鼻咽癌患者接受断层治疗时口腔黏膜轮廓法的推荐

中华放射肿瘤学杂志 Pub Date : 2020-01-15 DOI:10.3760/CMA.J.ISSN.1004-4221.2020.01.003

Yuanyuan Chen, Peijing Li, Shuangyan Yang, J. Fang, Jiang Zhang, Q. Hu, Ming Chen, Xiaozhong Chen, Ye Tian

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引用次数: 0

摘要

目的评价两种口腔黏膜轮廓法对鼻咽癌患者急性放射性口腔黏膜炎(A-ROM)的预测价值。方法选取2017 - 2019年在浙江省肿瘤医院接受根治性放疗(TOMO)的AJCC 7期Ⅱ-IVB NPCs患者150例作为前瞻性观察研究对象。采用口腔轮廓(OCC)和粘膜表面轮廓(MSC)来描绘口腔粘膜结构。根据RTOG评分标准，每周对A-ROM评分进行前瞻性评估和记录。统计比较两种方法对A-ROM的预测值。结果≥3级A-ROM发生率为33.3%。单因素分析中，OCC的V5、V10、V15、V45、V50、V55、V60、V65、V70和MSC的V5、V10、V50、V55、V60、V65、V70和Dmean与A-ROM≥3级的风险显著相关(均P<0.05)。在二元logistic回归分析中，性别和吸烟与OCC检测的≥3级A-ROM发生率显著相关(男vs女:OR=0.141, 95%CI=0.037 ~ 0.538, P=0.004;吸烟vs.不吸烟:OR=5.109, 95%CI=1.413-18.470, P=0.013)。对于MSC，性别、吸烟、N期和MSC- V55是独立预测因素(男性vs女性:OR=0.129, 95%CI=0.032-0.519, P=0.004;吸烟vs.不吸烟:OR=4.448, 95%CI=1.224 ~ 16.164, P=0.023;N期:OR=2.291, 95%CI=1.268 ~ 4.137, P=0.006;Msc-v55: or =1.432, 95%ci =1.008-2.033, p =0.045)。回顾性分析，MSC-V55的截止值为7.70%，ROC曲线下面积为0.754，敏感性和特异性分别为0.680和0.740 (P均<0.001)。结论与OCC相比，MSC对接受TOMO治疗的鼻咽癌患者a - rom严重程度的预测准确度更高。关键词:鼻咽肿瘤/断层扫描治疗;急性放射性口腔黏膜炎;剂量测定的参数

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Recommendation for an oral mucosal contouring method in nasopharyngeal carcinoma patients receiving tomotherapy

Objective To evaluate the value of two oral mucosal contouring methods for predicting acute radiation-induced oral mucositis (A-ROM) in nasopharyngeal carcinoma (NPC) patients. Methods A total of 150 AJCC 7th stage Ⅱ-IVB NPCs receiving radical tomotherapy (TOMO) in Zhejiang Cancer Hospital from 2017 to 2019 were included in this prospective observational study. Oral cavity contour (OCC) and mucosal surface contour (MSC) were applied to delineate the oral mucosal structure. A-ROM grade was prospectively assessed and recorded weekly according to RTOG scoring criteria. The prediction value of two methods for A-ROM was statistically compared. Results The incidence rate of ≥3 grade A-ROM was 33.3%. In univariate analysis, V5, V10, V15, V45, V50, V55, V60, V65 and V70 of OCC and V5, V10, V50, V55, V60, V65, V70 and Dmean of MSC were significantly correlated with the risk of ≥3 grade A-ROM (all P<0.05). In binary logistic regression analysis, gender and smoking were significantly associated with the incidence of ≥3 grade A-ROM by using OCC (male vs. female: OR=0.141, 95%CI=0.037-0.538, P=0.004; smoking vs.non-smoking: OR=5.109, 95%CI=1.413-18.470, P=0.013). For MSC, gender, smoking, N stage and MSC- V55 were the independent predictors (male vs. female: OR=0.129, 95%CI=0.032-0.519, P=0.004; smoking vs.non-smoking: OR=4.448, 95%CI=1.224-16.164, P=0.023; N stage: OR=2.291, 95%CI=1.268-4.137, P=0.006; MSC-V55: OR=1.432, 95%CI=1.008-2.033, P=0.045). The cutoff value of MSC-V55 was 7.70%, the area under ROC curve was 0.754, the sensitivity and specificity were 0.680 and 0.740, retrospectively (all P<0.001). Conclusions Compared with OCC, MSC yields a higher prediction accuracy for the severity of A-ROM in nasopharyngeal carcinoma patients receiving TOMO treatment. Key words: Nasopharyngeal neoplasms/tomography therapy; Acute radiation-induced oral mucositis; Dosimetric parameter

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来源期刊

中华放射肿瘤学杂志

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6375

期刊介绍： The Chinese Journal of Radiation Oncology is a national academic journal sponsored by the Chinese Medical Association. It was founded in 1992 and the title was written by Chen Minzhang, the former Minister of Health. Its predecessor was the Chinese Journal of Radiation Oncology, which was founded in 1987. The journal is an authoritative journal in the field of radiation oncology in my country. It focuses on clinical tumor radiotherapy, tumor radiation physics, tumor radiation biology, and thermal therapy. Its main readers are middle and senior clinical doctors and scientific researchers. It is now a monthly journal with a large 16-page format and 80 pages of text. For many years, it has adhered to the principle of combining theory with practice and combining improvement with popularization. It now has columns such as monographs, head and neck tumors (monographs), chest tumors (monographs), abdominal tumors (monographs), physics, technology, biology (monographs), reviews, and investigations and research.