Background
Methods
General information
Stage
|
T1
|
T2
|
T3
|
T4
|
Total
|
---|---|---|---|---|---|
N0 | 14 | 35 | 18 | 4 | 71 |
N1 | 10 | 37 | 26 | 15 | 88 |
N2 | 3 | 25 | 14 | 6 | 48 |
N3 | 1 | 0 | 0 | 0 | 1 |
Total | 28 | 97 | 58 | 25 | 208 |
The exposure dose of the target region and the organs at-risk
Target volume
|
Minimal dose mean
|
Maximum dose mean
|
Average dose mean
|
Average fractional dose mean
|
V95 mean
|
Volume
|
D33/D5 mean
| |
---|---|---|---|---|---|---|---|---|
(Gy)
|
(Gy)
|
(Gy)
|
(Gy)
|
(%)
|
(Gy)
| |||
GTVnx | 63.42 | 78.34 | 71.99 | 2.40 | 99.38 | |||
GTVndL | 59.07 | 71.53 | 71.53 | 2.38 | 99.73 | |||
GTVndR | 59.16 | 73.42 | 66.47 | 2.22 | 99.93 | |||
CTV1 | 54.16 | 77.38 | 67.59 | 2.25 | 99.60 | |||
CTV2 | 37.54 | 76.68 | 60.83 | 2.03 | 98.22 | |||
OAR | ||||||||
Brainstem | 5.47 | 50.47 | 21.99 | 1.54 | 5% | 46.13 | ||
Spinal cord | 7.59 | 37.23 | 24.74 | 1.32 | 1 cc | 39.45 | ||
Temporal lobes | L | 1.73 | 61.79 | 12.49 | 0.49 | 33% | 14.76 | |
R | 2.00 | 61.95 | 12.42 | 0.51 | 15.27 | |||
Parotids | L | 14.68 | 58.30 | 31.62 | 1.18 | 33% | 35.38 | |
R | 15.00 | 59.09 | 32.26 | 1.22 | 36.60 | |||
Temporomandibular joints | L | 19.34 | 47.54 | 29.22 | 1.15 | 33% | 34.51 | |
R | 19.75 | 46.51 | 29.38 | 1.16 | 34.84 | |||
Optical nerves | L | 6.66 | 34.00 | 16.15 | 1.09 | 5% | 32.58 | |
R | 6.88 | 33.52 | 16.27 | 1.10 | 32.99 | |||
Optic chiasma | 9.79 | 27.50 | 16.75 | 0.90 | 5% | 26.93 |
Chemotherapy
Follow-up and late toxicity assessment
Statistical methods
Results
Follow-up period and late toxic effect occurrence
Late toxicity of the nervous system
Total number 208
| ||||||
---|---|---|---|---|---|---|
Late injury
|
Total
|
Total %
|
Distribution of patients
| |||
1
|
2
|
3
|
4
| |||
n
|
Grade
|
Grade
|
Grade
|
Grade
| ||
Brain stem | 1 | 0.48 | 0 | 1 | 0 | 0 |
Temporal lobe | 9 | 4.33 | 0 | 8 |
1
| 0 |
Cranial nerve | 6 | 2.88 | 0 | 4 | 0 | 2 |
Spinal cord | 0 | 0 | 0 | 0 | 0 | 0 |
Late nerves system injuries
| |||||
---|---|---|---|---|---|
Stage
|
Brain stem
|
Temporal lobe
|
Cranial nerve
|
Total
| |
Front
|
Post
| ||||
T1 | 1 | 1 | |||
T2 | 1 | 1 | 2 | ||
T3 | 4 | 3 | 7 | ||
T4 | 1 | 4 | 1 | 6 | |
Total | 1 | 9 | 4 | 2 | 16 |
Non-nervous system toxicity
Total number 208
| ||||||
---|---|---|---|---|---|---|
Late injury
|
Total
|
Total %
|
Distribution of patients
| |||
1
|
2
|
3
|
4
| |||
n
|
Grade
|
Grade
|
Grade
|
Grade
| ||
Parotid | 85 | 40.9 | 75 | 10 | 0 | 0 |
Ear | 141 | 67.8 | 98 | 41 | 2 | 0 |
Subcutaneous soft tissue | 187 | 89.9 | 139 | 44 | 4 | 0 |
Skin | 99 | 47.6 | 81 | 17 | 1 | 0 |
Temporomandibular joints | 15 | 7.21 | 10 | 5 | 0 | 0 |
Eye | 3 | 1.44 | 2 | 1 | 0 | 0 |
Mandible | 0 | 0 | 0 | 0 | 0 | 0 |
Multifactorial analysis of late injuries
HR (95% CI; P)
| |||||
---|---|---|---|---|---|
Salivary glands
|
Ears
|
TMJS
|
Skin
|
Subcutaneous soft tissue
| |
Gender | 0.911 (0.439-1.890) | 1.015 (0.983-1.049) | 1.766 (0.508-6.141) | 0.759 (0.376-1. 53) | 6.046 (0.775-47.153) |
P > 0.05 | P > 0.05 | P > 0.05 | P > 0.05 | P > 0.05 | |
Age | 0.987 (0.959-1.017) | 3.311 (1.322-8.288) | 1.035 (0.983-1.089) | 0.994 (0.967-1.022) | 1.005 (0.957-1.054) |
P > 0.05 | P = 0.011 | P > 0.05 | P > 0.05 | P > 0.05 | |
Stage (I-II vs III-IV) | 1.455 (0.673-3.143) | 1.919 (0.833-4.42) | 2.511 (0.462-13.656) | 0.720 (0.336-1.54) | 2.081 (0.596-7.267) |
P > 0.05 | P > 0.05 | P > 0.05 | P > 0.05 | P > 0.05 | |
T Stage (T1-2vs T3-4) | 0.977 (0.454-2.101) | 0.926 (0.400-2.144) | 2.496 (0.469-13.280) | 1.759 (0.831-3.727) | 0.776 (0.230-2.618) |
P > 0.05 | P > 0.05 | P > 0.05 | P > 0.05 | P > 0.05 | |
Radiotherapy vs Chemoradiotherapy | 2.249 (1.186-4.265) | 4.012 (1.839-8.749) | 0.681 (0.211-2.203) | 1.282 (0.682-2.409) | 3.823 (0.998-14.649) |
P = 0.013 | P = 0.000 | P > 0.05 | P > 0.05 | P = 0.050 |
Discussion
Xerostomia
|
Ears
|
Subcutaneous soft tissue
|
Skin reaction
|
Trismus
|
Mandible
|
Eyes
|
Brain
|
Spinal cord
|
Cranial nerve
| |
---|---|---|---|---|---|---|---|---|---|---|
Sanguineti [5] 1954-92 | ≥G3 2.6% | ≥G3 4.2% | ≥G3 1.1% | ≥G3 2.9% | ≥G3 2.6% | ≥G3 1.1% | ≥G3 2.4% | ≥G3 4.5% | ||
N = 378 | ||||||||||
Perez [4] 1956-86 | ≥G3 10% | ≥G3 2% | ≥G3 1% | |||||||
N = 143 | ||||||||||
Yeh [16] 1983-98 | 90.3% | 54% | 25% | 12% | 6% | 21% | ||||
N = 849 | ≥G3 12.4% | |||||||||
Lee [24] 1994-97 | ≥G3 8.0% | ≥G3 6.5% | ≥G3 0.3% | ≥G3 0.9% | ≥G3 0.6% | ≥G3 0.3% | ||||
N = 325 | ||||||||||
Sumitsawan [3] 2003-05 | 97.5% | 82.5% | 62.5% | 56% | 41.5% | 5.5% | 7.0% | 6.5% | ||
N = 200 | ≥G3 2.5% | ≥G3 36% | ≥G3 4% | ≥G3 1.5% | ≥G3 3% | ≥G3 0.5% | ≥G3 1.5% | |||
Kong [2] | 99.7% | 67.0% | 89.0% | 81.2% | 28.3% | 0.6% | 12.0% | 1.2% | 9.8% | 31.8% |
N = 336 | ≥G3 23.5% | ≥G3 22.0% | ≥G3 23.6% | ≥G3 16.4% | ≥G3 3.3% | |||||
This study N = 208 | 40.9% | 67.8% | 89.9% | 47.6% | 7.21% | 0% | 1.44% | 4.80% | 0% | 2.88% |
≥G3 0% | ≥G3 0.96% | ≥G3 1.9% | ≥G3 0.48% | ≥G3 0% | ≥G3 0% | ≥G3 0% | ≥G3 0.48% | ≥G3 0% | ≥G3 0.96% |
Xerostomia
|
Ears
|
Subcutaneous Soft tissue
|
Skin reaction
|
Trismus
|
Mandible
|
Eyes
|
Brain
|
Spinal cord
|
Cranial nerve
| |
---|---|---|---|---|---|---|---|---|---|---|
Xiao [13] 2001-05 | 61.8% | 91.2% | 94.1% | 35.3% | 7.4% | 0% | 1.5% | 17.6% | 4.4% | |
N = 68 MFU* = 54 m | ≥G3 0% | ≥G3 0% | ≥G3 1.5% | ≥G3 0% | ≥G3 0% | ≥G3 0% | ≥G3 0% | ≥G3 0% | ≥G3 0% | |
Chen YY [23] 2001-04 | 5.7% | |||||||||
N = 211 MFU* = 48 m | ≥G3 0% | |||||||||
Su [18] 2001-08 | 15.4% | |||||||||
N = 259 MFU* = 40 m | ||||||||||
Zhou [17] 2003-06 | 16% | |||||||||
N = 305 MFU* = 48.9 m | ||||||||||
Wang [21] 2003-06 | ≥G3 2.7% | ≥G3 0% | ≥G3 0.14% | ≥G3 0.3% | ≥G3 0.7% | ≥G3 0% | ≥G3 0.14% | |||
N = 695 MFU* = 66.4 m | ||||||||||
Wu [20] 2006-09 | ≥G3 0% | ≥G3 10% | ≥G3 2% | ≥G3 1% | ||||||
N = 249 MFU* = 54.1 m | ||||||||||
This study 2003–07 N = 208 MFU* = 78 m | 40.9% | 67.8% | 89.9% | 47.6% | 7.21% | 0% | 1.44% | 4.80% | 0% | 2.88% |
≥G3 0% | ≥G3 0.96% | ≥G3 1.9% | ≥G3 0.48% | ≥G3 0% | ≥G3 0% | ≥G3 0% | ≥G3 0.48% | ≥G3 0% | ≥G3 0.96% |