舌底体积和剂量作为口腔鳞状细胞癌最终或辅助放疗后晚期吞咽困难的预测因素

IF 3.2 Q2 ONCOLOGY

Physics and Imaging in Radiation Oncology Pub Date : 2026-07-01 Epub Date: 2026-07-12 DOI:10.1016/j.phro.2026.101038

Joseph Azria, Arnaud Beddok, Esteban Brenet, Delphine Antoni, Laurence Auzeau, Nathaniel Assouly, Marine Fontaine, Sofiane Guendouzen, Jean-Claude Merol, Yacine Merrouche, Philippe Guilbert, Antonio Da Silva Ribeiro Mota

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引用次数: 0

摘要

背景和目的放射诱导的吞咽困难是影响口腔鳞状细胞癌（OCSCC）患者生活质量的主要因素。虽然对咽部收缩肌的剂量已经进行了广泛的研究，但对舌底（BOT）的研究仍然很少。本研究旨在评估BOT体积和剂量-体积参数与晚期吞咽困难之间的关系。材料与方法回顾性分析2019年至2023年接受体积调节电弧疗法（VMAT）治疗的52例OCSCC患者。所有患者在VMAT前都放置了预防性饲管。舌基使用基于人工智能的分割算法进行描绘，并由高级放射肿瘤学家进行审查。晚期吞咽困难被定义为延长的FT依赖，使用队列特定的第75百分位数（>； 442.5天）。采用logistic回归、受试者工作特征（ROC）曲线分析和Kaplan-Meier法分析BOT （d0% ~ d100%）的体积和剂量/体积参数。结果整个队列的BOT容积中位数为18.4 cm3（四分位数间距[IQR]: 15.7-21.3 cm3）。晚期吞咽困难患者BOT体积小于无吞咽困难患者（15.9 cm3 vs. 19.5 cm3, p = 0.02）。19.12 cm3的BOT容积与吞咽困难风险增加相关。没有剂量/体积参数达到统计学意义，尽管趋势表明BOT D50% <； 52.2 Gy的风险较低（p = 0.21）。整合BOT体积和D50%的联合模型的曲线下面积（AUC）为0.74 （95% CI: 0.61-0.87）。结论：小BOT体积与OCSCC放疗后延长FT依赖的风险增加有关。BOT剂量指标并不显著，但显示出假设产生的趋势，值得在更大的队列和剂量优化研究中验证。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Base of tongue volume and dose as predictors of late dysphagia after definitive or adjuvant radiotherapy for oral cavity squamous cell carcinoma

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Base of tongue volume and dose as predictors of late dysphagia after definitive or adjuvant radiotherapy for oral cavity squamous cell carcinoma

Background and purpose

Radiation-induced dysphagia is a major determinant of quality of life in patients treated for oral cavity squamous cell carcinoma (OCSCC). While dose to the pharyngeal constrictor muscles has been extensively investigated, the base of tongue (BOT) remains poorly studied. This study aimed to evaluate the association between BOT volume and dose–volume parameters and late dysphagia.

Material and methods

Fifty-two patients with OCSCC treated with volumetric modulated arc therapy (VMAT) between 2019 and 2023 were retrospectively analyzed. All patients had a prophylactic feeding tube (FT) placed before VMAT. The base of tongue was delineated using an artificial intelligence-based segmentation algorithm and reviewed by a senior radiation oncologist. Late dysphagia was defined as prolonged FT dependency using the cohort-specific 75th percentile (> 442.5 days). Volumetric and dose/volume parameters of the BOT (D_0%–D_100%) were analyzed using logistic regression, receiver operating characteristic (ROC) curve analysis, and Kaplan–Meier methods.

Results

The median BOT volume for the entire cohort was 18.4 cm³ (interquartile range [IQR]: 15.7–21.3 cm³). Patients with late dysphagia had smaller BOT volumes than those without (15.9 vs. 19.5 cm³, p = 0.02). A BOT volume < 19.12 cm³ was associated with increased dysphagia risk. No dose/volume parameter reached statistical significance, although a trend suggested lower risk for a BOT D_50% < 52.2 Gy (p = 0.21). A combined model integrating BOT volume and D_50% achieved an area under the curve (AUC) of 0.74 (95% CI: 0.61–0.87).

Conclusions

Smaller BOT volume was associated with increased risk of prolonged FT dependency after radiotherapy for OCSCC. BOT dose metrics were not significant but showed hypothesis-generating trends that warrant validation in larger cohorts and dose-optimization studies.

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