Effects of the dose-volume relationship on and risk factors for maxillary osteoradionecrosis after carbon ion radiotherapy.
Effects of the dose-volume relationship on and risk factors for maxillary osteoradionecrosis after carbon ion radiotherapy.
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DOI：
10.1186/1748-717x-9-92
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发表时间：
2014-04-03
期刊：
影响因子：
--
通讯作者：
Kamada T
中科院分区：
文献类型：
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作者：
Sasahara G;Koto M;Ikawa H;Hasegawa A;Takagi R;Okamoto Y;Kamada T
放射性骨坏死（ORN）是头颈部肿瘤接受碳离子（C-ion）或光子放射治疗（RT）后的严重并发症。然而，C-离子RT后ORN的风险因素仍不清楚。因此，本研究的目的是调查的剂量-体积关系的影响和风险因素，ORN发展后，C-离子RT。然而，我们专注于上颌骨，因为大多数肿瘤治疗C-离子RT主要位于鼻腔鼻窦。入组本研究的患者接受了超过10%的处方总剂量57.6戈伊当量（GyE），分16次照射至其上颌骨。所有患者在C-离子放疗后随访2年以上。那些在C-离子放疗前肿瘤侵犯上颌骨或治疗后局部复发的患者被排除在研究之外，以准确评估放射对骨的影响。最终入选患者63例。根据不良事件通用术语标准第4.0版评估ORN的严重程度。回顾性分析临床和剂量学参数与ORN发生率的相关性。中位随访期为79个月。在63例入组患者中，26例发生≥1级ORN。多变量分析显示，上颌骨体积接受超过50 GyE（V50）和牙齿的存在下，在计划的目标体积是显着的风险因素ORN。剂量-体积直方图分析显示，ORN患者的V10至V50参数显著高于无ORN患者。V50和计划目标体积内牙齿的存在是使用16-分数方案的C-离子RT后ORN发展的独立风险因素。
Osteoradionecrosis (ORN) is a critical complication after carbon ion (C-ion) or photon radiotherapy (RT) for head and neck tumors. However, the risk factors for ORN after C-ion RT remain unclear. Therefore, the present study aimed to investigate the effects of the dose-volume relationship on and risk factors for ORN development after C-ion RT. We, however, focused on the maxillary bone because most tumors treated with C-ion RT were primarily located in the sinonasal cavity. The patients enrolled in this study received more than 10% of the prescribed total dose of 57.6 Gy equivalent (GyE) in 16 fractions to their maxilla. All patients were followed up for more than 2 years after C-ion RT. Those with tumor invasion to the maxilla before C-ion RT or local recurrence after the treatment were excluded from the study to accurately evaluate the effects of irradiation on the bone. Sixty-three patients were finally selected. The severity of ORN was assessed according to the Common Terminology Criteria for Adverse Events version 4.0. The correlation between clinical and dosimetric parameters and ORN incidence was retrospectively analyzed. The median follow-up period was 79 months. Of the 63 enrolled patients, 26 developed ORN of grade ≥1. Multivariate analysis revealed that the maxilla volume receiving more than 50 GyE (V50) and the presence of teeth within the planning target volume were significant risk factors for ORN. Dose-volume histogram analysis revealed that V10 to V50 parameters were significantly higher in patients with ORN than in those without ORN. V50 and the presence of teeth within the planning target volume were independent risk factors for the development of ORN after C-ion RT using a 16-fraction protocol.