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首页> 外文期刊>Radiotherapy and oncology: Journal of the European Society for Therapeutic Radiology and Oncology >Development of NTCP models for head and neck cancer patients treated with three-dimensional conformal radiotherapy for xerostomia and sticky saliva: The role of dosimetric and clinical factors
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Development of NTCP models for head and neck cancer patients treated with three-dimensional conformal radiotherapy for xerostomia and sticky saliva: The role of dosimetric and clinical factors

机译：三维共形放射治疗口腔干燥症和黏性唾液的头颈癌患者NTCP模型的开发：剂量学和临床因素的作用

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Purpose: The purpose of this multicentre prospective study was to investigate the significance of the radiation dose in the major and minor salivary glands, and other pre-treatment and treatment factors, with regard to the development of patient-rated xerostomia and sticky saliva among head and neck cancer (HNC) patients treated with primary (chemo-) radiotherapy ((CH)RT). Methods and materials: The study population was composed of 167 consecutive HNC patients treated with three-dimensional conformal (3D-CRT) (CH) RT. The primary endpoint was moderate to severe xerostomia (XER6m) as assessed by the EORTC QLQ-H&N35 at 6 months after completing (CH)RT. The secondary endpoint was moderate to severe sticky saliva at 6 months (STIC6 m). All organs at risk (OARs) potentially involved in salivary function were delineated on planning-CT, including the parotid, submandibular and sublingual glands and the minor glands in the soft palate, cheeks and lips. Patients with moderate to severe xerostomia or sticky saliva at baseline were excluded. The optimum number of variables for a multivariate logistic regression model was determined using a bootstrapping method. Results: The multivariate analysis showed the mean parotid dose, age and baseline xerostomia (none versus a bit) to be the most important predictors for XER6m. The risk of developing xerostomia increased with age and was higher when minor baseline xerostomia was present in comparison with patients without any xerostomia complaints at baseline. Model performance was good with an area under the curve (AUC) of 0.82. For STIC6m, the mean submandibular dose, age, the mean sublingual dose and baseline sticky saliva (none versus a bit) were most predictive for sticky saliva. The risk of developing STIC6 m increased with age and was higher when minor baseline sticky saliva was present in comparison with patients without any sticky saliva complaints at baseline. Model performance was good with an AUC of 0.84. Conclusions: Dose distributions in the minor salivary glands in patients receiving 3D-CRT have limited significance with regard to patient-rated symptoms related to salivary dysfunction. Besides the parotid and submandibular glands, only the sublingual glands were significantly associated with sticky saliva. In addition, reliable risk estimation also requires information from other factors such as age and baseline subjective scores. When these selected factors are included in predictive models, instead of only dose volume histogram parameters, model performance can be improved significantly.
机译：目的：这项多中心前瞻性研究的目的是调查辐射剂量在主要和次要唾液腺以及其他预处理和治疗因素中对患者额定的口腔干燥症和头部黏性唾液发展的影响。原发性（化学）放疗（（CH）RT）治疗的宫颈癌（HNC）患者。方法和材料：该研究人群由167名接受三维共形（3D-CRT）（CH）RT治疗的HNC连续患者组成。主要终点为完成（CH）RT后6个月通过EORTC QLQ-H＆N35评估的中度至重度口腔干燥症（XER6m）。次要终点在6个月（STIC6 m）为中度至重度粘稠唾液。在计划CT上标出了所有可能与唾液功能有关的高危器官（OAR），包括腮腺，颌下和舌下腺以及软pa，脸颊和嘴唇的小腺。基线时有中度至重度口腔干燥或唾液粘稠的患者被排除在外。使用自举方法确定多元逻辑回归模型的最佳变量数。结果：多变量分析显示腮腺平均剂量，年龄和基线口干症（无或有一点）是XER6m的最重要预测指标。与基线时无任何口干症的患者相比，发生口干症的风险随着年龄的增长而增加，并且当存在较小的基线口干症时，发生口干症的风险更高。曲线下面积（AUC）为0.82，模型性能良好。对于STIC6m，下颌平均剂量，年龄，舌下平均剂量和基线粘性唾液（无或有一点）最能预测粘性唾液。与基线时没有任何粘性唾液症状的患者相比，发展成STIC6 m的风险随年龄增加，并且当存在少量基线粘性唾液时更高。模型性能良好，AUC为0.84。结论：接受3D-CRT治疗的患者唾液腺中的剂量分布在与唾液功能障碍相关的患者评分症状方面意义有限。除腮腺和下颌下腺外，仅舌下腺与唾液粘性显着相关。此外，可靠的风险评估还需要其他因素的信息，例如年龄和基线主观评分。如果将这些选定因素包括在预测模型中，而不仅仅是剂量体积直方图参数，则可以显着提高模型性能。

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