Dose-volume factors correlating with trismus following chemoradiation for head and neck cancer.
Dose-volume factors correlating with trismus following chemoradiation for head and neck cancer.
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DOI：
10.3109/0284186x.2015.1037864
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发表时间：
2016
期刊：
影响因子：
--
通讯作者：
Lee NY
中科院分区：
文献类型：
--
作者：
Rao SD;Saleh ZH;Setton J;Tam M;McBride SM;Riaz N;Deasy JO;Lee NY
研究头颈部肿瘤调强放疗（IMRT）联合化疗后咀嚼肌的剂量-体积因素，这些因素可能是导致患者牙关紧闭的原因。2004年1月至2009年4月期间在我们机构接受化疗和调强放疗治疗口咽、鼻咽、下咽或喉鳞状细胞癌的所有可评价患者均纳入本分析（N = 421）。使用CTCAE 4.0评估牙关紧闭。双侧咬肌，颞肌，翼外肌和翼内肌的轴向计算机断层扫描（CT）治疗计划图像划定，并提取剂量-体积参数，以调查单变量和多度量的相关性。观察到46名患者（10.9%）患有1级或更高级别的慢性牙关紧闭。根据基线患者特征分析，毒性与原发部位和患者年龄相关。从剂量-体积分析，最陡的剂量阈值和最高的相关性被视为平均剂量同侧咬肌（斯皮尔曼的等级相关系数Rs = 0.25）和内侧翼（Rs = 0.23）肌肉。Lyman-Kutcher-Burman模型显示相同肌肉的相关性最高。多指标逻辑回归模型的最佳相关性是V68 Gy与同侧内侧翼突（Rs = 0.29）。放化疗引起的牙关紧闭仍然是一个问题，特别是口咽癌患者。强剂量-体积相关性支持了这样的假设：限制同侧咬肌（特别是翼内肌）的剂量可能会降低牙关紧闭的可能性。
To investigate the dose-volume factors in mastication muscles that are implicated as possible causes of trismus in patients following treatment with intensity-modulated radiotherapy (IMRT) and concurrent chemotherapy for head and neck cancers. All evaluable patients treated at our institution between January 2004 and April 2009 with chemotherapy and IMRT for squamous cell cancers of the oropharynx, nasopharynx, hypopharynx or larynx were included in this analysis (N = 421). Trismus was assessed using CTCAE 4.0. Bi-lateral masseter, temporalis, lateral pterygoid and medial pterygoid muscles were delineated on axial computed tomography (CT) treatment planning images, and dose-volume parameters were extracted to investigate univariate and multimetric correlations. Forty-six patients (10.9%) were observed to have chronic trismus of grade 1 or greater. From analysis of baseline patient characteristics, toxicity correlated with primary site and patient age. From dose-volume analysis, the steepest dose thresholds and highest correlations were seen for mean dose to ipsilateral masseter (Spearman’s rank correlation coefficient Rs = 0.25) and medial pterygoid (Rs = 0.23) muscles. Lyman-Kutcher-Burman modeling showed highest correlations for the same muscles. The best correlation for multimetric logistic regression modeling was with V68Gy to the ipsilateral medial pterygoid (Rs = 0.29). Chemoradiation-induced trismus remains a problem particularly for patients with oropharyngeal carcinoma. Strong dose-volume correlations support the hypothesis that limiting dose to the ipsilateral masseter muscle and, in particular, the medial pterygoid muscle may reduce the likelihood of trismus.