Benefits of an intraoral stent in decreasing the irradiation dose to oral healthy tissue: dosimetric and clinical features

Verrone, Juliana Rocha; Alves, Fábio Abreu; Prado, José Divaldo; Marcicano, Alessandra Das Dores; Pellizzon, A.C.; Damascena, Aline Santos; Jaguar, Graziella Chagas

doi:10.1016/j.oooo.2014.08.008

Cited by 45 publications

(81 citation statements)

References 14 publications

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“…The intraoral stent is an individualized mouth-opening device, which may be used during HNC RT with the intention of preventing unnecessary irradiation in normal adjacent tissue [57,58]. Several benefits have been described for the use of this device: It increases the distance between the mandible and the maxilla, focusing the radiation dose more precisely on the target volume, and immobilize the mandible (Fig.…”

Section: Intraoral Stentmentioning

confidence: 99%

“…2a,b). Besides, its production is safe, easy to fabricate and comfortable to wear [58][59][60]. Recent studies have investigated the use of this device with the intention of minimizing the adverse effects of radiation, including osteoradionecrosis, oral mucositis and xerostomia [57][58][59][60][61].…”

Section: Intraoral Stentmentioning

confidence: 99%

“…In 2014, another study [58] conducted for our group evaluated the real benefit of intraoral stent in 33 patients with tongue or floor of the mouth cancer who underwent IMRT in a retrospective setting. The patients were divided into two groups: group 1 (with stent, n = 19) and group 2 (without stent, n = 14).…”

Section: Intraoral Stentmentioning

confidence: 99%

“…Some authors indicate their use only during tongue cancer radiation therapy [59][60][61]; whereas others show them to be of benefit in tumors located in the floor of the mouth [58] and nasopharyngeal [62]. In Verrone et al [58] opinion, this device must be referred to in all tumor cases that present healthy contralateral structures (maxilla or mandible) that need to be spared from dose irradiation with no reduced effect in the prescribed dose to the target volume. Long-term prospective studies are needed to evaluate not only the real indication of this device but also the benefits from other radiation techniques.…”

Section: Intraoral Stentmentioning

confidence: 99%

“…Based on our experience and published researches [36,57,58], we could establish a xerostomia prevention protocol, as follow:…”

Section: Ac Camargo Cancer Center Protocol For Xerostomia Preventionmentioning

confidence: 99%

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Clinical features and preventive therapies of radiation-induced xerostomia in head and neck cancer patient: a literature review

et al. 2017

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Xerostomia or dry mouth is one of the most common and disturbing adverse effects following radiotherapy for head and neck cancer (HNC). This complication strongly increases the risk for dental caries, difficulties with chewing, swallowing and sleep disorders with significant impact on patients' quality of life. Current treatment approaches of xerostomia are often difficult and bring in many cases no substantial relief for the patient. This paper discusses the clinical features and current knowledge of xerostomia prevention in order to evaluate the real possibilities of reducing the incidence and severity of this complication in HNC patients. Salivary gland cytoprotectants (amifostine), muscarinic agonist stimulation (pilocarpine and bethanechol), salivary gland-sparing radiation technique (intensity-modulated radiotherapy-IMRT), surgical relocation of the submandibular gland, intraoral stent and stem cell transplantation are promising techniques that are discussed in this study.

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Section: Intraoral Stentmentioning

confidence: 99%

Section: Intraoral Stentmentioning

confidence: 99%

Section: Intraoral Stentmentioning

confidence: 99%

Section: Intraoral Stentmentioning

confidence: 99%

“…Based on our experience and published researches [36,57,58], we could establish a xerostomia prevention protocol, as follow:…”

Section: Ac Camargo Cancer Center Protocol For Xerostomia Preventionmentioning

confidence: 99%

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Clinical features and preventive therapies of radiation-induced xerostomia in head and neck cancer patient: a literature review

et al. 2017

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Dosimetric impact of hollow intraoral stents for head and neck cancer radiotherapy: A phantom study

Song

et al. 2023

J Applied Clin Med Phys

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PurposeTo investigate the dosimetric impact of the calculation boundaries and dose calculation algorithms of radiotherapy in head and neck cancer patients with an opened oral cavity connected to the exterior by a hollow intraoral positioning stent.Methods and MaterialsA homemade silicone phantom with an opened oral cavity was placed in a CIRS head phantom to model head and neck cancer patients with a hollow intraoral positioning stent. 3D‐CRT plans were designed on CT images of the phantom in Monaco and Pinnacle3 treatment planning systems (TPSs) with the same beam parameters. The default boundary and manually extrapolated boundary were both adopted in these two TPSs to explore the dosimetric impact on treatment plans. The nanoDot™ optically stimulated luminescence dosimeters (OSLDs) were chosen to measure the planned dose surrounding the oral cavity of the head phantom after calibration.ResultThe doses in the air cavity and two measuring points at the joint area were dramatically changed from 0.0, 92.4 and 148.8 cGy to 177.8, 244.2 and 244.1 cGy in Monaco after adopting the extrapolated boundary. While the calculated doses at the same place were changed from 61.2, 143.7 and 198.3 cGy to 175.4, 234.7 and 233.2 cGy in Pinnacle3 with a similar calculation boundary. For the Monaco TPS, the relative errors compared to the OSLD measured doses were 2.94 ± 1.93%, 0.53 ± 8.64%, 2.65 ± 1.87% and 3.93 ± 1.69% at 4 measuring positions. In contrast, the relative errors 4.03 ± 1.93%, 4.85 ± 8.64%, 7.61 ± 1.87% and 5.61 ± 1.69% were observed in Pinnacle3.ConclusionThe boundary setting of an opened oral cavity in TPSs has a significant dosimetric impact on head and neck cancer radiotherapy. An extrapolated boundary should be manually set up to include the whole oral cavity in the dose calculation domain to avoid major dose deviations.

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Benefits of intraoral stents in patients with head and neck cancer undergoing radiotherapy: Systematic review

et al. 2021

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Intraoral stents aim to reduce the oral complications associated with head and neck cancers radiotherapy. The aim of this study is to determine the benefits associated with these devices. A systematic review was conducted in PubMed, Web of Science, and Scopus databases selecting full articles published in English, Portuguese, or Spanish until June 6, 2020 (PROSPERO registration: CRD42020185065). The studies were evaluated by Hadorn and Somerfield criteria and guidelines were established. Nineteen studies were identified suggesting the use of intraoral stent for radiotherapy for patients with cancer on/near the mandible to reduce oral mucositis, trismus, xerostomia (LoE III), and dose in healthy structures (LoE IV) and for cancer on/near the maxilla to reduce oral mucositis and dose in healthy structures (LoE IV). Despite the limited scientific evidence, several benefits associated with the use of intraoral stent for radiotherapy of the head and neck neoplasia have been reported.

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Benefits of an intraoral stent in decreasing the irradiation dose to oral healthy tissue: dosimetric and clinical features

Cited by 45 publications

References 14 publications

Clinical features and preventive therapies of radiation-induced xerostomia in head and neck cancer patient: a literature review

Clinical features and preventive therapies of radiation-induced xerostomia in head and neck cancer patient: a literature review

Dosimetric impact of hollow intraoral stents for head and neck cancer radiotherapy: A phantom study

Benefits of intraoral stents in patients with head and neck cancer undergoing radiotherapy: Systematic review

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