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Abstract：
To determine dosimetric parameters associated with osteoradionecrosis (ORN) in oropharyngeal cancer (OPC) patients in the IMRT era.
Subsequent to institutional review board approval, we identified ORN in OPC patients treated with IMRT from 2002 to 2013. 1:2 case-control matching was implemented. Mandibular dose-volume histograms (DVH) were extracted. Dosimetric parameters were compared using non-parametric stats. Recursive partitioning analysis (RPA) was done to identify DVH correlates of ORN.
68 ORN cases and 131 controls were matched. Median follow-up was 41months and median time to development of ORN was 16months. Mandibular mean dose was significantly higher in the ORN cohort (48.1 vs 43.6Gy, p<0.0001). However, the maximum dose was not statistically different. DVH bins from V35 to V73 were all significantly higher in the ORN cohort compared with controls (p<0.0006). Two DVH parameters were identified in RPA analysis, V43 and V58. The majority (81%) of ORN cases were observed with both V44≥42% and V58≥25%.
Our data demonstrate that a wide range of DVH parameters in the intermediate and high beam path were all significantly higher in ORN patients. Mandibular V44<42% and V58<25% represent reasonable DVH constraints for IMRT plan acceptability, when tumor coverage is not compromised.
Subsequent to institutional review board approval, we identified ORN in OPC patients treated with IMRT from 2002 to 2013. 1:2 case-control matching was implemented. Mandibular dose-volume histograms (DVH) were extracted. Dosimetric parameters were compared using non-parametric stats. Recursive partitioning analysis (RPA) was done to identify DVH correlates of ORN.
68 ORN cases and 131 controls were matched. Median follow-up was 41months and median time to development of ORN was 16months. Mandibular mean dose was significantly higher in the ORN cohort (48.1 vs 43.6Gy, p<0.0001). However, the maximum dose was not statistically different. DVH bins from V35 to V73 were all significantly higher in the ORN cohort compared with controls (p<0.0006). Two DVH parameters were identified in RPA analysis, V43 and V58. The majority (81%) of ORN cases were observed with both V44≥42% and V58≥25%.
Our data demonstrate that a wide range of DVH parameters in the intermediate and high beam path were all significantly higher in ORN patients. Mandibular V44<42% and V58<25% represent reasonable DVH constraints for IMRT plan acceptability, when tumor coverage is not compromised.
摘要：
确定IMRT时代口咽恶性肿瘤（OPC）患者与骨坏死（ORN）相关的剂量学参数。
在机构审查委员会批准后，我们在2002年至2013年接受IMRT治疗的OPC患者中发现了ORN.实施1:2病例对照匹配。提取下颌剂量-体积直方图（DVH）。使用非参数统计比较剂量学参数。进行递归划分分析(RPA)以鉴定ORN的DVH相关物。
68例ORN病例和131例对照匹配。中位随访时间为41个月，ORN发展的中位时间为16个月。ORN队列中下颌平均剂量明显较高（48.1vs43.6Gy，p<0.0001)。然而,最大剂量无统计学差异.与对照组相比，ORN队列中从V35到V73的DVHbin均显着较高（p<0.0006）。在RPA分析中确定了两个DVH参数，V43和V58。观察到大多数（81％）ORN病例的V44≥42％和V58≥25％。
我们的数据表明，在ORN患者中，中等和高光束路径中的DVH参数范围均显着较高。下颌V44<42%和V58<25%代表IMRT计划可接受性的合理DVH约束，当肿瘤覆盖率不受影响时。
在机构审查委员会批准后，我们在2002年至2013年接受IMRT治疗的OPC患者中发现了ORN.实施1:2病例对照匹配。提取下颌剂量-体积直方图（DVH）。使用非参数统计比较剂量学参数。进行递归划分分析(RPA)以鉴定ORN的DVH相关物。
68例ORN病例和131例对照匹配。中位随访时间为41个月，ORN发展的中位时间为16个月。ORN队列中下颌平均剂量明显较高（48.1vs43.6Gy，p<0.0001)。然而,最大剂量无统计学差异.与对照组相比，ORN队列中从V35到V73的DVHbin均显着较高（p<0.0006）。在RPA分析中确定了两个DVH参数，V43和V58。观察到大多数（81％）ORN病例的V44≥42％和V58≥25％。
我们的数据表明，在ORN患者中，中等和高光束路径中的DVH参数范围均显着较高。下颌V44<42%和V58<25%代表IMRT计划可接受性的合理DVH约束，当肿瘤覆盖率不受影响时。
