PDF(Pubmed)
Abstract：
OBJECTIVE: Active radiation skin injury (ARSI) has the highest incidence of acute adverse reactions caused by radiotherapy (RT) in patients with head and neck cancer (HNC). This study aimed to screen risk factors that can facilitate the identification of HNC patients at high risk of ARSI.
METHODS: Data from 255 stage III-IV HNC patients who underwent intensity-modulated radiation therapy (IMRT) were collected. The data from our medical records, including clinical characteristics and hematological indices before RT, were retrospectively collected and arranged. The Common Terminology Criteria for Adverse Events Criteria (CTCAE), Radiation Therapy Oncology Group Criteria (RTOG), World Health Organization Criteria (WHO), Oncology Nursing Society (ONS), Acute Radiation Dermatitis Graduation Scale, Douglas & Fowler and Radiation Dermatitis Severity Scale (RDSS) were used to assess ARSI. Of these, CTCAE was used for further analysis. Binary logistic regression analyses were used to identity risk factors. To establish the correction between each risk factor and the ARSI score, the odds ratio (OR) and 95% confidence interval (CI) were computed.
RESULTS: The assessment results of the CTCAE with RTOG, WHO, ONS, Graduation Scale, Douglas & Fowler and RDSS have good consistency. After radiotherapy, 18.4% of patients had at least 3 (3 +) grade ARSI. Multivariate logistic regression analysis revealed that the KPS score, blood glucose level, white blood cell count, and plasma free thyroxine (FT4) concentration were independent risk factors for 3 + grade ARSI. A nomogram was constructed on the basis of these risk factors, which demonstrated good predictive power according to the area under the ROC curve (AUC). The satisfactory consistency and clinical efficacy of the nomogram were confirmed by calibration curves and decision curve analysis (DCA).
CONCLUSIONS: A low KPS score, high blood glucose level, high white blood cell count, and high thyroid hormone prior to radiotherapy for stage III-IV HNC are independent risk factors for grade 3 + RSI.
METHODS: Data from 255 stage III-IV HNC patients who underwent intensity-modulated radiation therapy (IMRT) were collected. The data from our medical records, including clinical characteristics and hematological indices before RT, were retrospectively collected and arranged. The Common Terminology Criteria for Adverse Events Criteria (CTCAE), Radiation Therapy Oncology Group Criteria (RTOG), World Health Organization Criteria (WHO), Oncology Nursing Society (ONS), Acute Radiation Dermatitis Graduation Scale, Douglas & Fowler and Radiation Dermatitis Severity Scale (RDSS) were used to assess ARSI. Of these, CTCAE was used for further analysis. Binary logistic regression analyses were used to identity risk factors. To establish the correction between each risk factor and the ARSI score, the odds ratio (OR) and 95% confidence interval (CI) were computed.
RESULTS: The assessment results of the CTCAE with RTOG, WHO, ONS, Graduation Scale, Douglas & Fowler and RDSS have good consistency. After radiotherapy, 18.4% of patients had at least 3 (3 +) grade ARSI. Multivariate logistic regression analysis revealed that the KPS score, blood glucose level, white blood cell count, and plasma free thyroxine (FT4) concentration were independent risk factors for 3 + grade ARSI. A nomogram was constructed on the basis of these risk factors, which demonstrated good predictive power according to the area under the ROC curve (AUC). The satisfactory consistency and clinical efficacy of the nomogram were confirmed by calibration curves and decision curve analysis (DCA).
CONCLUSIONS: A low KPS score, high blood glucose level, high white blood cell count, and high thyroid hormone prior to radiotherapy for stage III-IV HNC are independent risk factors for grade 3 + RSI.
摘要：
目的：头颈部肿瘤（HNC）患者放疗（RT）引起的急性不良反应发生率最高的是放射性皮肤损伤（ARSI）。这项研究旨在筛选可以帮助识别ARSI高危HNC患者的危险因素。
方法：收集255例接受调强放疗（IMRT）的III-IV期HNC患者的数据。我们医疗记录中的数据,包括RT前的临床特征和血液学指标，进行回顾性收集和安排。不良事件标准通用术语标准(CTCAE)放射治疗肿瘤组标准（RTOG），世界卫生组织标准（WHO）肿瘤护理学会（ONS），急性放射性皮炎毕业量表,采用Douglas&Fowler和放射性皮炎严重程度量表(RDSS)评估ARSI。其中,CTCAE用于进一步分析。采用二元logistic回归分析确定危险因素。为了建立每个风险因素与ARSI评分之间的校正，计算比值比(OR)和95%置信区间(CI).
结果：使用RTOG对CTCAE的评估结果，WHO,ONS,毕业量表,Douglas&Fowler和RDSS有很好的一致性。放疗后,18.4%的患者至少有3(3+)级ARSI。多因素logistic回归分析显示，KPS评分，血糖水平，白细胞计数,血浆游离甲状腺素（FT4）浓度是3级ARSI的独立危险因素。根据这些风险因素构建列线图，根据ROC曲线下面积（AUC）显示出良好的预测能力。通过校准曲线和决策曲线分析（DCA）证实了列线图的一致性和临床疗效。
结论：KPS得分低，高血糖水平，高白细胞计数,III-IV期HNC放疗前甲状腺激素升高是3+RSI的独立危险因素.
方法：收集255例接受调强放疗（IMRT）的III-IV期HNC患者的数据。我们医疗记录中的数据,包括RT前的临床特征和血液学指标，进行回顾性收集和安排。不良事件标准通用术语标准(CTCAE)放射治疗肿瘤组标准（RTOG），世界卫生组织标准（WHO）肿瘤护理学会（ONS），急性放射性皮炎毕业量表,采用Douglas&Fowler和放射性皮炎严重程度量表(RDSS)评估ARSI。其中,CTCAE用于进一步分析。采用二元logistic回归分析确定危险因素。为了建立每个风险因素与ARSI评分之间的校正，计算比值比(OR)和95%置信区间(CI).
结果：使用RTOG对CTCAE的评估结果，WHO,ONS,毕业量表,Douglas&Fowler和RDSS有很好的一致性。放疗后,18.4%的患者至少有3(3+)级ARSI。多因素logistic回归分析显示，KPS评分，血糖水平，白细胞计数,血浆游离甲状腺素（FT4）浓度是3级ARSI的独立危险因素。根据这些风险因素构建列线图，根据ROC曲线下面积（AUC）显示出良好的预测能力。通过校准曲线和决策曲线分析（DCA）证实了列线图的一致性和临床疗效。
结论：KPS得分低，高血糖水平，高白细胞计数,III-IV期HNC放疗前甲状腺激素升高是3+RSI的独立危险因素.
