Impact of Radiotherapy Dose on Dentition Breakdown in Head and Neck Cancer Patients.
Impact of Radiotherapy Dose on Dentition Breakdown in Head and Neck Cancer Patients.
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放射疗法剂量对头颈癌患者牙列崩溃的影响。
DOI：
10.1016/j.prro.2011.03.003
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发表时间：
2011
影响因子：
3.3
通讯作者：
Williams KB
中科院分区：
文献类型：
--
作者：
Walker MP;Wichman B;Cheng AL;Coster J;Williams KB
评估头颈部癌症患者放射后牙齿病变的严重程度以及与牙齿辐射剂量的可能相关性。回顾性分析1997年至2008年接受头颈部放射治疗的93例患者的资料。主要影响，辐射剂量的个别牙齿，与辐射后，口干，局部氟化物的使用，口腔卫生状况的协变量进行了评估。使用患者的放射治疗计划来计算每颗牙齿的累积暴露量。使用经验证的指数评估患者的牙齿，然后将其分类为无/轻微或中度/重度辐射后损伤。患者（31名女性，62名男性）年龄范围为18-82岁（平均=57岁）。每例患者的牙齿数量范围为3-30颗（平均=20颗），共评价了1873颗牙齿。总体而言，51%的牙齿有中度或重度损伤，其余的牙齿几乎没有或没有损伤。使用比值比和95%置信区间，与无辐射相比，暴露于30-60戈伊之间的牙齿的中度/重度损伤的几率高2- 3倍。然而，对于暴露于≥60戈伊的牙齿，与无辐射相比，中度/重度牙齿损伤的几率高10倍。结果表明，低于30戈伊（唾液腺阈值）时，牙齿损伤最小，30- 60年之间的剂量-反应增加大于1：1，可能与唾液腺损伤有关，≥ 60戈伊的临界阈值可能与辐射对牙齿结构的直接影响有关。这些发现表明，在治疗计划过程中应注意限制牙齿剂量，并在临床上可能时将牙齿剂量限制在60戈伊以下。
To evaluate the severity of post-radiation dental lesions and possible correlation with radiation dose to the teeth in patients treated for head and neck cancers. Data from 93 head and neck radiotherapy patients treated between 1997 and 2008 were analyzed retrospectively. The main effect, radiation dose to the individual teeth, was evaluated with covariates of elapsed time after radiation, xerostomia, topical fluoride use, and oral hygiene status included. Patients’ radiotherapy plans were used to calculate cumulative exposure for each tooth. Patients’ teeth were evaluated using a validated index and then categorized as having none/slight or moderate/severe post-radiation damage. Patients (31 females, 62 males) ranged in age from 18–82 yrs (mean=57). The number of teeth/patient ranged from 3–30 (mean=20) with a total of 1873 teeth evaluated. Overall, 51% of teeth had moderate/severe damage, with the remaining having little or none. Using odds ratios and 95% confidence intervals, the odds for moderate/severe damage were 2–3x greater for teeth exposed to between 30–60 Gy as compared to no radiation. However, for teeth exposed to ≥60 Gy as compared to no radiation the odds of moderate/severe tooth damage was greater by a magnitude of 10 times. The results indicate that there is minimal tooth damage below 30 Gy (salivary gland threshold), a greater than 1:1 increased dose-response between 30–60y likely related to salivary gland damage, and a critical threshold of ≥60Gy which may be linked to direct effects of radiation on tooth structure. These findings suggest that care should be taken during the treatment planning process to limit tooth dose, and when clinically possible to limit tooth dose to less than 60 Gy.