Adverse Events Associated With Concurrent Chemoradiation Therapy in Patients With Head and Neck Cancer
Adverse Events Associated With Concurrent Chemoradiation Therapy in Patients With Head and Neck Cancer
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DOI：
10.1001/archoto.2009.174
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发表时间：
2009-12-01
影响因子：
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通讯作者：
Funk, Gerry F.
中科院分区：
文献类型：
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作者：
Givens, Daniel J.;Karnell, Lucy Hynds;Funk, Gerry F.
目的：评估与并发糖尿病相关的毒性、功能结局和健康相关的生活质量。化疗（CRT）在头颈癌患者中的应用。设计：前瞻性和回顾性结果研究背景：三级医疗机构。患者：在2000年2月1日至2007年3月1日期间接受过CRT治疗的头颈癌纵向结局评估项目参与者（n = 104）。干预措施：患者前瞻性地提供了功能和健康相关的生活质量信息，包括1年和最近一次随访的数据。审查医疗记录以确定毒性和存活率。主要观察指标：明确的急性和晚期毒性；功能结果（饮食、牙列、气管切开术）；头颈癌特异性、一般健康和抑郁结局；还有存活率。结果：多数患者有口咽或喉部肿瘤（87.5%）和晚期疾病（75.0%）。大约一半的患者有血液学毒性和毒性相关的治疗延迟。大约四分之一的患者有神经毒性和/或耳毒性、湿性脱屑、肺炎、恶心和呕吐（需要住院或静脉输液）、脱水或营养不良（需要住院），以及轻度或中度发烧。尽管使用Pinnacle(3)计划系统接受当前调强放射治疗（IMRT）方案的患者有更多的毒性相关治疗延迟，但与接受常规侧对位放射或使用Best nomos PEACOCK计划系统的初始调强放射治疗方案的患者相比，他们的毒性更少，功能和健康相关生活质量更好。结论：接受CRT的患者经历了大量与治疗相关的不良事件，主要影响口咽和喉部功能，目前的IMRT方案有明显改善。在治疗前和治疗期间，改善牙齿修复康复，包括言语和吞咽病理学家的评估，可能会提高患者的预后。
Objective: To assess toxicities, functional outcomes, and health-related quality of life associated with concurrent. chemoradiation therapy (CRT) in patients with head and neck cancer.Design: Prospective and retrospective outcomes studySetting: Tertiary care institution.Patients: Participants in the longitudinal Outcomes Assessment Project whose head and neck cancer was treated with CRT between February 1, 2000, and March 1, 2007 (n = 104).Interventions: Patients prospectively provided functional and health-related quality of life information, including data from the 1-year and most current follow-up visits. Medical records were reviewed to determine toxicity and survival rates.Main Outcome Measures: Well-defined acute and late toxicities; functional outcomes (diet, dentition, tracheostomies); head and neck cancer-specific, general health, and depression outcomes; and survival rates.Results: Most patients had oropharyngeal or laryngeal tumors (87.5%) and advanced-stage disease (75.0%). Approximately one-half had hematologic toxicities and toxicity-related treatment delays. Approximately one-quarter had neurotoxicities and/or ototoxicites, moist desquamation, pneumonia, nausea and vomiting requiring hospitalization or intravenous fluids, dehydration or malnutrition requiring hospitalization, and mild or moderate fever. Although patients receiving the current intensity-modulated radiation therapy (IMRT) protocol using the Pinnacle(3) planning system had more toxicity-related treatment delays, they had fewer toxicities and better functional and health-related quality of life outcomes compared with those receiving conventional lateral opposing-field radiation or the initial IMRT protocol using the Best nomos PEACOCK planning system.Conclusions: Patients receiving CRT experience a Substantial number of treatment-related adverse events, primarily affecting oropharyngeal and laryngeal function, with improvement noted for the current IMRT protocol. Improving dental prosthetic rehabilitation and including evaluations with speech and swallowing pathologists before and during treatment may enhance patient outcomes.