口腔癌患者放疗相关口腔并发症及功能结局的评估

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中文摘要

目的： 放疗（RT）是头颈癌的主要治疗方式之一，可能引起口腔黏膜炎、口干症、吞咽困难和味觉功能障碍等口腔并发症，对患者的生活质量和治疗依从性产生负面影响。本研究旨在评估口腔癌（OCC）患者唾液流率和龈沟液（GCF）容量的纵向变化，并探讨RT相关口腔并发症与牙周状况、放射剂量、体积参数及肿瘤定位之间的关联。
方法： 本前瞻性研究纳入52例接受手术并计划接受RT的OCC患者。其中28例完成了T1评估，纳入纵向及口腔并发症分析。在基线（T0）和RT开始后8周（T1）进行临床牙周检查以及唾液和GCF采样。研究期间监测RT相关口腔并发症。比较完成与未完成T1评估患者的基线人口学和临床特征，以探讨可能的失访相关差异。统计分析包括描述性分析、比较分析和相关性分析，以p<0.05为差异有统计学意义。
结果： 在28例具有配对测量的患者中，GCF容量（µL）在T0为50.80±36.53，在T1为55.32±36.31；唾液流率（mL/min）分别为0.34±0.27和0.27±0.26。GCF容量（p=0.655）和唾液流率（p=0.084）均未显示具有统计学意义的总体变化。按处方原发计划靶区（PTV）剂量（62-64 Gy vs. 66-70 Gy）分层的探索性分析发现唾液流率存在显著的时间效应（p=0.042），而GCF容量未见显著变化。按选择性PTV剂量（54-56 Gy vs. 58-60 Gy）分层未显示GCF容量（p=0.647）或唾液流率（p=0.089）的显著纵向变化。在纳入口腔并发症分析的28例患者中，口腔黏膜炎是最常见的并发症（82.1%），以1-2级为主，其次为口干症（39.3%）和吞咽困难（35.7%）。有和无T1随访数据的患者在所评估的基线特征方面未观察到统计学显著差异（所有p>0.05）。
结论： OCC患者在RT期间口腔并发症常见。尽管探索性剂量分层分析发现唾液流率存在显著的时间效应，但由于分析样本有限、失访较多、并发症数据不完整以及依赖处方PTV剂量而非危及器官剂量学，这些发现应谨慎解读。需要更大规模、随访更完整且剂量学评估更详细的前瞻性研究来阐明这些关联。

英文摘要

OBJECTIVE: Radiotherapy (RT), a major treatment modality for head and neck cancers, may cause oral complications such as mucositis, xerostomia, dysphagia, and taste dysfunction, negatively affecting patients' quality of life and treatment compliance. This study aimed to evaluate longitudinal changes in salivary flow and gingival crevicular fluid (GCF) volume and explore associations between RT-related oral complications and periodontal status, radiation dose, volumetric parameters, and tumor localization in patients with oral cavity cancer (OCC).
METHODS: Fifty-two patients with OCC who underwent surgery and were scheduled for RT were enrolled in this prospective study. Of these, 28 completed the T1 assessment and were included in the longitudinal and oral complication analyses. Clinical periodontal examinations and saliva and GCF sampling were performed at baseline (T0) and eight weeks after RT initiation (T1). RT-related oral complications were monitored during the study period. Baseline demographic and clinical characteristics were compared between patients who completed and did not complete the T1 assessment to explore potential attrition-related differences. Statistical analyses included descriptive, comparative, and correlation analyses, with p < 0.05 considered statistically significant.
RESULTS: Among the 28 patients with paired measurements, GCF volumes (µL) were 50.80 ± 36.53 at T0 and 55.32 ± 36.31 at T1, while salivary flow rates (mL/min) were 0.34 ± 0.27 and 0.27 ± 0.26, respectively. Neither GCF volume (p = 0.655) nor salivary flow rate (p = 0.084) showed a statistically significant overall change. An exploratory analysis stratified by prescribed primary planning target volume (PTV) dose (62-64 Gy vs. 66-70 Gy) identified a significant time effect for salivary flow (p = 0.042), whereas no significant change was observed in GCF volume. Stratification by elective PTV dose (54-56 Gy vs. 58-60 Gy) revealed no significant longitudinal changes in GCF volume (p = 0.647) or salivary flow (p = 0.089). Among the 28 patients included in the oral complication analyses, mucositis was the most frequently observed complication (82.1%), predominantly Grade 1-2, followed by xerostomia (39.3%) and dysphagia (35.7%). No statistically significant differences were observed in the evaluated baseline characteristics between patients with and without T1 follow-up data (all p > 0.05).
CONCLUSION: Oral complications were frequently observed during RT in patients with OCC. Although an exploratory dose-stratified analysis identified a significant time effect for salivary flow, the findings should be interpreted cautiously because of the limited analytical sample, substantial loss to follow-up, incomplete complication data, and reliance on prescribed PTV doses rather than organ-at-risk dosimetry. Larger prospective studies with more complete follow-up and detailed dosimetric assessment are needed to clarify these associations.