鼻咽癌调强放疗中急性恶心和呕吐的相关剂量学因素分析

Analysis of dosimetric factors related to acute nausea and vomiting in intensity modulated radiotherapy for nasopharyngeal cancer

目的:探讨鼻咽癌调强放疗中引起急性放射性恶心呕吐的相关剂量学因素。方法:回顾性分析2018年2月至2023年2月于河南省肿瘤医院接受单纯放射治疗的130例早期鼻咽癌患者的一般临床资料及相关危及器官(OAR)剂量,记录剂量学参数,采用单因素和多因素logistic回归对剂量学参数与恶心呕吐程度的相关性进行分析。结果:130例患者均出现了≥1级恶心和呕吐症状。发生<2级与≥2级恶心的两组患者的剂量学参数对比中,除了脑干V 20 Gy之外的指标在两组间比较差异均有统计学意义(P均<0.05)。内耳D max,喉、口腔、咽缩肌、背侧迷走神经复合体(DVC)的D max、D mean、V 10 Gy、V 20 Gy、V 30 Gy指标在1级与2级呕吐两组患者间的差异均有统计学意义(P均<0.05)。多因素回归分析结果显示,DVC V 30 Gy是恶心严重程度的影响因子(OR=73.95,95%CI为4.66~1172.60,P<0.001),口腔V 30 Gy与呕吐严重程度明显存在关联(OR=37.69,95%CI为1.26~1125.42,P=0.04)。结论:即使OAR接受了较低剂量的照射也会出现恶心或呕吐症状,放射性恶心呕吐的发生与DVC、口腔照射剂量显著相关。

Objective To investigate the dosimetric factors associated with acute nausea and vomiting(RINV)during intensity modulated radiotherapy for nasopharyngeal carcinoma.Methods General clinical data and organs at risk(OAR)doses from 130 newly diagnosed early nasopharyngeal carcinoma patients who received radiation therapy alone in Henan Cancer Hospital from February 2018 to February 2023 were retrospectively analyzed.Dosimetric parameters were recorded,and the correlation between the parameters and the degree of nausea and vomiting was statistically analyzed using univariate and multivariate logistic regression models.Results All 130 patients had symptoms of≥grade 1 nausea and vomiting.In the comparison of dosimetric parameters between patients with<grade 2 and≥grade 2 nausea,except the brainstem V20 Gy,all parameters showed statistically significant differences(all P<0.05).The inner ear Dmax,and Dmax,Dmean,V10 Gy,V20 Gy,V30 Gy of the throat,oral cavity,pharyngeal constrictor,dorsal vagal complex(DVC)showed statistically significant differences between patients with grade 1 and grade 2 nausea(all P<0.05).The results of multivariate regression analysis showed that DVC V30 Gy was a significant influencing factor in predicting the severity of nausea(OR=73.95,95%CI:4.66-1172.60,P<0.001),and there was a significant correlation between oral V30 Gy and the severity of vomiting(OR=37.69,95%CI:1.26-1125.42,P=0.04).Conclusions Even if OAR are exposed to lower doses of radiation,nausea or vomiting symptoms can still occur.The occurrence of RINV is significantly associated with DVC and oral radiation doses.