Modelling Radiation-Induced Salivary Dysfunction during IMRT and Chemotherapy for Nasopharyngeal Cancer Patients

Abstract

Background: Radiation-induced xerostomia is one of the most prevalent adverse effects of head and neck cancer treatment, and it could seriously affect patients’ qualities of life. It results primarily from damage to the salivary glands, but its onset and severity may also be influenced by other patient-, tumour-, and treatment-related factors. We aimed to build and validate a predictive model for acute salivary dysfunction (aSD) for locally advanced nasopharyngeal carcinoma (NPC) patients by combining clinical and dosimetric factors. Methods: A cohort of consecutive NPC patients treated curatively with IMRT and chemotherapy at 70 Gy (2–2.12 Gy/fraction) were utilised. Parotid glands (cPG, considered as a single organ) and the oral cavity (OC) were selected as organs-at-risk. The aSD was assessed at baseline and weekly during RT, grade ≥ 2 aSD chosen as the endpoint. Dose-volume histograms were reduced to the Equivalent Uniform Dose (EUD). Dosimetric and clinical/treatment features selected via LASSO were inserted into a multivariable logistic model. Model validation was performed on two cohorts of patients with prospective aSD, and scored using the same schedule/scale: a cohort (NPC_V) of NPC patients (as in model training), and a cohort of mixed non-NPC head and neck cancer patients (HNC_V). Results: The model training cohort included 132 patients. Grade ≥ 2 aSD was reported in 90 patients (68.2%). Analyses resulted in a 4-variables model, including doses of up to 98% of cPG (cPG_D98%, OR = 1.04), EUD to OC with n = 0.05 (OR = 1.11), age (OR = 1.08, 5-year interval) and smoking history (OR = 1.37, yes vs. no). Calibration was good. The NPC_V cohort included 38 patients, with aSD scored in 34 patients (89.5%); the HNC_V cohort included 93 patients, 77 with aSD (92.8%). As a general observation, the incidence of aSD was significantly different in the training and validation populations (p = 0.01), thus impairing calibration-in-the-large. At the same time, the effect size for the two dosimetric factors was confirmed. Discrimination was also satisfactory in both cohorts: AUC was 0.73, and 0.68 in NPC_V and HNC_V cohorts, respectively. Conclusion: cPG D98% and the high doses received by small OC volumes were found to have the most impact on grade ≥ 2 acute xerostomia, with age and smoking history acting as a dose-modifying factor. Findings on the development population were confirmed in two prospectively collected validation populations.

Chemotherapy for locoregionally advanced nasopharyngeal carcinoma: Who really needs it

“… 16 , 17 , 18 Moreover, whether it is two‐dimensional radiotherapy or intensity‐modulated radiotherapy, several prospective randomized controlled studies have shown that the addition of concurrent chemotherapy significantly increases the acute toxicity of patients during radiotherapy. 19 , 20 , 21 …”

“…Additionally, some retrospective studies found that in patients with locoregionally advanced nasopharyngeal carcinoma, there was no significant difference in overall survival (OS), local recurrence‐free survival (LRFS), and disease‐free survival (DFS) between the two groups who received CCRT and those who receive radiotherapy alone 16–18 . Moreover, whether it is two‐dimensional radiotherapy or intensity‐modulated radiotherapy, several prospective randomized controlled studies have shown that the addition of concurrent chemotherapy significantly increases the acute toxicity of patients during radiotherapy 19–21 …”

“…[16][17][18] Moreover, whether it is two-dimensional radiotherapy or intensity-modulated radiotherapy, several prospective randomized controlled studies have shown that the addition of concurrent chemotherapy significantly increases the acute toxicity of patients during radiotherapy. [19][20][21] In conclusion, for patients with locoregionally advanced and low-risk NPC, the value of combined chemotherapy is challenged. Therefore, this study intends to explore the therapeutic efficacy and prognostic factors of locoregionally advanced NPC based on the Surveillance, Epidemiology, and End Results (SEER) database, especially pay attention to the survival benefits of chemotherapy based on radiotherapy for patients with negative lymph nodes, hoping to provide a certain basis for clinical practice and clinical trials in the future.…”