Mức hemoglobin thấp trước hóa-xạ trị chỉ ra nguy cơ tăng cao về hoại tử xạ trị ở bệnh nhân ung thư vòm họng tiến triển tại chỗ

Busra Yilmaz1, Efsun Somay2, Erkan Topkan3, Berrin Pehlivan4, Ugur Selek5,6
1Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Baskent University, Ankara, Turkey
2Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Baskent University, Adana, Turkey
3Department of Radiation Oncology, Faculty of Medicine, Baskent University, Adana, Turkey
4Department of Radiation Oncology, Bahcesehir University, Istanbul, Turkey
5Department of Radiation Oncology, MD Anderson Cancer Center, The University of Texas, Houston, USA
6Department of Radiation Oncology, School of Medicine, Koc University, Istanbul, Turkey

Tóm tắt

Chúng tôi nhằm xác định liệu mức hemoglobin (Hb) trước điều trị có thể dự đoán nguy cơ hoại tử xạ trị (ORN) ở bệnh nhân nhận hóa xạ trị đồng thời (CCRT) cho ung thư vòm họng tiến triển tại chỗ (LA-NPC) hay không. Các trường hợp ORN được xác định từ hồ sơ của bệnh nhân LA-NPC đã được khám miệng trước và sau CCRT. Tất cả các phép đo Hb được thực hiện vào ngày đầu tiên của điều trị. Phân tích đường cong hoạt động nhận được được sử dụng để xác định mối quan hệ giữa các mức Hb và tỷ lệ ORN. Mối quan hệ giữa các mức Hb trước điều trị và tỷ lệ ORN được coi là điểm cuối chính, trong khi các điểm cuối thứ cấp bao gồm việc phát hiện thêm các yếu tố nguy cơ tiềm ẩn khác của ORN. Trong số 263 bệnh nhân LA-NPC đủ điều kiện, chúng tôi đã xác định được 8,7% trường hợp ORN. Mức Hb cắt đứt lý tưởng trước CCRT là 10,6 g/dL. Kết quả cho thấy nhóm HPR ≤ 10,6 có tỷ lệ ORN cao hơn đáng kể (32,5% so với 1,5% với Hb > 10,6; P < 0,001). Các yếu tố khác liên quan đến tỷ lệ ORN tăng cao đáng kể bao gồm V59.8 của xương hàm ≥ 36% Gy, số lượng nhổ răng trước CCRT ≥ 4, sự hiện diện của các nhổ răng sau CCRT, và thời gian nhổ răng sau CCRT > 8 tháng (P < 0,05 cho mỗi yếu tố). Mức Hb thấp trước CCRT dường như liên quan độc lập đến tỷ lệ ORN cao hơn đáng kể. Mức Hb trước điều trị có thể được sử dụng để thiết lập các biện pháp phòng ngừa và dự đoán ORN.

Từ khóa

#hemoglobin #hoại tử xạ trị #ung thư vòm họng #hóa xạ trị #tiên lượng

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