介绍头颈部鳞状细胞癌(HNSCC)在印度是一个重要的健康问题,每年大约有100万新病例。HNSCC在亚洲的患病率很高,尤其是在印度,由于咀嚼烟草等习惯,槟榔的用法,和酒精消费。治疗通常包括手术的组合,辐射,化疗,和生物治疗,旨在控制肿瘤,同时保持功能和生活质量。然而,幸存者经常面临吞咽困难等长期副作用,导致吸入性肺炎等并发症。调强放疗(IMRT)已显示出通过保留关键的吞咽结构来改善结果的希望。尽量减少辐射相关吞咽困难的努力对于提高患者治疗后的生活质量至关重要。我们的研究重点是检查与吞咽困难误吸相关的剂量学参数,同时使用RTOG量表评估两个治疗组的吞咽困难等级。材料和方法2018年11月至2020年4月,我们将组织学证实的非转移性头颈部癌患者纳入研究。总共56名患者被纳入我们的研究,每臂28名。他们接受了根治性放疗(RT),总剂量为66-70Gy,有或没有同步化疗,符合特定的纳入标准,排除接受再照射或远处转移的患者。将患者分为两组:I组接受三维适形放疗(3D-CRT),第二组接受了IMRT。治疗计划涉及固定,CT成像,目标体积和危险器官的轮廓,和吞咽结构的轮廓。剂量-体积直方图参数(平均剂量,最大剂量,V30,V70,V80,D50和D80)用于评估计划目标体积(PTV)之外的吞咽结构的平均剂量,平均剂量约束为50Gy。在基线时使用RTOG标准评估吞咽困难,治疗期间,治疗后六个月。统计分析采用SPSS,显著性设置为p<0.05。结果在我们的研究中,IMRT和3D-CRT组的平均年龄略有不同:58岁与55岁,分别。两组患者中出现症状三到六个月的比例较高,53.6%的3D-CRT和42.9%的IMRT。阶段分布各不相同,IV在3D-CRT中最常见,而II期在IMRT中最常见。两组中约有56%的患者有吸烟史。在3DCRT和IMRT技术之间观察到脊髓剂量的显着差异(p<0.001)。同样,在3D-CRT和IMRT组之间,吞咽困难误吸相关结构(DARSs)接受的平均剂量存在显著差异(p=0.04).与3D-CRT组患者相比,IMRT组患者的吞咽困难等级更高,在第三个月(p=0.008)和第六个月(p=0.048)观察到统计学意义。结论我们的研究发现,与3D-CRT组相比,IMRT组3个月和6个月时的平均DARS剂量显着降低,吞咽困难严重程度降低。然而,由于研究人群的多样性,在DARS剂量和吞咽困难严重程度之间建立明确的相关性具有挑战性.需要未来的大规模研究来验证这些发现,以改善DARS结构的保存。
Introduction Head and neck squamous cell carcinoma (HNSCC) is a significant health concern in India, with around one million new cases annually. The prevalence of HNSCC is notably high in Asia, especially in India, due to habits like tobacco chewing, betel nut usage, and alcohol consumption. Treatment typically involves a combination of surgery, radiation, chemotherapy, and biological therapy, aiming for tumor control while preserving function and quality of life. However, survivors often face long-term side effects like difficulty swallowing, leading to complications such as aspiration pneumonia. Intensity-modulated radiotherapy (IMRT) has shown promise in improving outcomes by sparing critical swallowing structures. Efforts to minimize radiation-related dysphagia are crucial for enhancing patients\' quality of life post-treatment. Our study focuses on examining dosimetric parameters associated with dysphagia aspiration, alongside evaluating dysphagia grades in both treatment groups using the RTOG scale. Material and methods Patients with histologically confirmed non-metastatic head and neck carcinomas were included in our study in November 2018-April 2020. A total of 56 patients were taken into our study with 28 in each arm. They underwent radical radiotherapy (RT) with a total dose of 66-70 Gy, with or without concurrent chemotherapy, meeting specific inclusion criteria and excluding those receiving reirradiation or with distant metastasis. Patients were divided into two groups: Group I received three-dimensional conformal radiotherapy (3D-CRT), and Group II received IMRT. Treatment planning involved immobilization, CT imaging, delineation of target volumes and organs at risk, and contouring of swallowing structures. Dose-volume histogram parameters (mean dose, maximum dose, V30, V70, V80, D50, and D80) were used to assess mean dose to swallowing structures outside the planning target volume (PTV), with a mean dose constraint of 50 Gy. Dysphagia was evaluated using the RTOG criteria at baseline, during treatment, and six months post-treatment. Statistical analysis was performed using SPSS, with significance set at p < 0.05. Results In our study, the mean age at presentation differed slightly between the IMRT and 3D-CRT arms: 58 years versus 55 years, respectively. A higher proportion of patients in both arms experienced symptoms for three to six months, with 53.6% in 3D-CRT and 42.9% in IMRT. Stage distribution varied, with IV being most common in 3D-CRT and stage II in IMRT. Approximately 56% of patients in both groups had a history of smoking. Significant differences were observed in spinal cord dose between 3DCRT and IMRT techniques (p < 0.001). Similarly, a significant difference was found in the mean dose received by dysphagia aspiration-related structures (DARSs) between the 3D-CRT and IMRT arms (p = 0.04). Patients in the IMRT arm exhibited superior dysphagia grades compared to those in the 3D-CRT arm, with statistical significance observed in the third month (p = 0.008) and sixth month (p = 0.048). Conclusion Our study found a notable decrease in the mean DARS dose and reduced dysphagia severity at three and six months in the IMRT group compared to the 3D-CRT group. However, due to the diverse study population, establishing a definitive correlation between the DARS dose and dysphagia severity was challenging. Future large-scale studies are needed to validate these findings for improved preservation of DARS structures.