口腔整体勾画与黏膜表面勾画法预测≥3级急性放射性口腔黏膜反应对比  

Dosimetric parameters predicting grade ≥ 3 acute oral mucosal toxicity induced by radiation： anindependent validation study comparing oral cavity versus mucosal surface contouring

作　　者：李凯新[1] 陈媛媛[2] 胡巧英[2] 陈明[2] 辛培玲[1] 

机构地区：[1]福建医科大学附属泉州第一医院放疗科,泉州362000 [2]浙江省肿瘤医院放疗科浙江省放疗重点实验室,杭州310000

出　　处：《中华放射肿瘤学杂志》2017年第12期1365-1369,共5页Chinese Journal of Radiation Oncology

基　　金：国家自然科学基金项目（81672971）

摘　　要：目的 探讨口腔黏膜表面体积能否替代口腔整体体积,并用于预测≥3级急性口腔黏膜反应。方法 选取2015—2016年间92例行IMRT同步化疗的局部晚期鼻咽癌患者,口腔黏膜勾画分别采用口腔整体勾画法（OCC）和黏膜表面勾画法（MSC）。获取DVH数据并进行不良反应分析。采用ROC曲线和Logistic回归分析法分别对2种勾画方法所得的数据进行统计分析。结果 2种勾画方法均能显示口腔黏膜受照射情况与急性不良反应显著的剂量体积关系。Logistic回归分析结果显示OCC、MSC中≥3级不良反应相关因素均是体重下降（P=0.017、0.005）,而剂量学参数相关因素分别为V30（P=0.003）和V50（P=0.003）。ROC曲线分析结果显示OCC的V30曲线下面积为0.753（P=0.001）,而MSC的V50曲线下面积为0.714（P=0.004）。结论 口腔黏膜表面DVH分析结果能准确预测IMRT同步化疗的局部晚期鼻咽癌患者口腔黏膜≥3级不良反应,但OCC在临床应用上优于MSC。Objective To investigate whether the mucosal surface volume can be an alternative to the oral cavity volume for predicting grade 3/4 acute oral mucosal toxicity in patients with locally advanced nasopharyngeal carcinoma （LANPC）. Methods A total of 92 patients with LANPC who underwent intensity- modulated radiotherapy （IMRT） and concurrent chemotherapy were enrolled in this study. The delineation of the oral mucosa was performed using oral cavity contours （OCC） or mucosal surface contours （MSC）. Dosimetric comparisons of toxicity were performed based on the obtained dose-volume histograms （DVHs）. The receiver operating characteristic （ROC） curve and logistic regression analysis were used to do statistical analysis of the data obtained from the two different contour methods. Results Both contouring methods showed a significant dose-volume association between oral mucosal exposure and acute oral mucosal toxicity. Logistic regression analysis showed that body weight loss was the independent associated factor for grade 3/4 toxicity in both OCC group and MSC group （P= O. 017 and 0. 005）. And the independent correlation factors for dosimetric parameters in OCC group and MSC group were V30（P=0. 003） and V50（P=0. 003） , respectively. The area under the ROC curve （AUC） of OCC at V30 was 0.753（P=0.001） and the AUC of MSC at Vs0 was 0.714（P=0.004）. Conclusions DVH analysis of mucosal surface volume can accurately predict grade ≥ 3 oral mucosal toxicity in patients with LANPC who receive IMRT and concurrent chemotherapy. However, OCC is superior to MSC in clinical application.

关 键 词：口腔整体勾画法 黏膜表面勾画法 剂量学 鼻咽肿瘤 放射疗法 

分 类 号：R730.55[医药卫生—肿瘤] R739.8[医药卫生—临床医学]