Beyond mean pharyngeal constrictor dose for beam path toxicity in non-target swallowing muscles: Dose-volume correlates of chronic radiation-associated dysphagia (RAD) after oropharyngeal intensity modulated radiotherapy

被引：77

作者：

Dale, Timothy ^{[1
,5
]}

Hutcheson, Katherine ^{[2
]}

Mohamed, Abdallah S. R. ^{[1
,6
]}

Lewin, Jan S. ^{[2
]}

Gunn, G. Brandon ^{[1
]}

Rao, Arvind U. K. ^{[3
]}

Kalpathy-Cramer, Jayashree ^{[7
]}

Frank, Steven J. ^{[1
]}

Garden, Adam S. ^{[1
]}

Messer, Jay A. ^{[1
,9
]}

Warren, Benjamin ^{[1
,9
]}

Lai, Stephen Y. ^{[2
]}

Beadle, Beth M. ^{[1
]}

Morrison, William H. ^{[1
]}

Phan, Jack ^{[1
]}

Skinner, Heath ^{[1
]}

Gross, Neil ^{[2
]}

Ferrarotto, Renata ^{[4
]}

Weber, Randal S. ^{[2
]}

Rosenthal, David I. ^{[1
]}

Fuller, Clifton D. ^{[1
,8
]}

机构：

[1] Univ Texas MD Anderson Canc Ctr, Dept Radiat Oncol, Houston, TX 77030 USA

[2] Univ Texas MD Anderson Canc Ctr, Dept Head & Neck Surg, Houston, TX 77030 USA

[3] Univ Texas MD Anderson Canc Ctr, Dept Bioinformat & Computat Biol, Houston, TX 77030 USA

[4] Univ Texas MD Anderson Canc Ctr, Dept Thorac & Head & Neck Oncol, Houston, TX 77030 USA

[5] Baylor Coll Med, Houston, TX 77030 USA

[6] Univ Alexandria, Dept Clin Oncol, Alexandria, Egypt

[7] Massachusetts Gen Hosp, MIT, Athinoula A Martinos Ctr Biomed Imaging, Charlestown, MA USA

[8] Univ Texas Houston, Grad Sch Biomed Sci, Med Phys Program, Houston, TX USA

[9] Univ Texas Hlth Sci Ctr Houston, Sch Med, Houston, TX 77030 USA

来源：

RADIOTHERAPY AND ONCOLOGY | 2016年 / 118卷 / 02期

基金：

美国国家卫生研究院; 美国国家科学基金会;

关键词：

Dysphagia; Intensity-modulated radiation therapy; Oropharyngeal cancer; Mylohyoid; Geniohyoid; Dose-volume; FACTORS AFFECTING PLACEMENT; GASTROSTOMY TUBE PLACEMENT; PATIENT-RATED XEROSTOMIA; SQUAMOUS-CELL CARCINOMA; NORMAL TISSUE TOXICITY; LOCALLY-ADVANCED HEAD; NECK-CANCER TREATMENT; QUALITY-OF-LIFE; INDUCTION CHEMOTHERAPY; REDUCE DYSPHAGIA;

D O I：

10.1016/j.radonc.2016.01.019

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Purpose/objective(s): We sought to identify swallowing muscle dose-response thresholds associated with chronic radiation-associated dysphagia (RAD) after IMRT for oropharyngeal cancer. Materials/methods: T1-4 N0-3 MO oropharyngeal cancer patients who received definitive IMRT and systemic therapy were examined. Chronic RAD was coded as any of the following >= 12 months post-IMRT: videofluoroscopyiendoscopy detected aspiration or stricture, gastrostomy tube and/or aspiration pneumonia. DICOM-RT plan data were autosegmented using a custom region-of-interest (ROI) library and included inferior, middle and superior constrictors (IPC, MPC, and SPC), medial and lateral pterygoids (MPM, LPM), anterior and posterior digastrics (ADM, PDM), intrinsic tongue muscles (ITM), mylo/geniohyoid complex (MHM), genioglossus (GGM), masseter (MM), buccinator (BM), palatoglossus (PGM), and cricopharyngeus (CPM), with ROI dose-volume histograms (DVHs) calculated. Recursive partitioning analysis (RPA) was used to identify dose-volume effects associated with chronic-RAD, for use in a multivariate (MV) model. Results: Of 300 patients, 34 (11%) had chronic-RAD. RPA showed DVH-derived MHM V69 (i.e. the volume receiving >= 69 Gy), GGM V35, ADM V60, MPC V49, and SPC V70 were associated with chronic-RAD. A model including age in addition to MHM V69 as continuous variables was optimal ambng tested MV models (AUC 0.835). Conclusion: In addition to SPCs, dose to MHM should be monitored and constrained, especially in older patients (>62-years), when feasible. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

引用

页码：304 / 314

页数：11

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