避免頭頸部癌症放射治療口乾症的治療計劃限值：使用生活問卷調查數據資料的QUANTEC準則驗證

Treatment Planning Constraints t Avoid Xerostomia in Head and Neck Radiotherapy: A QUANTEC Guideline Validation Using Quality of Life Questionnaire Datasets

李曉飛(Hsiao-Fei Lee) ； 李財福(Tsair-Fwu Lee) ； 丁慧敏(Hui-Min Ting) ； 趙珮如(Pei-Ju Chao) ； 許軒之(Hsuan-Chih Hsu) ； 廖冠焯(Kuan-Cho Liao) ； 方富民(Fu-Min Fang)

《放射治療與腫瘤學》 19卷3期 (2012/09) Pp. 189-199

https://doi.org/10.6316/TRO/201219(3)189

摘要

目的：本研究針對頭頸癌（HN）病患，包括頭頸部鱗狀細胞癌（HNSCC）和鼻咽癌（NPC）患者，進行生活品質（QoL）問卷調查，驗證臨床正常組織效應定量分析（QUANTEC）準則。材料與方法：針對95位NPC和142位HNSCC患者的QoL問卷調查分別進行分析，並使用歐洲癌症研究與治療組織（The European Organization for Research and Treatment of Cancer）所提供的頭頸部QoL問卷調查結果（H&N35）作為評估療效指標。與治療前比較，如果口乾的QoL程度被評為66至100分，則定義為中重度口乾。使用萊曼等人（Lyman-Kutcher-Burman）所提出的正常組織併發症機率模型（NTCP）借述口乾症（xerostomia）的發生率，並用陰性預測值（NPVs）來決定未發生併發症的預測準確率。結果：NTCP的擬合參數設定在2個時間點，分別為3個月時TD50 =39.8 Gy、m=0.28，以及12個月時TD50 = 45.2Gy、m=0.24。當腮腺的平均劑量小於20和25 Gy，在3個月時，HN全體和HNSCC驗證了相似的結果，QoL問卷分析的數據分別顯示約有6%和16%的機會產生xerostomia；而在12個月時，xerostomia機率則分別約為5%和14%。針對NPC患者，數據顯示在3個月時分別約有0%和33%（NPV約為67%）的機會產生xerostomia。而在12個月時xerostomia機率皆約為0% （NPV 約為100%），此與HNSCC的結果顯著不同。結論：QoL問卷分析數據資料驗證QUANTEC準則的實用性，並建議修正腮腺的QUANTEC準則為20/20 Gy，此數據適用於HNSCC的臨床使用，可有效地避免xerostomia，而腮腺的QUANTEC準則為25 Gy則適用於NPC的患者。

關鍵字

QUANTEC準則 ； 頭頸部 ； 鱗狀細胞癌 ； 鼻咽癌 ； 生活品質

並列摘要

Purpose: To check the clinical normal tissue effects of quantitative analyses in the clinical (QUANTEC) guidelines by using quality of life (QoL) questionnaire dataset on the head and neck (HN) cancers, including head and neck squamous cell carcinoma (HNSCC) and nasopharyngeal carcinoma (NPC) patients.Materials and Methods: Questionnaires of QoL for 95 patients with NPC and 142 with HNSCC were analysed, and the European Organization for Research and Treatment of Cancer H&N35 QoL questionnaire was performed as the endpoint assessment. Compared with pre-treatment, the degree of QoL scoring of 66-100 points were defined as moderate to severe xerostomia. We used the Lyman-Kutcher-Burman normal tissue complication probability model (NTCP) to describe the incidence of xerostomia. Negative predictive value (NPV) was used to determine the prediction accuracy of the complications.Results: The fitting parameters of NTCP were set at two time points, for 3-months and 12-month with TD50=39.8 Gy, m=0.28 and TD50= 45.2 Gy, m=0.24, respectively. We found that the parotid gland with the mean doses of less than 20 and 25 Gy in the HN and HNSCC cohorts were verified with similar results at 3 months. Besides, the analysis of the QoL datasets at 3 months showed that about ~6% and ~16% rates of xerostomia, and those at 12 months showed that about ~5% and ~14%, respectively. For patients with NPC, the data showed that about the ~0% and ~33% opportunity respectively to produce xerostomia at 3 months (NPV of approximately 67%). However, both data showed that ~0% (NPV of approximately 100%) at 12 months. There are with significant difference from the results for the HNSCC cohort.Conclusion: The QoL datasets testified the practicality of QUANTEC guidelines. We proposed amendments to the parotid gland QUANTEC 20/20 Gy spared-gland guideline for HNSCC cohort. Moreover, the QUANTEC 25 Gy guideline was applicable to the clinical use of the NPC, which can effectively avoid xerostomia.

並列關鍵字

QUANTEC ； Head and neck ； Head and neck squamous cell carcinoma ； Nasopharyngeal carcinoma ； Quality of life