光生物调节疗法在接受放化疗的头颈癌患者中的作用：在毒性预防中的角色

文献信息

中文摘要

背景： 头颈癌（HNC）的放化疗（CRT）常伴随严重的急性毒性，影响治疗依从性和生活质量。本研究在真实世界队列中评估了光生物调节（PBM）减轻CRT所致毒性的有效性。
方法： 2021年5月至2024年7月，我们回顾性分析了117例接受根治性或辅助性CRT并同时接受PBM的HNC患者：PBM是一种将红光或近红外光无创应用于皮肤和黏膜表面以调节炎症反应的方法，使用620/820 nm或650 nm设备，根据治疗方案照射时间为2-12分钟，能量密度为3-12 J/cm2。毒性在基线、治疗期间、治疗完成时及整个随访期间根据CTCAE v5.0进行分级。采用重复测量逻辑回归（广义估计方程）评估与毒性的关联。患者按PBM暴露情况分层（<10次 vs. ≥10次）。
结果： 中位随访时间为16个月。治疗完成时，2-3级口腔黏膜炎和放射性皮炎分别发生于38.5%和25.6%的患者，均低于未接受PBM的历史队列报告的发生率。接受≥10次PBM治疗的患者（72例）在治疗完成时2-3级吞咽痛的发生率显著更低（16.7% vs. 42.2%，p = 0.005），在末次随访时持续性吞咽困难的发生率也显著更低（12.5% vs. 33.3%，p = 0.009）。PBM暴露与体重减轻、无进展生存期或总生存期的显著差异无关。
结论： 本研究提供了接受PBM的HNC患者毒性结局的真实世界数据，在接受≥10次PBM治疗的患者中观察到部分毒性发生率更低。尽管回顾性设计和缺乏对照组限制了因果推断，但这些发现为前瞻性随机试验提供了强有力的依据，以确定最佳PBM方案并验证其临床影响。

英文摘要

Background: Chemoradiotherapy (CRT) for head and neck cancer (HNC) is frequently associated with severe acute toxicities that compromise treatment adherence and quality of life. This study evaluated the effectiveness of photobiomodulation (PBM) in reducing CRT-induced toxicities in a real-world cohort. Methods: Between May 2021 and July 2024, we retrospectively analyzed 117 HNC patients treated with definitive or adjuvant CRT and concomitant PBM: a non-invasive application of red or near-infrared light to cutaneous and mucosal surfaces to modulate inflammatory responses, using 620/820 nm or 650 nm devices, with irradiation times of 2-12 min and energy densities of 3-12 J/cm2 according to the treatment protocol. Toxicities were graded according to CTCAE v 5.0 at baseline, during treatment, at treatment completion, and throughout follow-up. Associations with toxicity were assessed with logistic regression for repeated measurements (generalized estimating equations). Patients were stratified according to PBM exposure (<10 vs. ≥10 sessions). Results: Median follow-up was 16 months. At treatment completion, grade 2-3 oral mucositis and radiodermatitis occurred in 38.5% and 25.6% of patients, respectively, both lower than rates reported in historical cohorts without PBM. Patients receiving ≥10 PBM sessions (72 pts) experienced significantly lower rates of grade 2-3 odynophagia at treatment completion (16.7% vs. 42.2%, p = 0.005) and persistent dysphagia at the last follow-up (12.5% vs. 33.3%, p = 0.009). PBM exposure was not associated with significant differences in weight loss, progression-free survival, or overall survival. Conclusions: This study provides real-world data on toxicity outcomes among HNC patients receiving PBM, with lower rates of selected toxicities observed among patients receiving ≥10 PBM sessions. Although the retrospective design and lack of a control group limit causal inference, these findings provide a strong rationale for prospective randomized trials to define the optimal PBM schedule and validate its clinical impact.