Clinical implications of tubarial salivary glands

Thakar, Alok; Kumar, Rakesh; Thankaraj, Arunraj Sreedharan; Rajeshwari, Madhu; Sakthivel, Pirabu

doi:10.1016/j.radonc.2020.12.006

Cited by 8 publications

(5 citation statements)

References 3 publications

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“…The existence of the tubarial glands as major salivary glands is not without debate [11][12][13][14][15][16][17], and this contention would be best settled through experimentation, by testing the impact of treating tubarial glands as OARs during radiotherapy plan optimization. A logical next step in assessing the impact of the dose on these glands is to carry out a clinical study, comparing patient outcomes for plans created with and without tubarial gland dose constraints.…”

Section: Introductionmentioning

confidence: 99%

Development of a CT-Based Auto-Segmentation Model for Prostate-Specific Membrane Antigen (PSMA) Positron Emission Tomography-Delineated Tubarial Glands

Caleb¹,

Jung²,

Rahmim³

et al. 2022

Cureus

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Modern inverse planning radiotherapy techniques allow for organs at risk (OARs) to evade radiation doses that they would have been subjected to with earlier techniques. The extent to which patient outcomes may be improved using these techniques depends on the delineation accuracy of target volumes and OARs on medical images as well as clinical dose constraints applied to regions of interest (ROIs). The recent discovery of bilateral "tubarial" salivary glands, which were found in the nasopharynx using prostate-specific membrane antigen (PSMA) positron emission tomography (PET), raises concerns over how dose to this region might affect patient outcomes. The dose response of the major salivary glands is known to be variable, and it is possible that the dose in tubarial glands constitutes a missing variable in the optimization of head and neck (HN) radiotherapy plans. A necessary first step toward conducting clinical studies that include the tubarial glands in plan optimization is to develop methods for delineating these glands without the use of PSMA PET images, as their acquisition is not considered a part of the standard of care for HN patients. In this study, we develop an open-source program, Organogenesis, for the auto-segmentation of tubarial glands using only computed tomography (CT) images. A predictive model is trained using contours derived from PSMA PET images, allowing for accurate delineation of tubarial glands, which cannot be manually contoured using CT only. Organogenesis provides a predictive model for tubarial glands that can be iteratively improved on with additional data, creating a viable pathway to clinical studies that can assess the importance of incorporating tubarial glands into HN radiotherapy plan optimization.

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Section: Introductionmentioning

confidence: 99%

Development of a CT-Based Auto-Segmentation Model for Prostate-Specific Membrane Antigen (PSMA) Positron Emission Tomography-Delineated Tubarial Glands

Caleb¹,

Jung²,

Rahmim³

et al. 2022

Cureus

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“…Radiation therapy in the form of intensity-modulated radiotherapy or stereotactic radiotherapy (gamma knife therapy) is indicated for residual/recurrent/inoperable cases of JNA 25 . The tubarial salivary glands are more difficult to detect on structural imaging such as CT/MRI, and with PSMA PET/CT, they are seen with ease 26 . Imaging experts may not even be aware of their existence before imaging with PSMA PET/CT.…”

Section: Discussionmentioning

confidence: 99%

“…25 The tubarial salivary glands are more difficult to detect on structural imaging such as CT/MRI, and with PSMA PET/CT, they are seen with ease. 26 Imaging experts may not even be aware of their existence before imaging with PSMA PET/CT. Mapping these tubarial glands (Fig.…”

Section: Therapeutic Concernsmentioning

confidence: 99%

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Physiological PSMA Uptake in the Tubarial Salivary Glands and Its Implications in the PARIS Protocol—A First Study of Its Kind!

Sakthivel

Thakar²,

Arunraj

et al. 2021

Clin Nucl Med

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Objectives Because prostate-specific membrane antigen (PSMA) expression is universal in juvenile nasal angiofibroma (JNA), PSMA PET/CT is commonly used in the postoperative setting using the postoperative angiofibroma radionuclide imaging study protocol. Our study aims to illustrate physiological PSMA ligand uptake distribution characteristics in the salivary glands, specifically the tubarial glands with tumor, to aid in accurate PSMA PET/CT analysis. Study Design Forty-three consecutive patients who underwent a dedicated head and neck spot PSMA PET/CT for JNA were evaluated retrospectively. PSMA SUVmax values in the tumor, tubarial, parotid, submandibular, and sublingual salivary glands were determined visually and quantitatively. Results All the tumors and the salivary glands showed increased tracer uptake. The median SUVmax ± SD ratios of the tumor, right and left tubarial gland, right and left parotid gland, right and left submandibular gland, and right and left sublingual gland were 2.7 ± 0.8 (range, 0.5–7.5), 3.8 ± 1.9 (range, 0.9–8.1), 4.7 ± 2.1 (range, 0.8–7.4), 9.5 ± 4.8 (range, 3.2–21.9), 9.2 ± 4.7 (range, 2.9–18.9), 10.4 ± 5.7 (range, 3.5–25.4), 10.4 ± 5.5 (range, 3.7–26.4), 6 ± 4.1 (range, 1.3–20.6), and 6.5 ± 4.2 (range, 1.8–19.7), respectively. The uptake in the tubarial glands was comparable with that of the tumor but less compared with other major salivary glands. Conclusions Ours is the first study demonstrating the quantitative uptake of tubarial salivary glands in detail. Because the tubarial glands uptake and the anatomical location are similar to that of the tumor, these physiological uptakes must be borne in mind to circumvent false-positive interpretations and care must be given during the planning of stereotactic radiotherapy for JNAs.

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“…As clinical relevance, during an intensity-modulated radiotherapy for head and neck cancer, a radiotherapy mean dose can have significant local toxicity, expressed by dysphagia and xerostomia [122].…”

Section:  the Tubarial Salivary Glands -A New Type Of Salivary Gland?mentioning

confidence: 99%

Untitled

2022

Rom J Morphol Embryol

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This article is a review of new advances in histology, concerning either classification or structure of different tissular elements (basement membrane, hemidesmosomes, urothelium, glandular epithelia, adipose tissue, astrocytes), and various organs' constituents (blood-brain barrier, human dental cementum, tubarial salivary glands, hepatic stellate cells, pineal gland, fibroblasts of renal interstitium, Leydig testicular cells, ovarian hilar cells), as well as novel biotechnological techniques (tissue engineering in angiogenesis), recently introduced.

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Clinical implications of tubarial salivary glands

Cited by 8 publications

References 3 publications

Development of a CT-Based Auto-Segmentation Model for Prostate-Specific Membrane Antigen (PSMA) Positron Emission Tomography-Delineated Tubarial Glands

Development of a CT-Based Auto-Segmentation Model for Prostate-Specific Membrane Antigen (PSMA) Positron Emission Tomography-Delineated Tubarial Glands

Physiological PSMA Uptake in the Tubarial Salivary Glands and Its Implications in the PARIS Protocol—A First Study of Its Kind!

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