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定义最佳辐射值阶层化关骨质放射性死结的风险在头癌的头癌

Mohammad Moharrami¹, Erin Watson¹, Shao Hui Huang²

¹Faculty of Dentistry, University of Toronto, Toronto, ON, Canada; Department of Dental Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada.

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology

|June 22, 2025

概括

在头部和部癌症 (HNC) 患者中确定骨形瘤 (ORN) 的最佳剂量体积图 (DVH) 值可以改善风险分层. 这有助于个性化放射治疗 (RT) 计划,以减少ORN风险.

科学领域:

在瘤学瘤学.
辐射瘤学辐射瘤学
医学物理医学物理

背景情况:

骨放射性瘤 (ORN) 是头癌 (HNC) 的放射治疗 (RT) 后的一种严重并发症.
准确的ORN风险分层对于优化RT规划和患者结果至关重要.
现有的方法可能不能完全考虑竞争的风险,如死亡.

研究的目的:

为了建立最佳的剂量-体积组图 (DVH) 参数值,以区分ORN发展的低风险和高风险HNC患者.
将死亡的竞争风险纳入ORN风险分层的分析.
确定特定的DVH指标,最好预测ORN跟随HNC的RT.

主要方法:

对2,466名HNC患者进行了回顾性分析,这些患者接受了治疗意图RT (2011-2018) 的治疗.
ORN定义为ClinRad等级≥1;用于DVH截止值的最大选择等级统计数据.
用于评估风险和竞争风险的灰色统计,累积发病率函数 (CIF) 和细灰色模型.

主要成果:

在2,466名患者中,有183人患有ORN.
59.2 Gy的D10cc值是ORN风险最具歧视性的DVH参数.
脱皮D10cc与ORN有显著的关联 (csHR:2.54,sdHR:2.27);牙周状况,瘤部位和保险也是显著的预测因素.

结论:

临床相关的DVH值提高了HNC患者的ORN风险分层.
将这些DVH值纳入RT规划可以改善决策.
基于DVH参数的个性化RT规划可能会导致更好的患者结果和减少ORN发生率.

关键词:

竞争的风险竞争的风险剂量-体积组图剂量-体积组图头部和部癌症头部和部癌症骨质放射性死 (Osteoradionecrosis) 是一种导致骨质放射性死的疾病.辐射疗法辐射疗法

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