Patient- and treatment-related risk factors associated with neck muscle spasm in nasopharyngeal carcinoma patients after intensity-modulated radiotherapy

Lu-Lu Zhang, Guan-Qun Zhou, Zhen-Yu Qi, Xiao-Jun He, Jia-Xiang Li, Ling-Long Tang, Yan-Ping Mao, Ai-Hua Lin, Jun Ma, Ying Sun, Lu-Lu Zhang, Guan-Qun Zhou, Zhen-Yu Qi, Xiao-Jun He, Jia-Xiang Li, Ling-Long Tang, Yan-Ping Mao, Ai-Hua Lin, Jun Ma, Ying Sun

Abstract

Background: To evaluate the incidence of neck muscle spasm in nasopharyngeal carcinoma (NPC) patients that received intensity-modulated radiotherapy (IMRT), and to analyse the patient- and treatment-related risk factors associated with neck muscle spasm.

Methods: A sample of 152 IMRT-treated, biopsy-proven, nondisseminated NPC patients were retrospectively analysed. All had documented IMRT treatment plans and had returned for follow-up review at 4 years post-radiotherapy. Spasm of the sternocleidomastoid (SCM) muscle was graded from 0 to 3 (absent to severe) and this grade served as the clinical endpoint. Risk factors were identified using logistic regression analysis.

Results: Within 4 years of radiotherapy, neck muscle spasm developed in 23.68% of the patients; Grades 0, 1, 2 and 3 were respectively assigned to 83.55, 7.57, 6.58 and 2.30% of assessed SCMs. Multivariate analysis indicated that gender, N stage, V60 (percentage of SCM volume that received >60 Gy) were independent prognostic variables, and that the optimal threshold for using V60 to predict neck muscle spasm was 61.92% (sensitivity = 0.900, specificity = 0.953).

Conclusions: Gender, N stage and V60 were independent predictive factors for post-radiotherapy neck muscle spasm, and a V60 of ≤61.92% in the SCM was relatively safe.

Keywords: Dose tolerance; Intensity-modulated radiotherapy; Nasopharyngeal carcinoma; Neck muscle spasm.

Conflict of interest statement

Ethics approval and consent to participate

This study was conducted in compliance with institutional policy to protect patients’ private information, and was approved by the Institutional Review Board of Sun Yat-sen University Cancer Center. As the current study was a retrospective assessment of routine data, the ethics committee of our Cancer Center waived the need for individual informed consent.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Dose tolerance curves for post-radiotherapy neck muscle spasm in the sternocleidomastoid muscle (SCM). Dose-volume histograms was created using the cut-off points in Table 3. The area under the DVH curve represented tolerable doses for the SCM with respect to post-radiotherapy neck muscle spasm
Fig. 2
Fig. 2
Receiver operating characteristic (ROC) curve for the V60 (percentage of the sternocleidomastoid muscle volume that received more than 60 Gy). A ROC curve was generated to determine the dose tolerance for moderate/severe neck muscle spasm. A V60 of 61.92% had a sensitivity of 0.900 and a specificity of 0.953 and was considered the tolerance dose of the sternocleidomastoid (SCM) muscle with respect to post-radiotherapy spasms. The area under the ROC curve for a V60 of 61.92% was 0.934

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