A Novel Dose Constraint to Reduce Xerostomia in Head-and-Neck Cancer Patients Treated With Intensity-Modulated Radiotherapy

Strigari, Lidia; Benassi, Marcello; Arcangeli, Giorgio; Bruzzaniti, Vicente; Giovinazzo, G.; Marucci, Laura

doi:10.1016/j.ijrobp.2009.07.1734

Cited by 27 publications

(29 citation statements)

References 35 publications

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“…Our data showed that lower mean doses to the contralateral SMG correlated with xerostomia outcomes, which has reported by several studies. 6,7,17,18 Mean doses to the oral cavity also showed a trend in predicting xerostomia outcomes and is consistent with literature. 15,18 Although no clear threshold exists, these mean dose levels have been associated with improved xerostomia outcomes.…”

Section: Discussionsupporting

confidence: 88%

“…5 Sparing additional major and minor salivary glands may further improve xerostomia. 6–8 The SMGs produce saliva in the non-stimulated state and the minor salivary glands produce mucin, both of which may be inhibited by current treatment methods. 9,10 However, a number of uncertainties remain concerning the actual benefits from sparing these salivary glands.…”

Section: Introductionmentioning

confidence: 99%

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Sparing Bilateral Neck Level IB in Oropharyngeal Carcinoma and Xerostomia Outcomes

Tam

Riaz

Kannarunimit

et al. 2015

American Journal of Clinical Oncology

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Objectives To assess whether sparing neck level IB in target delineation of node positive (N+) oropharyngeal carcinoma (OPC) can improve xerostomia outcomes without compromising local-regional control (LRC). Methods 125 N+ OPC patients with a median age of 57 years underwent chemoradiation between 5/10 and 12/11. 74% of patients had T1-2 disease, 26% T3-4, 16% N1, 8% N2A, 48% N2B, 28% N2C; 53% base of tongue, 41% tonsil, and 6% other. Patients were divided into those who had target delineation sparing of bilateral level IB (the spared cohort) vs. no sparing (the treated cohort). Sparing of contralateral high level II nodes was also performed more consistently in the spared cohort. A prospective xerostomia questionnaire (patient reported) was given at each patient follow-up visit to this cohort of patients to assess late xerostomia. Clinical assessment (observer rated) at each patient follow-up visit was also recorded. Results The 2-year LRC for the spared and treated cohorts was 97.5% and 93.8%, respectively (median follow-up, 23.2 months). No local-regional failures occurred outside of treatment fields. The spared cohort experienced significant benefits in patient-reported xerostomia summary scores (P = 0.021) and observer-rated xerostomia scores (P = 0.006). In addition, there were significant reductions in mean doses to the ipsilateral submandibular gland (SMG; 63.9 Gy vs. 70.5 Gy; P < 0.001), contralateral SMG (45.0 Gy vs. 56.2 Gy; P < 0.001), oral cavity (35.9 Gy vs. 45.2 Gy; P < 0.001), and contralateral parotid gland (20.0 Gy vs. 24.4 Gy; P < 0.001). Conclusions Target delineation sparing of bilateral level IB nodes in N+ OPC reduced mean doses to salivary organs without compromising LRC. Patients with reduced target volumes had better patient-reported xerostomia outcomes.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Sparing Bilateral Neck Level IB in Oropharyngeal Carcinoma and Xerostomia Outcomes

Tam

Riaz

Kannarunimit

et al. 2015

American Journal of Clinical Oncology

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“…Approaches that reduce doses to at least one SM gland can reduce the incidence of xerostomia [16,17]. Furthermore, there seems to be a better correlation between the incidence of xerostomia and the mean dose to the PGs and SM glands taken together as one organ, than to the PGs alone [18]. …”

Section: Introductionmentioning

confidence: 99%

Sparing the contralateral submandibular gland without compromising PTV coverage by using volumetric modulated arc therapy

et al. 2011

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BackgroundSalivary gland function decreases after radiation doses of 39 Gy or higher. Currently, submandibular glands are not routinely spared. We implemented a technique for sparing contralateral submandibular glands (CLSM) during contralateral elective neck irradiation without compromising PTV coverage.MethodsVolumetric modulated arc therapy (RapidArc™) plans were applied in 31 patients with stage II-IV HNC without contralateral neck metastases, all of whom received elective treatment to contralateral nodal levels II-IV. Group 1 consisted of 21 patients undergoing concurrent chemo-radiotherapy, with elective nodal doses of 57.75 Gy (PTVelect) and 70 Gy to tumor and pathological nodes (PTVboost) in 7 weeks. Group 2 consisted of 10 patients treated with radiotherapy to 54.45 Gy to PTVelect and 70 Gy to PTVboost in 6 weeks. All clinical plans spared the CLSM using individually adapted constraints. For each patient, a second plan was retrospectively generated without CLSM constraints ('non-sparing plan').ResultsPTV coverage was similar for both plans, with 98.7% of PTVelect and 99.2% of PTVboost receiving ≥95% of the prescription dose. The mean CLSM dose in group 1 was 33.2 Gy for clinical plans, versus 50.6 Gy in 'non-sparing plans' (p < 0.001). In group 2, mean CLSM dose was 34.4 Gy for clinical plans, and 46.8 Gy for non-sparing plans (p = 0.002).ConclusionsElective radiotherapy to contralateral nodal levels II-IV using RapidArc consistently limited CLSM doses well below 39 Gy, without compromising PTV-coverage. Future studies will reveal if this extent of dose reduction can reduce patient symptoms.

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“…The minor salivary gland in the oral mucosa is also irradiated in head and neck cancer with low radiation doses. Because whole salivary glands contribute to total salivary function, Strigari et al [17] suggested a novel dose constraint using the mean dose of total salivary glands. For these reasons, in the clinical setting, salivary dysfunction caused by parotid gland damage from WBRT may be offset by preserved function from non-irradiated salivary glands.…”

Section: Discussionmentioning

confidence: 99%

Parotid gland as a risk organ in whole brain radiotherapy

Noh

Chun

Nam

et al. 2011

Radiotherapy and Oncology

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A Novel Dose Constraint to Reduce Xerostomia in Head-and-Neck Cancer Patients Treated With Intensity-Modulated Radiotherapy

Cited by 27 publications

References 35 publications

Sparing Bilateral Neck Level IB in Oropharyngeal Carcinoma and Xerostomia Outcomes

Sparing Bilateral Neck Level IB in Oropharyngeal Carcinoma and Xerostomia Outcomes

Sparing the contralateral submandibular gland without compromising PTV coverage by using volumetric modulated arc therapy

Parotid gland as a risk organ in whole brain radiotherapy

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