Objective:This study aims to examine whether radiation therapy doses are related to incidences of carotid artery stenosis and brain necrosis in a large-scale real-world database.Methods:We identified a cohort of HNC patients from the catastrophic illness patient dataset using ICD-9 or ICD-10 to compare the incidence and risks of carotid artery stenosis (CAS) and brain necrosis (RIBN) in patients who received a radiation therapy dose of ≥5400 cGy/30 fractions (group A) with those who received a radiation therapy dose of <5400 cGy/30 fractions (group B). The incidence and hazard ratios were quantified using Cox proportional hazards models.Results:A total of 19,964 patients were identified in group A and group B. Among them, 965 and 863 cases of CAS and 435 and 359 cases of RIBN were identified in group A and group B, respectively. There was no statistically significant association between the two groups for CAS risk, whereas there was a statistically significant association between the two groups for RIBN risk. The most common primary site of head and neck cancers was the nasopharynx (1144 of 19,964, 5.73%).Conclusions:Our study suggests that RT may increase the risk of carotid stenosis and brain necrosis in patients with NPC. To ensure patient safety during treatment, the optimal balance between tumor control and toxicity prevention in individual patients through minimization of the radiation dose to all relevant OARs must be properly understood.
目的：本研究旨在通过大规模真实世界数据库，探讨放射治疗剂量是否与颈动脉狭窄及脑坏死发生率相关。方法：我们从重大伤病患数据库中，通过ICD-9或ICD-10编码识别出头颈癌患者队列，比较接受放射治疗剂量≥5400 cGy/30次（A组）与<5400 cGy/30次（B组）患者的颈动脉狭窄（CAS）和放射性脑坏死（RIBN）发生率及风险。采用Cox比例风险模型量化发生率与风险比。结果：A组与B组共纳入19,964例患者。其中A组与B组分别发现965例与863例CAS，以及435例与359例RIBN。两组间CAS风险无统计学显著关联，而RIBN风险在两组间存在统计学显著关联。头颈癌最常见的原发部位为鼻咽部（19,964例中1,144例，占5.73%）。结论：本研究提示放射治疗可能增加鼻咽癌患者颈动脉狭窄和脑坏死的风险。为保障治疗期间患者安全，必须充分理解通过降低所有相关危及器官的照射剂量，在个体患者中实现肿瘤控制与毒性预防之间的最佳平衡。
肿瘤(癌症)患者之家