Skin DVHs predict cutaneous toxicity in Head and Neck Cancer patients treated with Tomotherapy
Skin DVHs predict cutaneous toxicity in Head and Neck Cancer patients treated with Tomotherapy
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DOI：
10.1016/j.ejmp.2019.02.015
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发表时间：
2019-03-01
影响因子：
3.4
通讯作者：
Fiorino, C.
中科院分区：
文献类型：
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作者：
Mori, M.;Cattaneo, G. M.;Fiorino, C.
目的：方法：70例头颈部恶性肿瘤患者行根治性螺旋断层放疗（SIB技术：54/66戈伊，PTV 1/PTV 2，30 fr），计划CT扫描显示2 mm厚（SL 2）化疗浅表层。CTCAE v4.0急性皮肤毒性数据可用。计算重度（G3）和重度/中度（G3/G2）皮肤急性毒性患者的SL 2绝对平均剂量体积直方图（DVH）。分析与无/轻度毒性（G 0/G1）患者的差异，以定义SL 2 DVH的最具鉴别力区域;对DVH值、CTV体积、年龄、性别、化疗进行单变量和多变量logistic分析。61%的患者发生了G2/G3毒性（G3发生率= 19%）。在53- 68 Gy范围内，皮肤DVH的差异是显著的（p值：0.005-0.01）。V56/V64是G2/G3（OR = 1.12，95% CI = 1.03-1.21，p = 0.001）和G3（OR = 1.13，95% CI = 1.01-1.26，p = 0.027）的最佳预测参数，最佳临界值分别为7.7 cc和2.7 cc。V56的逻辑模型校准良好，斜率和R2均接近1。两组的平均V64分别为2.2cc和6cc（G3 vs G 0-G2毒性）; V64的logistic模型校正良好，斜率接近1，R2 = 0.60。结论：SL 2 DVH与急性皮肤毒性风险相关。限制V64 < 3cc（相当于4x 4cm 2皮肤表面）应将G3毒性风险保持在10%以下或约10%。
Purpose: To explore the association between planning skin dose-volume data and acute cutaneous toxicity after Radio-chemotherapy for Head and Neck (HN) cancer patients.Methods: Seventy HN patients were treated with Helical Tomotherapy (HT) with radical intent (SIB technique: 54/66 Gy to PTV1/PTV2 in 30fr) +/- chemotherapy superficial body layer 2 mm thick (SL2) was delineated on planning CT. CTCAE v4.0 acute skin toxicity data were available. Absolute average Dose-Volume Histograms (DVH) of SL2 were calculated for patients with severe (G3) and severe/moderate (G3/G2) skin acute toxicities.Differences against patients with none/mild toxicity (G0/G1) were analyzed to define the most discriminative regions of SL2 DVH; univariable and multivariable logistic analyses were performed on DVH values, CTV volume, age, sex, chemotherapy.Results: Sixty-one % of patients experienced G2/G3 toxicity (rate of G3 = 19%). Differences in skin DVHs were significant in the range 53-68Gy (p-values: 0.005-0.01). V56/V64 were the most predictive parameters for G2/G3 (OR = 1.12, 95% CI = 1.03-1.21, p = 0.001) and G3 (OR = 1.13, 95% CI = 1.01-1.26, p = 0.027) with best cut-off of 7.7cc and 2.7cc respectively. The logistic model for V56 was well calibrated being both, slope and R2, close to 1. Average V64 were 2.2cc and 6cc for the two groups (G3 vs G0-G2 toxicity); the logistic model for V64 was quite well calibrated, with a slope close to 1 and R2 equal to 0.60.Conclusion: SL2 DVH is associated with the risk of acute skin toxicity. Constraining V64 < 3cc (equivalent to a 4x4cm2 skin surface) should keep the risk of G3 toxicity below or around 10%.