Patients with locally advanced head and neck squamous cell carcinoma (HNSCC) frequently require primary radiochemotherapy (RCT). Despite intensity modulation, the desired radiation-induced effects observed in HNSCC may also be observed as side effects in healthy tissue, e.g., the sternocleidomastoid muscle (SCM). These side effects (e.g., tissue fibrosis) depend on the interval between the completion of RCT and restaging CT. For salvage surgery, the optimal time window for surgery is currently clinically postulated at between 6 and 12 weeks after completion of RCT. Thus, no extensive tissue fibrosis is to be expected. This interval is based on clinical studies exploring surgical complications. Studies directly exploring radiation-induced changes of the SCM in HNSCC patients are sparse. The present study quantified tissue alterations in the SCM and paravertebral musculature (PVM) after RCT, applying radiomics to determine the optimal time window for salvage surgery. Three radiomic key parameters, (1) volume, (2) mean positivity of pixels (MPP), and (3) uniformity, were extracted with mint LesionTMin the staging CTs and restaging CTs of 98 HNSCC patients. Of these, 25 were female, the mean age was 62 (±9.6) years, and 80.9% were UICC Stage IV. The mean restaging interval was 55 (±28; range 29–229) days. Only the mean volume significantly decreased after RCT, from 9.0 to 8.4 and 96.5 to 91.9 mL for the SCM and PVM, respectively (bothp= 0.007, both Cohen’s d = 0.28). In addition, the mean body mass index (BMI) decreased from 23.9 (±4.2) to 21.0 (±3.6) kg/m² (p< 0.001; Cohen’s d = 0.9). The mean BMI decreased significantly and was correlated with the volume decrease for the SCM (r = 0.27;p= 0.007) and PVM (r = 0.41;p< 0.001). Ift-testp-values were adjusted for the BMI decrease, no significant change in volumes for the SCM and PVM was observed (bothp> 0.05). The present data support the clinically postulated optimal interval for salvage surgery of 6 to 12 weeks.
局部晚期头颈部鳞状细胞癌（HNSCC）患者常需接受根治性放化疗（RCT）。尽管采用了调强技术，在HNSCC中观察到的预期辐射效应同样可能以副作用形式出现在健康组织中，例如胸锁乳突肌（SCM）。这些副作用（如组织纤维化）取决于RCT完成与再分期CT检查的时间间隔。对于挽救性手术，目前临床公认的最佳手术时间窗为RCT完成后6至12周，此期间预期不会出现广泛的组织纤维化。该时间窗的设定基于探讨手术并发症的临床研究，而直接探究HNSCC患者SCM辐射性改变的研究较为缺乏。本研究通过影像组学方法量化RCT后SCM及椎旁肌群（PVM）的组织改变，以确定挽救性手术的最佳时间窗。研究使用mint LesionTM软件从98例HNSCC患者的基线CT与再分期CT中提取三个影像组学关键参数：（1）体积，（2）像素平均阳性值（MPP），（3）均匀度。患者中女性25例，平均年龄62（±9.6）岁，80.9%为UICC IV期。平均再分期间隔为55（±28；范围29-229）天。结果显示，RCT后仅平均体积显著下降：SCM从9.0 mL降至8.4 mL，PVM从96.5 mL降至91.9 mL（均为p=0.007，Cohen's d=0.28）。同时平均体重指数（BMI）从23.9（±4.2）kg/m²降至21.0（±3.6）kg/m²（p<0.001；Cohen's d=0.9）。BMI下降与SCM体积减少呈正相关（r=0.27；p=0.007），与PVM体积减少亦呈正相关（r=0.41；p<0.001）。若对t检验p值进行BMI下降校正，则SCM与PVM体积均未见显著变化（均为p>0.05）。本研究数据支持临床提出的6至12周挽救性手术最佳时间窗。
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