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首页> 外文期刊>Radiation oncology >Dosimetric predictors of temporal lobe injury after intensity-modulated radiotherapy for T4 nasopharyngeal carcinoma: a competing risk study
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Dosimetric predictors of temporal lobe injury after intensity-modulated radiotherapy for T4 nasopharyngeal carcinoma: a competing risk study

机译：T4鼻咽癌调强放疗后颞叶损伤的剂量学预测因子：一项竞争性风险研究

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In patients with T4 nasopharyngeal carcinoma (NPC), death may occur prior to the occurrence of temporal lobe injury (TLI). Because such competing risk death precludes the occurrence of TLI and thus the competing risk analysis should be applied to TLI research. The aim was to investigate the incidence and predictive factors of TLI after intensity-modulated radiotherapy (IMRT) among T4 NPC patients. From March 2008 to December 2014, T4 NPC patients treated with full-course radical IMRT at our center were reviewed retrospectively. A nested case-control study was designed for this cohort of patients. The cases were patients with TLI diagnosed by MRI during the follow-up period, and the controls were patients without TLI after IMRT matched 1:1 to each case by gender, age at diagnosis, intercranial involvement, and follow-up time. The end point was time to TLI or death without prior TLI. We analyzed the cumulative incidence function (CIF) and performed a competing risk regression model to identify the predictors of TLI. With a median follow-up of 40.1?months, 63 patients (63/506, 12.5%) developed TLI as diagnosed by MRI, and 136 deaths occurred during the period. The cumulative incidence of TLI at 5?years was 13.2%, while 26.7% died without prior TLI. The univariate analysis showed that all selected dosimetric parameters were associated with the occurrence of TLI. On multivariate analysis, D1cc and V20 remained statistically significant. Based on the area-under-the-curve (AUC) values, D1cc was considered the most predictive. The patients with D1cc ?71.14?Gy had a 7.920-fold increased risk of TLI compared with those with D1cc ≤71.14?Gy (P 42.22?cc was found to result in a statistically significant higher risk of TLI (subdistribution hazard ratio [sHR] =3.123, P??0.05). TL D1cc and V20 were predictive of TLI after IMRT for T4 NPC. They should be considered as first and second priorities of dose constraints of the TL. D1cc ≤71.14?Gy and V20?≤?42.22?cc could be useful dose-volume constraints for reducing the occurrence of TLI during IMRT treatment planning without obviously compromising the tumor coverage.
机译：在患有T4鼻咽癌（NPC）的患者中，死亡可能在颞叶损伤（TLI）发生之前发生。由于此类竞争风险死亡排除了TLI的发生，因此竞争风险分析应应用于TLI研究。目的是研究在T4 NPC患者中调强放疗（IMRT）后TLI的发生率和预测因素。从2008年3月至2014年12月，对我中心接受全程根治性IMRT治疗的T4 NPC患者进行回顾性检查。嵌套的病例对照研究是针对该组患者设计的。病例为随访期间经MRI诊断为TLI的患者，对照组为IMRT后按性别，诊断年龄，颅内受累程度和随访时间与每个病例1：1匹配的TLI患者。终点是达到TLI的时间或没有先行TLI的死亡。我们分析了累积发生率函数（CIF），并执行了竞争风险回归模型以识别TLI的预测因子。中位随访40.1个月，经MRI诊断为TLI的患者63例（63 / 506，12.5％），在此期间发生136例死亡。 5年时TLI的累积发生率为13.2％，而没有进行过TLI的死亡为26.7％。单变量分析表明，所有选定的剂量参数均与TLI的发生有关。在多变量分析中，D1cc和V20仍具有统计学意义。根据曲线下面积（AUC）值，D1cc被认为是最具预测性的。 D1cc>？71.14？Gy的患者发生TLI的风险是D1cc≤71.14？Gy的患者的7.920倍（P 42.22？cc导致TLI的风险在统计学上显着较高（分分布危险比[sHR ] = 3.123，P 0.05）。TL D1cc和V20是T4鼻咽癌IMRT后TLI的预测指标，应被认为是TL剂量限制的第一和第二优先级D1cc≤71.14？Gy和V20？≤在IMRT治疗计划期间，？42.22？cc可能是有用的剂量-体积限制，以减少TLI的发生，而不会明显损害肿瘤的覆盖范围。

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