鼻咽癌螺旋断层治疗中口腔黏膜勾画方法探索  

Recommendation for an oral mucosal contouring method in nasopharyngeal carcinoma patients receiving tomotherapy

作　　者：陈媛媛 李佩静 杨双燕 方佳本 张将 胡巧英 陈明 陈晓钟 田野[1] Chen Yuanyuan;Li Peijing;Yang Shuangyan;Fang Jiaben;Zhang Jiang;Hu Qiaoying;Chen Ming;Chen Xiaozhong;Tian Ye(Department of Radiotherapy Oncology,the Second Affiliated Hospital of Soochow University,Institute of Radiotherapy Oncology,Soochow University,Suzhou Key Laboratory for Radiation Oncology,Suzhou 215004,China;Department of Radiation Oncology,Cancer Hospital of University of Chinese Academy of Sciences(Zhejiang Cancer Hospital),Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences,Hangzhou 310022,China;Radiation Center,Shanghai Pulmonary Hospital,Shanghai 200433,China)

机构地区：[1]苏州大学附属第二医院放射治疗科苏州大学放射肿瘤治疗学研究所苏州市肿瘤放射治疗学重点实验室,215004 [2]中国科学院大学附属肿瘤医院(浙江省肿瘤医院)放疗科中国科学院肿瘤与基础医学研究所,杭州310022 [3]上海市肺科医院放疗中心,200433

出　　处：《中华放射肿瘤学杂志》2020年第1期11-16,共6页Chinese Journal of Radiation Oncology

基　　金：江苏省医学创新团队A类(CXDT-37);国家自然科学基金资助(81672971)。

摘　　要：目的评价两种口腔黏膜勾画方法在鼻咽癌患者中预测急性放射性口腔黏膜炎(A-ROM)价值。方法前瞻性观察分析2017-2019年间浙江省肿瘤医院收治的局部中晚期鼻咽癌150例,所有患者均接受根治性螺旋断层治疗并采用全口腔勾画法(OCC法)和表面黏膜勾画法(MSC法)勾画口腔黏膜。根据RTOG急性放射损伤分级标准每周评估并记录患者的A-ROM分级,比较两种方法对A-ROM的价值。结果所有患者≥3级A-ROM发生率为33.3%。单因素分析≥3级A-ROM发生的相关剂量学参数包括OCC法的V5、V10、V15、V45、V50、V55、V60、V65、V70和MSC法的V5、V10、V50、V55、V60、V65、V70、Dmean(P均<0.05)。二分类Logistic回归分析发现OCC法的性别、吸烟是≥3级A-ROM的危险因素(男/女:OR=0.141,95%CI为0.037~0.538,P=0.004;吸烟/不吸烟:OR=5.109,95%CI为1.413~18.470,P=0.013)。MSC法的性别、吸烟、N分期、V55是≥3级A-ROM的危险因素(男/女:OR=0.129,95%CI为0.032~0.519,P=0.004;吸烟/不吸烟:OR=4.448,95%CI为1.224~16.164,P=0.023;N分期:OR=2.291,95%CI为1.268~4.137,P=0.006;V55:OR=1.432,95%CI为1.008~2.033,P=0.045)。MSC的V55阈值为7.70%,曲线下面积为0.754,敏感性为0.680,特异性为0.740(P<0.001)。结论采用螺旋断层治疗鼻咽癌时,MSC法相比OCC法可以更加准确地预测A-ROM的严重程度。Objective To evaluate the value of two oral mucosal contouring methods for predicting acute radiation-induced oral mucositis(A-ROM)in nasopharyngeal carcinoma(NPC)patients.Methods A total of 150 AJCC 7th stageⅡ-IVB NPCs receiving radical tomotherapy(TOMO)in Zhejiang Cancer Hospital from 2017 to 2019 were included in this prospective observational study.Oral cavity contour(OCC)and mucosal surface contour(MSC)were applied to delineate the oral mucosal structure.A-ROM grade was prospectively assessed and recorded weekly according to RTOG scoring criteria.The prediction value of two methods for A-ROM was statistically compared.Results The incidence rate of≥3 grade A-ROM was 33.3%.In univariate analysis,V5,V10,V15,V45,V50,V55,V60,V65 and V70 of OCC and V5,V10,V50,V55,V60,V65,V70 and Dmean of MSC were significantly correlated with the risk of≥3 grade A-ROM(all P<0.05).In binary logistic regression analysis,gender and smoking were significantly associated with the incidence of≥3 grade A-ROM by using OCC(male vs.female:OR=0.141,95%CI=0.037-0.538,P=0.004;smoking vs.non-smoking:OR=5.109,95%CI=1.413-18.470,P=0.013).For MSC,gender,smoking,N stage and MSC-V55 were the independent predictors(male vs.female:OR=0.129,95%CI=0.032-0.519,P=0.004;smoking vs.non-smoking:OR=4.448,95%CI=1.224-16.164,P=0.023;N stage:OR=2.291,95%CI=1.268-4.137,P=0.006;MSC-V55:OR=1.432,95%CI=1.008-2.033,P=0.045).The cutoff value of MSC-V55 was 7.70%,the area under ROC curve was 0.754,the sensitivity and specificity were 0.680 and 0.740,retrospectively(all P<0.001).Conclusion s Compared with OCC,MSC yields a higher prediction accuracy for the severity of A-ROM in nasopharyngeal carcinoma patients receiving TOMO treatment.

关 键 词：鼻咽肿瘤/螺旋断层治疗 急性放射性口腔黏膜炎 剂量学参数 

分 类 号：R73[医药卫生—肿瘤]