of two methods for A-ROM was statistically compared. Results The incidence rate of ≥3 grade A-ROM was 33.3%. In univariate analysis,V5,V10,V15,V45,V50,V55,V60,V65 and V70 of OCC and V5,V10,V50,V55,V60,V65,V70 and Dmean of MSC were significantly correlated with the risk of ≥3 grade A-ROM (all P<0.05). In binary logistic regression analysis,gender and smoking were significantly associated with the incidence of ≥3 grade A-ROM by using OCC (male vs. female:OR=0.141,95%CI=0.037-0.538,P=0.004;smoking vs.non-smoking:OR=5.109,95%CI=1.413-18.470,P=0.013). For MSC,gender,smoking,N stage and MSC- V55 were the independent predictors (male vs. female:OR=0.129,95%CI=0.032-0.519,P=0.004;smoking vs.non-smoking:OR=4.448,95%CI=1.224-16.164,P=0.023;N stage:OR=2.291,95%CI=1.268-4.137,P=0.006;MSC-V55:OR=1.432,95%CI=1.008-2.033,P=0.045). The cutoff value of MSC-V55 was 7.70%, the area under ROC curve was 0.754, the sensitivity and specificity were 0.680 and 0.740, retrospectively (all P<0.001). Conclusion s Compared with OCC, MSC yields a higher prediction accuracy for the severity of A-ROM in nasopharyngeal carcinoma patients receiving TOMO treatment.

Key words： Nasopharyngeal neoplasms/tomography therapy Acute radiation-induced oral mucositis Dosimetric parameter

收稿日期: 2019-01-29

基金资助:江苏省医学创新团队A类(CXDT-37);国家自然科学基金资助(81672971)

通讯作者: 田野,Email:dryetian@126.com

引用本文:

陈媛媛,李佩静,杨双燕等. 鼻咽癌螺旋断层治疗中口腔黏膜勾画方法探索[J]. 中华放射肿瘤学杂志, 2020, 29(1): 11-16.

Chen Yuanyuan,Li Peijing,Yang Shuangyan et al. Recommendation for an oral mucosal contouring method in nasopharyngeal carcinoma patients receiving tomotherapy[J]. Chinese Journal of Radiation Oncology, 2020, 29(1): 11-16.

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[1]杨静,杨双燕. 鼻咽癌螺旋断层放疗与调强放疗的剂量学比较[J]. 医学理论与实践,2016,29(15):1999-2001.
Yang J,Yang SY. Dosimetric comparison between spiral tomographic radiotherapy and intensity-modulated radiotherapy[J]. J Med Theor Pract,2016,29(15):1999-2001.
[2]谷家冰,朱健,巩贯忠,等. 螺旋断层放疗提升鼻咽癌放疗剂量的可行性研究[J]. 中华放射医学与防护杂志,2016,3(1):1-7. DOI:10.3760/cma.j.issn.0254-5098.2016.01.006.
Gu JB,Zhu J,Gong GZ,et al. Study on the feasibility of enhancing radiotherapy dose of nasopharyngeal carcinoma by spiral tomotherapy[J]. Chin J Radiol Med Protect,2016,3(1):1-7. DOI:10.3760/cma.j.issn.0254-5098.2016.01.006.
[3]李全义,戴相昆,蔡博宁,等. 鼻咽癌螺旋断层调强与快速旋转调强放疗的剂量学比较[J]. 中国癌症防治杂志,2016,8(4):230-234. DOI:10.3969/j.issn.1674-5671.2016.04.07.
Li QY,Dai XK,Cai BN,et al. Dosimetric comparison of spiral intensity modulated radiotherapy and rapid rotational intensity modulated radiotherapy for nasopharyngeal carcinoma[J]. Chin J Cancer Cont,2016,8(4):230-234. DOI:10.3969/j.issn.1674-5671.2016.04.07.
[4]陈亚正,廖雄飞,黎杰,等. 鼻咽癌螺旋断层放疗与固定野动态调强放疗的剂量学比较研究[J]. 肿瘤预防与治疗,2015,28(3):122-126. DOI:10.3969/j.issn.1674-0904.2015.03.003.
Chen YY,Liao XF,Li J,et al. A comparative study of dosimetry between spiral tomographic radiotherapy and dynamic intensity-modulated radiotherapy for nasopharyngeal carcinoma[J]. Cancer Prevent Treat,2015,28(3):122-126. DOI:10.3969/j.issn.1674-0904.2015.03.003.
[5]Kelly C,Paleri V,Downs C,et al. Deterioration in quality of life and depressive symptoms during radiationtherapy for head and neck cancer[J]. Otol Head Neck Surg,2007,136(1):108-111. DOI:10.1016/j.otohns.2006.06.1278.
[6]Rahman S,Maillou P,Barker D,et al. Radiotherapy and the oral environment the effects of radiotherapy on the hard and soft tissues of the mouth and its[J]. Eur J Prosthod Restor Dent,2013,21(2):80-87. DOI:none.
[7]李佩静,李凯新,金厅,等. 局部晚期鼻咽癌患者放疗过程中营养支持疗法的疗效[J]. 中国临床营养杂志,2018,26(2):67-73. DOI:10.3760/cma.j.issn.1674-635X.2018.02.001.
Li PJ,Li KX,Jin T,et al. The effect of nutritional support therapy in radiotherapy of patients with locally advanced nasopharyngeal carcinoma[J]. Chin J Clin Nutr,2018,26(2):67-73. DOI:10.3760/cma.j.issn.1674-635X.2018.02.001.
[8]Wang ZH,Zhang SZ,Zhang ZY,et al. Protecting the oral mucosa in patients with oral tongue squamous cell carcinoma treated postoperatively with intensity-modulated radiotherapy:a randomized study[J]. Laryngoscope,2012,122(2):291-298. DOI:10.1002/lary.22434.
[9]Lin J,Lyu X,Niu M,et al. Radiation-induced abnormal cortical thickness in patients with nasopharyngeal carcinoma after radiotherapy[J]. NeuroImage Clin,2017,14(3):610-621. DOI:0.1016/j.nicl.2017.02.025.
[10]李凯新,辛培玲,陈媛媛,等. 局部中晚期鼻咽癌IMRT同步化疗后急性放射性口腔黏膜炎的预测因素分析[J]. 中华放射肿瘤学杂志,2017,26(3):255-260. DOI:10.3760/cma.j.issn.1004-4221.2017.03.002.
Li KX,Xin PL,Chen YY,et al. Predictive factors of acute radiation-induced oral mucositis in patients with locally advanced nasopharyngeal carcinoma after IMRT[J]. Chin J Radiat Oncol,2017,26(3):255-260. DOI:10.3760/cma.j.issn.1004-4221.2017.03.002.
[11]中国鼻咽癌临床分期工作委员会.2010鼻咽癌调强放疗靶区及剂量设计指引专家共识[J]. 中华放射肿瘤学杂志,2011,20(4):267-269. DOI:10.3760/cma.j.issn.1004-4221.2011.04.001.
China NPC clinical staging committee. Expert consensus on target area and dose design guidelines of intensity modulated radiotherapy for NPC in 2010[J]. Chin J Radiat Oncol志,2011,20(4):267-269. DOI:10.3760/cma.j.issn.1004-4221.2011.04.001.
[12]Sanguineti G,Sosa M,Culp L,et al. Is it feasible to spare part of the mucosa with IMRT and does It matter[J]. Int J Radiat Oncol,2004,60(1):S517-518. DOI:10.1016/j.ijrobp.2004.07.466.
[13]Sun Y,Yu XL,Luo W,et al. Recommendation for a contouring method and atlas of organs at risk in nasopharyngeal carcinoma patients receiving intensity-modulated radiotherapy[J]. Radiother Oncol,2014,110(3):390-397. DOI:10.1016/j.radonc.2013.10.035.
[14]Dean JA,Welsh LC,Gulliford SL,et al. A novel method for delineation of oral mucosa for radiotherapy dose-response studies[J]. Radiother Oncol,2015,115(1):63-66. DOI:10.1016/j.radonc.2015.02.020.
[15]Ueno D,Sato J,Igarashi C,et al. Accuracy of oral mucosal thickness measurements using spiral computed tomography[J]. J Periodontol, 2011,82(6):829-836. DOI:10.1902/jop.2010.100160.
[16]Li K,Yang L,Hu Q,et al. Oral mucosa dose parameters predicting grade ≥3 acute toxicity in locally advanced nasopharyngeal carcinoma patients treated with concurrent intensity-modulated radiation therapy and chemotherapy:an independent validation study comparing oral cavity versus mucosal surface contouring techniques[J]. Transl Oncol,2017,10(5):752-759. DOI:10.1016/j.tranon.2017.06.011.
[17]Musha A,Shimada H,Shirai K,et al. Prediction of acute radiation mucositis using an oral mucosal dose surface model in carbon ion radiotherapy for head and neck tumors[J/OL]. PLOS ONE,2015,10(10):e0141734. DOI:10.1371/journal.pone.0141734.
[18]Li K,Yang L,Xin P,et al. Impact of dose volume parameters and clinical factors on acute radiation oral mucositis for locally advanced nasopharyngeal carcinoma patients treated with concurrent intensity-modulated radiation therapy and chemoradiotherapy[J]. Oral Oncol,2017,72(1):32-37. DOI:10.1016/j.oraloncology.2017.06.026.
[19]Samir N,Joerg L,Matthew A,et al. Prospective evaluation to establish a dose response for clinical oral mucositis in patients undergoing head and neck conformal radiotherapy[J]. Int J Radiat Oncol Biol Phys,2008,72(3):756-762. DOI:10.1016/j.ijrobp.2008.01.060.
[20]Mazzola R,Ricchetti F,Fersino S,et al. Predictors of mucositis in oropharyngeal and oral cavity cancer in patients treated with volumetric modulated radiation treatment:a dose-volume analysis[J]. Head& Neck,2016,(April):815–9. DOI:10.1002/hed.24106.
[21]张海波,郝俊芳,袁双虎,等. 螺旋断层放疗在头颈部肿瘤中的应用[J]. 肿瘤防治研究,2016,43(1):78-81. DOI:10.3971/j.issn.1000-8578.2016.01.017.
Zhang HB,Hao JF,Yuan SH,et al. Application of spiral tomotherapy in head and neck tumor[J]. Cancer Prevent Treat,2016,43(1):78-81. DOI:10.3971/j.issn.1000-8578.2016.01.017.
[22]王鲁,曹咏梅,史金晔. 鼻咽癌调强放疗后放射性口腔黏膜炎发生的危险因素分析[J]. 中国中西医结合耳鼻咽喉科杂志,2017,26(6):456-459.