Recommendation for an oral mucosal contouring method in nasopharyngeal carcinoma patients receiving tomotherapy

Yuanyuan Chen; Peijing LI; Shuangyan Yang; Jiaben Fang; Jiang Zhang; Qiaoying HU; Ming Chen; Xiaozhong Chen; Ye Tian

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Recommendation for an oral mucosal contouring method in nasopharyngeal carcinoma patients receiving tomotherapy

VernacularTitle: 鼻咽癌螺旋断层治疗中口腔黏膜勾画方法探索
Author: Yuanyuan CHEN ¹ ; Peijing LI ² ; Shuangyan YANG ³ ; Jiaben FANG ² ; Jiang ZHANG ² ; Qiaoying HU ² ; Ming CHEN ² ; Xiaozhong CHEN ² ; Ye TIAN ¹
Author Information

1. Department of Radiotherapy & Oncology, the Second Affiliated Hospital of Soochow University, Institute of Radiotherapy & Oncology, Soochow University, Suzhou Key Laboratory for Radiation Oncology, Suzhou 215004, China
2. Department of Radiation Oncology, Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Hangzhou 310022, China
3. Radiation Center, Shanghai Pulmonary Hospital, Shanghai 200433, China
Publication Type:Journal Article
Keywords: Nasopharyngeal neoplasms/tomography therapy; Acute radiation-induced oral mucositis; Dosimetric parameter
From: Chinese Journal of Radiation Oncology 2020;29(1):11-16
CountryChina
Language:Chinese
Abstract: Objective:To evaluate the value of two oral mucosal contouring methods for predicting acute radiation-induced oral mucositis (A-ROM) in nasopharyngeal carcinoma (NPC) patients.
Methods:A total of 150 AJCC 7^th stage Ⅱ-IVB NPCs receiving radical tomotherapy (TOMO) in Zhejiang Cancer Hospital from 2017 to 2019 were included in this prospective observational study. Oral cavity contour (OCC) and mucosal surface contour (MSC) were applied to delineate the oral mucosal structure. A-ROM grade was prospectively assessed and recorded weekly according to RTOG scoring criteria. The prediction value of two methods for A-ROM was statistically compared.
Results:The incidence rate of ≥3 grade A-ROM was 33.3%. In univariate analysis, V₅, V₁₀, V₁₅, V₄₅, V₅₀, V₅₅, V₆₀, V₆₅ and V₇₀ of OCC and V₅, V₁₀, V₅₀, V₅₅, V₆₀, V₆₅, V₇₀ and D_mean of MSC were significantly correlated with the risk of ≥3 grade A-ROM (all P<0.05). In binary logistic regression analysis, gender and smoking were significantly associated with the incidence of ≥3 grade A-ROM by using OCC (male vs. female: OR=0.141, 95%CI=0.037-0.538, P=0.004; smoking vs.non-smoking: OR=5.109, 95%CI=1.413-18.470, P=0.013). For MSC, gender, smoking, N stage and MSC- V₅₅ were the independent predictors (male vs. female: OR=0.129, 95%CI=0.032-0.519, P=0.004; smoking vs.non-smoking: OR=4.448, 95%CI=1.224-16.164, P=0.023; N stage: OR=2.291, 95%CI=1.268-4.137, P=0.006; MSC-V₅₅: OR=1.432, 95%CI=1.008-2.033, P=0.045). The cutoff value of MSC-V₅₅ was 7.70%, the area under ROC curve was 0.754, the sensitivity and specificity were 0.680 and 0.740, retrospectively (all P<0.001).
Conclusions:Compared with OCC, MSC yields a higher prediction accuracy for the severity of A-ROM in nasopharyngeal carcinoma patients receiving TOMO treatment.