Dose, volume, and function relationships in parotid salivary glands following conformal and intensity-modulated irradiation of head and neck cancer

Eisbruch, Avraham; Haken, Randall K. Ten; Kim, H.M.; Marsh, Lon H.; Ship, Jonathan A.

doi:10.1016/s0360-3016(99)00247-3

Cited by 828 publications

(529 citation statements)

References 42 publications

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“…The threshold for the SMGs is higher than the threshold we have previously reported for the parotid glands (26 Gy) in a study which included many of the patients who participated in the current study and which used similar statistical analysis methods (20). Also, the steepness of the dose-response curve for the SMG at doses below the threshold [(1.2%) Gy for the stimulated and (3%) Gy for the non-stimulated flow rates] is lower than the steepness reported for the parotid glands (7).…”

Section: Discussionmentioning

confidence: 59%

“…Also, the steepness of the dose-response curve for the SMG at doses below the threshold [(1.2%) Gy for the stimulated and (3%) Gy for the non-stimulated flow rates] is lower than the steepness reported for the parotid glands (7). Notwithstanding the wide range of reported mean parotid gland doses causing significant gland dysfunction (7,20,36,(39)(40), the findings of the current study suggest that the SMGs are less sensitive to radiotherapy than the parotid glands.…”

Section: Discussionmentioning

confidence: 92%

“…In a previous study of dose-volume-effect relationships for the parotid glands we analyzed the correlations between fractional gland volumes receiving various doses and the mean doses, and concluded that they were highly correlated, therefore the mean dose was an adequate metric (20). Such an analysis was not performed in the current study assuming that the SMGs are similar in this regard to the parotid glands.…”

Section: Discussionmentioning

confidence: 92%

“…These patients were included in previous publications which analyzed parotid gland dose-effect relationships, the relationships between the parotid and submandibular salivary flows and xerostomia and QOL, or dysphagia-specific endpoints (3)(4)(19)(20)(21)(22)(23). All patients signed an informed consent approved by the Institutional Review Board of the University of Michigan.…”

Section: Patientsmentioning

confidence: 99%

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Dose-Effect Relationships for the Submandibular Salivary Glands and Implications for Their Sparing by Intensity Modulated Radiotherapy

Murdoch‐Kinch

Kim

Vineberg

et al. 2008

International Journal of Radiation Oncology*Biology*Physics

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218

143

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Purpose-Submandibular salivary glands (SMGs) dysfunction contributes to xerostomia after radiotherapy (RT) of head and neck (HN) cancer. We assessed SMG dose-response relationships and their implications for sparing these glands by intensity modulated radiotherapy (IMRT).Patients and Methods-148 HN cancer patients underwent unstimulated and stimulated SMG salivary flow rate measurements selectively from Wharton's duct orifices, before RT and periodically through 24 months after RT. Correlations of flow rates and mean SMG doses were modeled throughout all time points. IMRT re-planning in eight patients whose contralateral level I was not a target incorporated the results in a new cost function aiming to spare contralateral SMGs.Results-Stimulated SMG flow rates decreased exponentially by (1.2%) Gy as mean doses increased up to 39 Gy threshold, and then plateaued near zero. At mean doses ≤39 Gy, but not higher, flow rates recovered over time at 2.2%/month. Similarly, the unstimulated salivary flow rates decreased exponentially by (3%) Gy as mean dose increased and recovered over time if mean dose was <39 Gy. IMRT re-planning reduced mean contralateral SMG dose by average 12 Gy, achieving ≤39 Gy in 5/8 patients, without target under-dosing, increasing the mean doses to the parotid glands and swallowing structures by average 2-3 Gy.Conclusions-SMG salivary flow rates depended on mean dose with recovery over time up to a threshold of 39 Gy. Substantial SMG dose reduction to below this threshold and without target under-dosing is feasible in some patients, at the expense of modestly higher doses to some other organs.

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 92%

Section: Patientsmentioning

confidence: 99%

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Dose-Effect Relationships for the Submandibular Salivary Glands and Implications for Their Sparing by Intensity Modulated Radiotherapy

Murdoch‐Kinch

Kim

Vineberg

et al. 2008

International Journal of Radiation Oncology*Biology*Physics

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218

143

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“…In recent years, a number of works have provided parameter estimates, including statistical uncertainties, for several different normal tissues. Recent SDR model parameter estimates include those for the parotid gland, ( 18 – 20 ) the heart, (21) the lung, ( 22 – 24 ) and the liver (25) (26) For further details (e.g., treatment techniques, parameters) about the clinical data on which each of these parameter estimates is based, the reader is referred to the original papers.…”

Section: Methodsmentioning

confidence: 99%

A TCP‐NTCP estimation module using DVHs and known radiobiological models and parameter sets

Warkentin

Stavrev

Stavreva

et al. 2004

J Applied Clin Med Phys

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Radiotherapy treatment plan evaluation relies on an implicit estimation of the tumor control probability (TCP) and normal tissue complication probability (NTCP) arising from a given dose distribution. A potential application of radiobiological modeling to radiotherapy is the ranking of treatment plans via a more explicit determination of TCP and NTCP values. Although the limited predictive capabilities of current radiobiological models prevent their use as a primary evaluative tool, radiobiological modeling predictions may still be a valuable complement to clinical experience. A convenient computational module has been developed for estimating the TCP and the NTCP arising from a dose distribution calculated by a treatment planning system, and characterized by differential (frequency) dose‐volume histograms (DDVHs). The radiobiological models included in the module are sigmoidal dose response and Critical Volume NTCP models, a Poisson TCP model, and a TCP model incorporating radiobiological parameters describing linear‐quadratic cell kill and repopulation. A number of sets of parameter values for the different models have been gathered in databases. The estimated parameters characterize the radiation response of several different normal tissues and tumor types. The system also allows input and storage of parameters by the user, which is particularly useful because of the rapidly increasing number of parameter estimates available in the literature. Potential applications of the system include the following: comparing radiobiological predictions of outcome for different treatment plans or types of treatment; comparing the number of observed outcomes for a cohort of patient DVHs to the predicted number of outcomes based on different models/parameter sets; and testing of the sensitivity of model predictions to uncertainties in the parameter values. The module thus helps to amalgamate and make more accessible current radiobiological modeling knowledge, and may serve as a useful aid in the prospective and retrospective analysis of radiotherapy treatment plans.PACS number: 87.53.Tf

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Effect of True and Sham Acupuncture on Radiation-Induced Xerostomia Among Patients With Head and Neck Cancer

et al. 2019

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Dose, volume, and function relationships in parotid salivary glands following conformal and intensity-modulated irradiation of head and neck cancer

Cited by 828 publications

References 42 publications

Dose-Effect Relationships for the Submandibular Salivary Glands and Implications for Their Sparing by Intensity Modulated Radiotherapy

Dose-Effect Relationships for the Submandibular Salivary Glands and Implications for Their Sparing by Intensity Modulated Radiotherapy

A TCP‐NTCP estimation module using DVHs and known radiobiological models and parameter sets

Effect of True and Sham Acupuncture on Radiation-Induced Xerostomia Among Patients With Head and Neck Cancer

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