文章：

干细胞保留放疗临床引入以降低头颈癌患者口干症风险

Clinical Introduction of Stem Cell Sparing Radiotherapy to Reduce the Risk of Xerostomia in Patients with Head and Neck Cancer

原文发布日期：23 December 2024

DOI: 10.3390/cancers16244283

类型: Article

开放获取: 是

英文摘要：

Background/Objectives: Studies have shown that dose to the parotid gland stem cell rich (SCR) regions should be reduced to lower the risk of xerostomia after radiotherapy (RT). This study aimed to assess whether stem cell sparing (SCS)-RT can be adopted in routine clinical practice. Methods: Multiple planning studies were performed to compare SCS-RT with standard (ST)-RT using 30 head and neck cancer patients. Shifts in mean dose to the SCR regions (Dmean,SCR) and other organs at risk and their estimated impact on normal tissue complication probability (NTCP) for side-effects were compared using Wilcoxon signed-rank test. A multicenter study was performed (eight institutions, three patients) to test the generalizability of SCS-RT using the Friedman test. Results: Using photons, Dmean,SCRwas reduced with median 4.1/3.5 Gy for ipsilateral/contralateral (p< 0.001). The largest reductions were when the SCR regions overlapped less with target volumes. Subsequently, NTCPs for xerostomia decreased (p< 0.001). Using protons, Dmean,SCRwas also reduced (2.2/1.9 Gy for ipsilateral/contralateral,p< 0.002). Nevertheless, SCS-RT did not further decrease NTCPs for xerostomia (p> 0.17). Target coverage and prevention of other side-effects were not compromised. However, increased mean oral cavity dose was observed in some patients. Lastly, in the multicenter study Dmean,SCRcould be reduced by slightly adjusting the standard optimization. Contralateral Dmean,SCRreductions differed between centers (p= 0.01), which was attributed to differences in ST-RT plans. Conclusions: Stem cell sparing radiotherapy can be clinically introduced by making small adjustments to the optimization strategy and can reduce the risk of xerostomia.

摘要翻译： 

背景/目的：研究表明，降低腮腺干细胞富集区的照射剂量有助于减少放疗后口干症风险。本研究旨在评估干细胞保护放疗能否应用于常规临床实践。方法：通过30例头颈癌患者进行多组计划研究，比较干细胞保护放疗与标准放疗方案。采用Wilcoxon符号秩检验比较干细胞富集区平均剂量变化及其他危及器官受照剂量差异，并评估其对正常组织并发症概率的影响。通过多中心研究（8家机构，3例患者）采用Friedman检验验证干细胞保护放疗的普适性。结果：光子放疗中，同侧/对侧干细胞富集区平均剂量中位值分别降低4.1/3.5 Gy（p<0.001）。当干细胞富集区与靶区重叠较少时剂量降幅最大，相应口干症正常组织并发症概率显著降低（p<0.001）。质子放疗中，同侧/对侧干细胞富集区平均剂量亦分别降低2.2/1.9 Gy（p<0.002），但口干症正常组织并发症概率未见进一步改善（p>0.17）。所有方案均未影响靶区覆盖与其他副作用防控，但部分患者口腔平均剂量有所增加。多中心研究显示，通过微调标准优化方案即可实现干细胞富集区剂量降低，各中心对侧剂量降幅存在差异（p=0.01），这与标准放疗方案的基线差异相关。结论：通过对优化策略进行微调即可在临床实施干细胞保护放疗，该技术能有效降低口干症发生风险。

原文链接：

Clinical Introduction of Stem Cell Sparing Radiotherapy to Reduce the Risk of Xerostomia in Patients with Head and Neck Cancer