Predictors for trismus in patients receiving radiotherapy
Predictors for trismus in patients receiving radiotherapy
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DOI：
10.1080/0284186x.2016.1223341
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发表时间：
2016-01-01
期刊：
影响因子：
3.1
通讯作者：
Dijkstra, Pieter U.
中科院分区：
文献类型：
--
作者：
van der Geer, S. Joyce;Kamstra, Jolanda I.;Dijkstra, Pieter U.
背景资料：牙关紧闭是头颈部癌症患者张口受限的一种症状，可能是由于肿瘤浸润咀嚼肌、放射性纤维化或手术后瘢痕形成所致。它可能会严重影响口腔功能。我们研究的目的是确定：（1）不同时间点牙关紧闭的发生率;（2）使用大型数据库（n=641）预测头颈部癌症患者放疗后牙关紧闭发展的患者、肿瘤和治疗特征。在放疗前和放疗后6、12、18、24、36和48个月测量最大张口度。患者，肿瘤和治疗特点进行了分析，作为潜在的预测牙关紧闭症使用多变量logistic回归analysis.Results：在放疗后6个月，28.1%的患者没有牙关紧闭症放疗前首次发展牙关紧闭症。在随后的时间点，发病率下降。在放疗后的48个月内，牙关紧闭的发生率为3.6/10人年。肿瘤位于口腔、口咽或鼻咽、唾液腺或耳部的患者，以及放疗总治疗时间较长的患者，在放疗后的前6个月内更容易发生牙关紧闭。最大开口是一个预测发展牙关紧闭症在所有的时间points.Conclusion：牙关紧闭症的发病率是3.6每10人年的风险。肿瘤定位和放疗的总治疗时间是放疗后前六个月发生牙关紧闭的预测因素。最大张口度是所有时间点发生牙关紧闭的重要预测因子。需要定期测量最大张口度来预测牙关紧闭。
Background: Trismus, a restricted mouth opening in head and neck cancer patients may be caused by tumor infiltration in masticatory muscles, radiation-induced fibrosis or scarring after surgery. It may impede oral functioning severely. The aims of our study were to determine: (1) the incidence of trismus at various time points; and (2) the patient, tumor, and treatment characteristics that predict the development of trismus after radiotherapy in head and neck cancer patients using a large database (n=641).Methods: Maximal mouth opening was measured prior to and 6, 12, 18, 24, 36, and 48 months after radiotherapy. Patient, tumor, and treatment characteristics were analyzed as potential predictors for trismus using a multivariable logistic regression analysis.Results: At six months after radiotherapy, 28.1% of the patients without trismus prior to radiotherapy developed trismus for the first time. At subsequent time points the incidence declined. Over a total period of 48 months after radiotherapy, the incidence of trismus was 3.6 per 10 person years at risk. Patients who had tumors located in the oral cavity, oropharynx or nasopharynx, and the salivary glands or ear, and who had a longer overall treatment time of radiotherapy, were more likely to develop trismus in the first six months after radiotherapy. Maximal mouth opening was a predictor for developing trismus at all time points.Conclusion: Incidence of trismus is 3.6 per 10 person years at risk. Tumor localization and overall treatment time of radiotherapy are predictors for developing trismus the first six months after radiotherapy. Maximal mouth opening is a significant predictor for developing trismus at all time points. Regular measurements of maximal mouth opening are needed to predict trismus.