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首页> 美国卫生研究院文献>Translational Oncology >Oral Mucosa Dose Parameters Predicting Grade ≥3 Acute Toxicity in Locally Advanced Nasopharyngeal Carcinoma Patients Treated With Concurrent Intensity-Modulated Radiation Therapy and Chemotherapy: An Independent Validation Study Comparing Oral Cavity versus Mucosal Surface Contouring Techniques
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Oral Mucosa Dose Parameters Predicting Grade ≥3 Acute Toxicity in Locally Advanced Nasopharyngeal Carcinoma Patients Treated With Concurrent Intensity-Modulated Radiation Therapy and Chemotherapy: An Independent Validation Study Comparing Oral Cavity versus Mucosal Surface Contouring Techniques

机译：并发调强放射治疗和化学疗法治疗的局部晚期鼻咽癌患者的口腔粘膜剂量参数可预测≥3级急性毒性：比较口腔和粘膜表面轮廓技术的一项独立验证研究

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PURPOSE: To determine whether volumes based on the contours of the mucosal surface instead of the oral cavity can be used to predict grade ≥3 acute oral mucosa toxicity in patients with locally advanced nasopharyngeal carcinoma (LANPC) treated with concurrent intensity-modulated radiation therapy (IMRT) and chemotherapy. METHODS AND MATERIALS: A standardized method for the oral cavity (oral cavity contours, OCC) and a novel method for the mucosal surface (mucosal surface contours, MSC) were developed for the oral mucosa and prospectively applied to the radiation treatment plans of 92 patients treated with concurrent IMRT and chemotherapy for LANPC. Dose–volume histogram (DVH) data were extracted and then toxicity was analyzed. Receiver operating characteristic analysis and logistic regression were carried out for both contouring methods. RESULTS: Grade ≥3 acute oral mucosa toxicity occurred to 20.7% (19/92) of patients in the study. A highly significant dose–volume relationship between oral mucosa irradiation and acute oral mucosa toxicity was supported by using both oral cavity and mucosal surface contouring techniques. In logistic regression, body weight loss was an independent factor related to grade ≥3 acute toxicity for OCC and MSC (P = .017 and 0.005, respectively), and the independent factor of dosimetric parameters for OCC and MSC were V30Gy (P = .003) and V50Gy (P = .003) respectively. In the receiver operating characteristics curve, the areas under V30Gy of the OCC curves was 0.753 (P = .001), while the areas under V50Gy of MSC curves was 0.714 (P = .004); the cut-off value was 73.155% (sensitivity, 0.842; specificity, 0.671) and 14.32% (sensitivity, 0.842; specificity, 0.575), respectively. CONCLUSION: DVH analysis of mucosal surface volumes accurately predicts grade ≥3 acute oral mucosa toxicity in patients with LANPC receiving concurrent IMRT and chemotherapy, but in clinical practice the MSC method appears no better than the OCC one.
机译：目的：确定基于粘膜表面轮廓而不是口腔的体积是否可用于预测同时进行强度调制放射治疗的局部晚期鼻咽癌（LANPC）患者的≥3级急性口腔粘膜毒性（ IMRT）和化疗。方法和材料：制定了口腔粘膜的标准化方法（口腔轮廓，OCC）和粘膜表面的新方法（粘膜表面轮廓，MSC），并有望应用于92例患者的放射治疗计划中同时进行IMRT和LANPC化疗。提取剂量-体积直方图（DVH）数据，然后分析毒性。两种轮廓法均进行了接收机工作特性分析和逻辑回归。结果：本研究患者发生20.7％（19/92）的急性口腔粘膜毒性≥3级。口腔粘膜表面轮廓技术都支持口腔粘膜辐射与急性口腔粘膜毒性之间高度显着的剂量-体积关系。在逻辑回归中，体重减轻是与OCC和MSC≥3级急性毒性相关的独立因素（分别为P = .017和0.005），而OCC和MSC的剂量学参数的独立因素为V30Gy（P =。 003）和V50Gy（P = .003）。在接收器工作特性曲线中，OCC曲线的V30Gy下的面积为0.753（P = .001），而MSC曲线的V50Gy下的面积为0.714（P = .004）;截断值分别为73.155％（敏感性0.842；特异性0.671）和14.32％（敏感性0.842；特异性0.575）。结论：DVH分析粘膜表面体积能准确预测同时接受IMRT和化疗的LANPC患者的≥3级急性口腔粘膜毒性，但在临床实践中，MSC方法似乎并不比OCC方法好。

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