CAJ | 학술논문

目的探讨鼻咽癌调强放疗所致急性放射性口干与放疗剂量的关系.方法收集2013年12月至2014年7月接受调强放疗的109例鼻咽癌患者,分析患者的一般临床资料及双侧腮腺、双侧下颌下腺、双侧涎腺(双侧腮腺+双侧下颌下腺)的照射剂量等数据.在放疗结束时根据口干程度把患者分为非重度口干组(57例)和重度口干组(52例),并对两组之间的一般资料以及相关的剂量学因素进行比较分析.记录双侧腮腺接受15～50 Gy照射剂量的体积百分比,采用Logistic多因素回归法分析急性重度口干的独立预测因子,并用受试者工作特征曲线(ROC)分析其诊断界值点.结果至放疗结束,所有入组患者重度口干的发生率为47.7％ (52/109).临床因素的分析提示年龄、黏膜炎、化疗方式均与急性重度放射性口干的发生无关.非重度口干组和重度口干组剂量学指标比较的结果显示,两组平均剂量差异均有统计学意义(t=-6.179、-6.055、-2.293,P＜0.05).Logistic回归分析显示,V34是判断急性重度放射性口干的独立预测因素.V34的ROC曲线表明:V34=49％对重度放射性口干预测的敏感度和特异度分别为71.2％和75.4％ (OR=1.231,P＜0.05,95％ CI:1.116 ～1.357).结论在鼻咽癌调强放疗计划中,双侧腮腺的V34是重度急性放射性口干的独立预测因子,可以作为评估发生急性重度放射性口干发生风险的剂量学指标.
목적 탐토비인암조강방료소치급성방사성구간여방료제량적관계.방법 수집2013년12월지2014년7월접수조강방료적109례비인암환자,분석환자적일반림상자료급쌍측시선、쌍측하합하선、쌍측연선(쌍측시선+쌍측하합하선)적조사제량등수거.재방료결속시근거구간정도파환자분위비중도구간조(57례)화중도구간조(52례),병대량조지간적일반자료이급상관적제량학인소진행비교분석.기록쌍측시선접수15～50 Gy조사제량적체적백분비,채용Logistic다인소회귀법분석급성중도구간적독립예측인자,병용수시자공작특정곡선(ROC)분석기진단계치점.결과 지방료결속,소유입조환자중도구간적발생솔위47.7％ (52/109).림상인소적분석제시년령、점막염、화료방식균여급성중도방사성구간적발생무관.비중도구간조화중도구간조제량학지표비교적결과현시,량조평균제량차이균유통계학의의(t=-6.179、-6.055、-2.293,P＜0.05).Logistic회귀분석현시,V34시판단급성중도방사성구간적독립예측인소.V34적ROC곡선표명:V34=49％대중도방사성구간예측적민감도화특이도분별위71.2％화75.4％ (OR=1.231,P＜0.05,95％ CI:1.116 ～1.357).결론 재비인암조강방료계화중,쌍측시선적V34시중도급성방사성구간적독립예측인자,가이작위평고발생급성중도방사성구간발생풍험적제량학지표.
Objective To evaluate the relationship between radiation-induced acute xerostomia and the dosimetric factor changes of the parotid and submandibular glands.Methods A total of 109 nasopharyngeal carcinoma (NPC) patients who underwent IMRT were included.They were divided into two groups according to the severity of xerostomia: severe(52) and non-severe(57) mucositis groups.Several clinical factors including age, and chemotherapy were analyzed by chi-square test.The delivered doses as well as the volumes of the parotid and submandibular were also collected.The t-test was used to compare the differences between the two groups.The dosimetric factors(V15-V50)of the parotid glands were analyzed by Binary Logistic regression (Forward-conditional method).Results The incidence of severe acute xerostomia was 47.7％ (52/109).There was no statistical difference between severe acute xerostomia and several clinical factors, which included age,mucositis and chemotherapy.The mean radiation doses of the glands between the severe and non-severe xerostomia group were statistically significant (t =-6.179, -6.055,-2.293 ,P ＜0.05).Logistic regression of the parotid gland showed that V34 was an independent indicating factor of severe acute xerostomia.When using V34 =49％ as a cut-off to predict severe xerostomia, the sensitivity and specificity were 71.2％ and 75.4％ , respectively(OR =1.231, P ＜ 0.05, 95％ CI: 1.116-1.357).Conclusions The study evaluated the delivered doses of the parotid and submandibular glands and their relationship with acute xerostomia.V34 was a valuable indicator for predicting severe acute xerostomia.