PDF(Sci-hub)
Abstract：
UNASSIGNED: Dysphagia is a common, severe and dose-limiting toxicity after oncological treatment of head and neck cancer (HNC). This study aims to investigate relationships between radiation doses to structures involved in normal swallowing and patient-reported as well as clinically measured swallowing function in HNC patients after curative (chemo-) radiation therapy (RT) with focus on late effects.
UNASSIGNED: Patients (n = 90) with HNC curatively treated with RT ± chemotherapy in 2007-2015 were assessed for dysphagia post-treatment by telephone interview and videofluoroscopy (VFS). A study-specific symptom score was used to determine patient-reported dysphagia. The Penetration-Aspiration Scale (PAS) was applied to determine swallowing function by VFS (PAS ≥ 4/ ≥ 6 = moderate/severe dysphagia). Thirteen anatomical structures involved in normal swallowing were individually delineated on the patients\' original planning CT scans and associated dose-volume histograms (DVHs) retrieved. Relationships between structure doses and late toxicity were investigated through univariable and multivariable logistic regression analysis (UVA/MVA) accounting for effects by relevant clinical factors.
UNASSIGNED: Median assessment time was 7 months post-RT (range: 5-34 months). Mean dose to the contralateral parotid gland and supraglottic larynx as well as maximum dose to the contralateral anterior digastric muscle predicted patient-reported dysphagia (AUC = 0.64-0.67). Mean dose to the pharyngeal constrictor muscle, the larynx, the supraglottic larynx and the epiglottis, as well as maximum dose to the contralateral submandibular gland predicted moderate and severe dysphagia by VFS (AUC = 0.71-0.80).
UNASSIGNED: The patients in this cohort were consecutively identified pre-treatment, and were structurally approached and assessed for dysphagia after treatment at a specific time point. In addition to established dysphagia organs-at-risk (OARs), our data suggest that epiglottic and submandibular gland doses are important for swallowing function post-RT. Keeping DVH thresholds below V60 = 60% and V60 = 17%, respectively, may increase chances to reduce occurrence of severe late dysphagia. The results need to be externally validated in future studies.
UNASSIGNED: Patients (n = 90) with HNC curatively treated with RT ± chemotherapy in 2007-2015 were assessed for dysphagia post-treatment by telephone interview and videofluoroscopy (VFS). A study-specific symptom score was used to determine patient-reported dysphagia. The Penetration-Aspiration Scale (PAS) was applied to determine swallowing function by VFS (PAS ≥ 4/ ≥ 6 = moderate/severe dysphagia). Thirteen anatomical structures involved in normal swallowing were individually delineated on the patients\' original planning CT scans and associated dose-volume histograms (DVHs) retrieved. Relationships between structure doses and late toxicity were investigated through univariable and multivariable logistic regression analysis (UVA/MVA) accounting for effects by relevant clinical factors.
UNASSIGNED: Median assessment time was 7 months post-RT (range: 5-34 months). Mean dose to the contralateral parotid gland and supraglottic larynx as well as maximum dose to the contralateral anterior digastric muscle predicted patient-reported dysphagia (AUC = 0.64-0.67). Mean dose to the pharyngeal constrictor muscle, the larynx, the supraglottic larynx and the epiglottis, as well as maximum dose to the contralateral submandibular gland predicted moderate and severe dysphagia by VFS (AUC = 0.71-0.80).
UNASSIGNED: The patients in this cohort were consecutively identified pre-treatment, and were structurally approached and assessed for dysphagia after treatment at a specific time point. In addition to established dysphagia organs-at-risk (OARs), our data suggest that epiglottic and submandibular gland doses are important for swallowing function post-RT. Keeping DVH thresholds below V60 = 60% and V60 = 17%, respectively, may increase chances to reduce occurrence of severe late dysphagia. The results need to be externally validated in future studies.
摘要：
■吞咽困难是常见的，头颈部肿瘤治疗后的严重和剂量限制性毒性（HNC）。本研究旨在研究治疗性（化学）放射治疗（RT）后HNC患者的正常吞咽结构与患者报告的放射剂量之间的关系以及临床测量的吞咽功能，重点是后期效果。
■2007-2015年接受RT±化疗治疗的HNC患者（n=90）通过电话访谈和视频透视（VFS）评估治疗后吞咽困难。研究特定的症状评分用于确定患者报告的吞咽困难。应用穿透抽吸量表（PAS）通过VFS确定吞咽功能（PAS≥4/≥6=中度/重度吞咽困难）。在患者的原始计划CT扫描和检索的相关剂量-体积直方图（DVH）上分别描绘了正常吞咽中涉及的13个解剖结构。通过单变量和多变量逻辑回归分析（UVA/MVA）研究了结构剂量与晚期毒性之间的关系，并考虑了相关临床因素的影响。
■中位评估时间为RT后7个月（范围：5-34个月）。对侧腮腺和声门上喉的平均剂量以及对侧前腹肌的最大剂量预测了患者报告的吞咽困难（AUC=0.64-0.67）。咽缩肌的平均剂量，喉部,声门上喉和会厌,以及对侧颌下腺的最大剂量通过VFS预测了中度和重度吞咽困难（AUC=0.71-0.80）。
■该队列中的患者在治疗前被连续识别，并在治疗后的特定时间点进行结构接近和评估吞咽困难。除了确定的吞咽困难危险器官（OAR），我们的数据表明,会厌和颌下腺剂量对RT后吞咽功能很重要.保持DVH阈值低于V60=60%和V60=17%，分别,可能会增加机会，以减少严重的晚期吞咽困难的发生。结果需要在未来的研究中进行外部验证。
■2007-2015年接受RT±化疗治疗的HNC患者（n=90）通过电话访谈和视频透视（VFS）评估治疗后吞咽困难。研究特定的症状评分用于确定患者报告的吞咽困难。应用穿透抽吸量表（PAS）通过VFS确定吞咽功能（PAS≥4/≥6=中度/重度吞咽困难）。在患者的原始计划CT扫描和检索的相关剂量-体积直方图（DVH）上分别描绘了正常吞咽中涉及的13个解剖结构。通过单变量和多变量逻辑回归分析（UVA/MVA）研究了结构剂量与晚期毒性之间的关系，并考虑了相关临床因素的影响。
■中位评估时间为RT后7个月（范围：5-34个月）。对侧腮腺和声门上喉的平均剂量以及对侧前腹肌的最大剂量预测了患者报告的吞咽困难（AUC=0.64-0.67）。咽缩肌的平均剂量，喉部,声门上喉和会厌,以及对侧颌下腺的最大剂量通过VFS预测了中度和重度吞咽困难（AUC=0.71-0.80）。
■该队列中的患者在治疗前被连续识别，并在治疗后的特定时间点进行结构接近和评估吞咽困难。除了确定的吞咽困难危险器官（OAR），我们的数据表明,会厌和颌下腺剂量对RT后吞咽功能很重要.保持DVH阈值低于V60=60%和V60=17%，分别,可能会增加机会，以减少严重的晚期吞咽困难的发生。结果需要在未来的研究中进行外部验证。
