- 作者：Giuseppe Sanguineti ; Nikhil Rao ; Br ; on Gunn ; Francesco Ricchetti ; Claudio Fiorino
- 关键词：IMRT ; PEG tube ; Dysphagia ; Predictive models
- 刊名：Radiotherapy and Oncology
- 出版年：2013
- 出版时间：June, 2013
- 年：2013
- 卷：107
- 期：3
- 页码：300-304
- 全文大小：323 K
Purpose
To prospectively assess predictors of PEG dependence after IMRT with/without concomitant chemotherapy (CHT).Methods and materials
One-hundred-seventy-one patients were considered (exclusive RT: 58, RT+CHT: 113; 159/171 treated at a median dose of 70 Gy, 2 Gy/fr). Patients treated with RT+CHT underwent prophylactic PEG insertion; PEG was as needed for the others. A number of clinical factors and dose-volume information concerning oral mucosa (OM), constrictors, masticatory muscles, larynx, esophagus and parotids were available. The 25th/10th percentiles of the duration of PEG dependence were our end-points (respectively 3.3 and 7 months, PEG3/PEG7). Logistic uni and multi-variate (MVA) analyses were performed.
Results
Concerning PEG3, the independent predictors at MVA were: CHT/PEG policy (OR: 6.8, p = 0.001), V9.5G_OM Gy/week (OR: 1.017, p = 0.01), larynx V50 (OR: 1.018, p = 0.01) and superior constrictor (SC) D_mean (OR: 1.002, p = 0.005); the predictive value of the model (AUC) was 0.818 (95 % CI: 0.751-0.873). The independent predictors of PEG7 were: larynx V50 (OR: 1.042, p = 0.0005) and SC D_mean (OR: 1.003, p = 0.02), symptoms at diagnosis (yes vs no, OR: 3.6, p = 0.08) and sex (male vs female, OR: 0.25, p = 0.07); AUC was 0.897 (95 % CI: 0.841-0.939).
Conclusions
OM V9.5 Gy/week and CHT/PEG_policy modulate the risk of early PEG dependence. For longer PEG dependence, larynx V50 (or D_mean) and SC D_mean are highly predictive, suggesting that the fibrosis of constrictors and larynx is the main cause.