Xerostomia and its predictors following parotid-sparing irradiation of head-and-neck cancer
Xerostomia and its predictors following parotid-sparing irradiation of head-and-neck cancer
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DOI：
10.1016/s0360-3016(01)01512-7
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发表时间：
2001-07-01
影响因子：
7
通讯作者：
Ship, JA
中科院分区：
文献类型：
--
作者：
Eisbruch, A;Kim, HM;Ship, JA
目的：为了评估长期口干患者接受腮腺保留放射治疗（RT）的头颈癌，并找到患者和治疗相关因素，影响其severity.Patients和方法：从1994年3月至2000年1月，84例患者接受全面的双边颈部RT适形和多段调强放疗（IMRT），旨在备用的主要唾液腺。在RT之前和RT完成后2年内，选择性地测量每个主要唾液腺的唾液流率。在相同的时间间隔，每个患者完成一个8项的自报口腔干燥症特异性问卷（XQ），以获得一个相对的测量RT对小唾液腺的影响，其输出无法测量，口腔表面（延伸到包括舌根表面）的轮廓在计划CT扫描。记录新器官（“口腔”）的平均剂量。48例接受单侧颈部RT的患者进行了类似的研究，并作为比较的基准，使用随机效应模型分析预测XQ评分的因素。发现XQ在测量患者报告的口干症方面是可靠和有效的。在双侧RT组中接受中等剂量的备用唾液腺在RT后第二年恢复到其基线唾液流速，单侧RT组的备用腺体接受了非常低的剂量，显示唾液分泌增加，超过了RT前的水平。RT后第二年唾液排率的增加表明两组患者口干症的改善。与双侧RT组相比，单侧RT组口干症的改善更快，但2年时差异缩小。大唾液腺流速与口腔干燥评分仅存在弱相关性，与口腔干燥评分独立相关的因素为放疗前基线评分、放疗后时间和大唾液腺平均剂量（特别是对下颌下腺）和口腔。随着时间的推移，口腔干燥症的改善，与备用大唾液腺唾液分泌的增加相一致，表明它们的备用具有长期的临床益处。口腔平均剂量，代表RT对小唾液腺的影响，被认为是口干症的一个重要的，独立的预测因子，因此，除了大唾液腺，保留未受累的口腔应被视为进一步减少口干症的计划目标。(C)2001 Elsevier Science Inc.
Purpose: To assess long-term xerostomia in patients receiving parotid-sparing radiation therapy (RT) for head-and-neck cancer, and to find the patient and therapy-related factors that affect its severity.Patients and Methods: From March 1994 through January 2000, 84 patients received comprehensive bilateral neck RT using conformal and multisegmental intensity-modulated RT (IMRT) aiming to spare the major salivary glands. Before RT and periodically through 2 years after the completion of RT, salivary how rates from each of the major salivary glands were selectively measured. At the same time intervals, each patient completed an 8-item self-reported xerostomia-specific questionnaire (XQ), To gain a relative measure of the effect of RT on the minor salivary glands, whose output could not be measured, the surfaces of the oral cavity (extending to include the surface of the base of tongue) were outlined in the planning CT scans. The mean doses to the new organ ("oral cavity") were recorded. Forty-eight patients receiving unilateral neck RT were similarly studied and served as a benchmark for comparison, Factors predicting the XQ scores were analyzed using a random-effects model.Results: The XQ was found to be reliable and valid in measuring patient-reported xerostomia, The spared salivary glands which had received moderate doses in the bilateral RT group recovered to their baseline salivary flow rates during the second year after RT, and the spared glands in the unilateral RT group, which had received very low doses, demonstrated increased salivary production beyond their pre-RT levels. The increase in the salivary Row rates during the second year after RT paralleled an improvement in xerostomia in both patient groups. The improvement in xerostomia was faster in the unilateral compared with the bilateral RT group, but the difference narrowed at 2 years. The major salivary gland flow rates had only a weak correlation with the xerostomia scores, Factors found to be independently associated with the xerostomia scores were the pre-RT baseline scores, the time since RT, and the mean doses to the major salivary glands (notably to the submandibular glands) and to the oral cavity.Conclusion: An improvement over time in xerostomia, occurring in tandem with rising salivary production from the spared major salivary glands, suggests a long-term clinical benefit from their sparing. The oral cavity mean dose, representing RT effect on the minor salivary glands, was found to be a significant, independent predictor of xerostomia, Thus, in addition to the major salivary glands, sparing the noninvolved oral cavity should be considered as a planning objective to further reduce xerostomia. (C) 2001 Elsevier Science Inc.