Objective:To investigate the influencing factors of adverse reactions of reconstructive flaps after postoperative precision radiation therapy for head and neck tumors.Methods:Medical records of 46 patients who underwent radiotherapy after flap reconstruction for head and neck tumors in the Affiliated Hospital of Inner Mongolia Medical University between January 2016 and October 2022 were retrospectively analyzed. The overall survival (OS), local regional control (LRC) and dosimetric parameters after radiotherapy were analyzed. The adverse reactions mainly including radiation dermatitis and flap necrosis at 3 and 6 months after radiotherapy, flap atrophy, flap fibrosis, dysphagia and chewing dysfunction at 12 and 24 months after radiotherapy were recorded. Adverse reactions were graded using the common terminology criteria for adverse events (CTCAE) version 5.0. Quantitative data were analyzed by one-way analysis of variance or rank-sum test. Qualitative data were analyzed by chi-square test or Fisher's exact test. Multivariate analysis of influencing factors of adverse reactions was performed using binary logistic stepwise regression.Results:All 46 patients were aged 57.6 years on average. The median follow-up time was 65 months (12-100 months). After the follow-up, 22 patients died, 6 recurred, and 7 had distant metastases. The 5-year OS rate was 48% and 5-year LRC rate was 69%. The incidence of radiation dermatitis was decreased over time after the end of radiotherapy: 80% (37/46) and 65% (30/46) at 3 months and 6 months after radiotherapy, respectively. The incidence of grade 3 radiation dermatitis was 11% (5/46) and 0 at 3 and 6 months after radiotherapy, respectively. The incidence of grade 2 flap necrosis was 4% (2/46) at 3 months after radiotherapy. At 12 months after radiotherapy, the incidence of flap atrophy and fibrosis was 83% (38/46) and 67% (31/46) , and the incidence of grade 3 flap atrophy and fibrosis was equally 4% (2/46) , respectively. All patients had dysphagia and chewing dysfunction at 12 months after radiotherapy. At 24 months after radiotherapy, 83% (38/46) and 61% (28/46) of patients still had dysphagia and chewing dysfunction. Multivariate regression analysis showed that irradiated flap volume, total radiotherapy dose, pharyngeal constrictor D mean and pharyngeal constrictor V 60 Gy, the interval between surgery and radiotherapy, gender and age were the independent influencing factors of adverse reactions of reconstructive flaps after precision radiation therapy for head and neck tumors. Conclusions:For patients undergoing flap reconstruction for head and neck tumors, under the premise of ensuring tumor control, the dose to normal tissue and flap blood supply area should be strictly limited, the irradiated volume should be reduced, and the interval between surgery and radiotherapy should be shortened (≤6 weeks) to reduce the risk of adverse reactions. Hypo-fractionated radiotherapy plan should be formulated or the total radiotherapy dose should be appropriately adjusted for elderly patients to reduce long-term complications.

Objective:To investigate the influencing factors of adverse reactions of reconstructive flaps after postoperative precision radiation therapy for head and neck tumors.Methods:Medical records of 46 patients who underwent radiotherapy after flap reconstruction for head and neck tumors in the Affiliated Hospital of Inner Mongolia Medical University between January 2016 and October 2022 were retrospectively analyzed. The overall survival (OS), local regional control (LRC) and dosimetric parameters after radiotherapy were analyzed. The adverse reactions mainly including radiation dermatitis and flap necrosis at 3 and 6 months after radiotherapy, flap atrophy, flap fibrosis, dysphagia and chewing dysfunction at 12 and 24 months after radiotherapy were recorded. Adverse reactions were graded using the common terminology criteria for adverse events (CTCAE) version 5.0. Quantitative data were analyzed by one-way analysis of variance or rank-sum test. Qualitative data were analyzed by chi-square test or Fisher's exact test. Multivariate analysis of influencing factors of adverse reactions was performed using binary logistic stepwise regression.Results:All 46 patients were aged 57.6 years on average. The median follow-up time was 65 months (12-100 months). After the follow-up, 22 patients died, 6 recurred, and 7 had distant metastases. The 5-year OS rate was 48% and 5-year LRC rate was 69%. The incidence of radiation dermatitis was decreased over time after the end of radiotherapy: 80% (37/46) and 65% (30/46) at 3 months and 6 months after radiotherapy, respectively. The incidence of grade 3 radiation dermatitis was 11% (5/46) and 0 at 3 and 6 months after radiotherapy, respectively. The incidence of grade 2 flap necrosis was 4% (2/46) at 3 months after radiotherapy. At 12 months after radiotherapy, the incidence of flap atrophy and fibrosis was 83% (38/46) and 67% (31/46) , and the incidence of grade 3 flap atrophy and fibrosis was equally 4% (2/46) , respectively. All patients had dysphagia and chewing dysfunction at 12 months after radiotherapy. At 24 months after radiotherapy, 83% (38/46) and 61% (28/46) of patients still had dysphagia and chewing dysfunction. Multivariate regression analysis showed that irradiated flap volume, total radiotherapy dose, pharyngeal constrictor D mean and pharyngeal constrictor V 60 Gy, the interval between surgery and radiotherapy, gender and age were the independent influencing factors of adverse reactions of reconstructive flaps after precision radiation therapy for head and neck tumors. Conclusions:For patients undergoing flap reconstruction for head and neck tumors, under the premise of ensuring tumor control, the dose to normal tissue and flap blood supply area should be strictly limited, the irradiated volume should be reduced, and the interval between surgery and radiotherapy should be shortened (≤6 weeks) to reduce the risk of adverse reactions. Hypo-fractionated radiotherapy plan should be formulated or the total radiotherapy dose should be appropriately adjusted for elderly patients to reduce long-term complications.

Objective To investigate the effects of Andai therapy based on metabolomics on people with different constitution of Mongolian Medicine.Methods On the basis of literature research,expert interviews,questionnaires and field investigation on the historical origin,operational methods,clinical effects,indications and contraindications of Andai therapy,non-targeted metabolomics detection was performed on baseline plasma of all included cases by gas chromatography mass spectrometry(GC-MS).The differences in metabolites between the experimental group(three body groups receiving Andai therapy)and the control group(three body groups not receiving Andai therapy)were compared,and functional analysis of related metabolites was conducted,and the factors related to regulatory mechanisms were explored by screening related metabolites and their pathways.Results Andai therapy can significantly reduce the content of harmful metabolites in the experimental group,indicating that it may regulate the level of metabolites in vivo.The response of different constitutions to Andai therapy was different,with statistical significance(P＜0.05).The contents of metabolites such as serotonin and abietic acid in the samples of Heyi constitutions were reduced,while the contents of Xila constitutions and Baganda constitutions showed more complex changes.The effects of Andai therapy on metabolic pathways are mainly reflected in the citric acid cycle,glutathione metabolism and lipid metabolism,which may promote energy metabolism and other physiological processes.Conclusion Andai therapy shows potential in regulating metabolite levels and metabolic pathway activity in vivo,but further studies are needed to fully evaluate the feasibility and effectiveness of its clinical application.

Objective To investigate the effects of Andai therapy based on metabolomics on people with different constitution of Mongolian Medicine.Methods On the basis of literature research,expert interviews,questionnaires and field investigation on the historical origin,operational methods,clinical effects,indications and contraindications of Andai therapy,non-targeted metabolomics detection was performed on baseline plasma of all included cases by gas chromatography mass spectrometry(GC-MS).The differences in metabolites between the experimental group(three body groups receiving Andai therapy)and the control group(three body groups not receiving Andai therapy)were compared,and functional analysis of related metabolites was conducted,and the factors related to regulatory mechanisms were explored by screening related metabolites and their pathways.Results Andai therapy can significantly reduce the content of harmful metabolites in the experimental group,indicating that it may regulate the level of metabolites in vivo.The response of different constitutions to Andai therapy was different,with statistical significance(P＜0.05).The contents of metabolites such as serotonin and abietic acid in the samples of Heyi constitutions were reduced,while the contents of Xila constitutions and Baganda constitutions showed more complex changes.The effects of Andai therapy on metabolic pathways are mainly reflected in the citric acid cycle,glutathione metabolism and lipid metabolism,which may promote energy metabolism and other physiological processes.Conclusion Andai therapy shows potential in regulating metabolite levels and metabolic pathway activity in vivo,but further studies are needed to fully evaluate the feasibility and effectiveness of its clinical application.