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14-07-2022 | Radiotherapy | Original Article

Intensity-modulated radiotherapy does not induce volumetric changes of the Bichat fat pad in nasopharyngeal cancer

Authors: Alberto Cacciola, MD, Sara Lillo, MD, Silvana Parisi, MD, Consuelo Tamburella, MD, Anna Brogna, MSc, Gianluca Ferini, MD, Alfredo Blandino, MD, Fabio Minutoli, MD, Stefano Pergolizzi, MD

Published in: Strahlentherapie und Onkologie | Issue 11/2022

Abstract

Purpose

To evaluate morphological and functional changes in the Bichat fat pad (BFP) after curative concurrent chemoradiotherapy in nasopharyngeal cancer (NPC) patients.

Methods

We retrospectively analyzed the volumetric, metabolic, and dosimetry parameters of BFPs in 7 NPC patients who underwent intensity-modulated radiotherapy (IMRT) between 2015 and 2020. Inclusion criteria were i) histologically confirmed diagnosis of NPC, ii) follow-up period of at least 12 months, iii) no history of previous irradiation or surgery in the maxillofacial area, and ìv) availability of pre- and posttreatment MRI and ¹⁸F‑FDG PET-CT performed in our Institution. All patients had stage III–IVA disease (n = 7) and received platinum-based chemotherapy. Planned doses in 30 daily fractions/5 days per week were 66 Gy (2.2 Gy/die 5 days/week) to the gross tumor volume, 66 Gy (2.1–2.2 Gy/die 5 days/week) to the gross nodal volume, 60 Gy (2 Gy/die 5 days week) to clinical target volume (CTV)1, and 54 Gy (1.8 Gy/die 5 days/week) to CTV2. All patients completed the planned radiotherapy course in a median time of 42 days (range 42–43). Relationships between BFP volumes and the following DVH parameters were evaluated: mean dose, maximum dose (Dmax), and percentage of BFP volume receiving more than 5 to 65 Gy (V5 to V65).

Results

The pre-RT volumes of the left and right BFPs were 12.24 cc (range 6.51–20.01 cc) and 11.55 cc (range 5.78–17.53 cc), respectively. The mean volumes of left BFP_PRE and BFP_POST were 12.24 cc (range 6.51–20.01cc) and 13.85 cc (range 7.54–20.21 cc), respectively, with no significant statistical differences (P > 0.05). No statistically significant correlations were found between dosimetry features and BFP volumetric changes (all P > 0.05).

Conclusion

Our original results showed that chemoradiotherapy does not induce significant volumetric changes of the BFP. Further investigations are needed to evaluate the effects of higher radiation doses on BFP. This is the first real-world study on this issue.

Tostevin PMJ, Ellis H (1995) The buccal pad of fat: a review. Clin Anat 8:403–406. https://doi.org/10.1002/CA.980080606CrossRefPubMed

Bradley P (2011) Buccal pad of fat and its applications in oral and maxillofacial surgery: a review of published literature (February) 2004 to (July) 2009. Oral Surg 112:146. https://doi.org/10.1016/j.tripleo.2011.01.045CrossRef

Peñarrocha-Diago M, Alonso-González R, Aloy-Prósper A, Peñarrocha-Oltra D, Camacho F, Peñarrocha-Diago M (2015) Use of buccal fat pad to repair post-extraction peri-implant bone defects in the posterior maxilla. A preliminary prospective study. Med Oral Patol Oral Cir Bucal 20:e699–706. https://doi.org/10.4317/medoral.20212CrossRefPubMedPubMedCentral

Mannelli G, Arcuri F, Comini LV, Valente D, Spinelli G (2019) Buccal fat pad: report of 24 cases and literature review of 1,635 cases of oral defect reconstruction. ORL 81:24–35. https://doi.org/10.1159/000494027CrossRefPubMed

Dai T, Tian Z, Wang Z, Qiu W, Zhang Z, He Y (2015) Surgical management of osteoradionecrosis of the jaws. J Craniofac Surg 26:e175–179. https://doi.org/10.1097/SCS.0000000000001445CrossRefPubMed

Nabil S, Ramli R (2012) The use of buccal fat pad flap in the treatment of osteoradionecrosis. Int J Oral Maxillofac Surg 41:1422–1426. https://doi.org/10.1016/J.IJOM.2012.04.001CrossRefPubMed

Porcaro G, Amosso E, Mirabelli L, Busa A, Carini F, Maddalone M (2015) Osteoradionecrosis of the posterior maxilla: a new approach combining erbium: yttrium aluminium garnet laser and bichat bulla flap. J Craniofac Surg 26:e627–629. https://doi.org/10.1097/SCS.0000000000002136CrossRefPubMed

Marx RE (1983) Osteoradionecrosis: a new concept of its pathophysiology. J Oral Maxillofac Surg 41:283–288. https://doi.org/10.1016/0278-2391(83)90294-XCrossRefPubMed

Lyons A, Ghazali N (2008) Osteoradionecrosis of the jaws: current understanding of its pathophysiology and treatment. Br J Oral Maxillofac Surg 46:653–660. https://doi.org/10.1016/j.bjoms.2008.04.006CrossRefPubMed

10.

Chouikh F, Dierks EJ (2021) The buccal fat pad flap. Oral Maxillofac Surg Clin North Am. https://doi.org/10.1016/j.coms.2020.12.005CrossRefPubMed

11.

Tideman H, Bosanquet A, Scott J (1986) Use of the buccal fat pad as a pedicled graft. J Oral Maxillofac Surg 44:435–440. https://doi.org/10.1016/S0278-2391(86)80007-6CrossRefPubMed

12.

Merlotti A, Alterio D, Vigna-Taglianti R, Muraglia A, Lastrucci L, Manzo R et al (2014) Technical guidelines for head and neck cancer IMRT on behalf of the Italian association of radiation oncology—head and neck working group. Radiat Oncol 9:1–32. https://doi.org/10.1186/s13014-014-0264-9CrossRef

13.

Iatì G, Parisi S, Santacaterina A, Pontoriero A, Cacciola A, Brogna A et al (2020) Simultaneous integrated boost radiotherapy in unresectable stage IV (M0) head and neck squamous cell cancer patients: daily clinical practice. Rep Pract Oncol Radiother 25:399–404. https://doi.org/10.1016/j.rpor.2020.04.006CrossRefPubMedPubMedCentral

14.

Cacciola A, Conti A, Tomasello F (2020) Big data analysis: the leap into a new science methodology. World Neurosurg 133:97–98. https://doi.org/10.1016/j.wneu.2019.04.268CrossRefPubMed

15.

Parisi S, Lillo S, Cacciola A, Santacaterina A, Palazzolo C, Platania A et al (2020) Vaginal mucosal melanoma: a complete remission after immunotherapy radiotherapy regimen (24 Gy/3 fractions/21 days). Folia Med 62:605–609. https://doi.org/10.3897/folmed.62.e49926CrossRef

16.

Nutting CM, Morden JP, Harrington KJ, Urbano TG, Bhide SA, Clark C et al (2011) Parotid-sparing intensity modulated versus conventional radiotherapy in head and neck cancer (PARSPORT): a phase 3 multicentre randomised controlled trial. Lancet Oncol 12:127–136. https://doi.org/10.1016/S1470-2045(10)70290-4CrossRefPubMedPubMedCentral

17.

Gupta T, Sinha S, Ghosh-Laskar S, Budrukkar A, Mummudi N, Swain M et al (2020) Intensity-modulated radiation therapy versus three-dimensional conformal radiotherapy in head and neck squamous cell carcinoma: long-term and mature outcomes of a prospective randomized trial. Radiat Oncol 15:1–9. https://doi.org/10.1186/s13014-020-01666-5CrossRef

18.

Brouwer CL, Steenbakkers RJHM, Bourhis J, Budach W, Grau C, Grégoire V et al (2015) CT-based delineation of organs at risk in the head and neck region: DAHANCA, EORTC, GORTEC, HKNPCSG, NCIC CTG, NCRI, NRG Oncology and TROG consensus guidelines. Radiother Oncol 117:83–90. https://doi.org/10.1016/J.RADONC.2015.07.041CrossRefPubMed

19.

Gierloff M, Stöhring C, Buder T, Gassling V, Açil Y, Wiltfang J (2012) Aging changes of the midfacial fat compartments: a computed tomographic study. Plast Reconstr Surg 129:263–273. https://doi.org/10.1097/PRS.0B013E3182362B96CrossRefPubMed

Title: Intensity-modulated radiotherapy does not induce volumetric changes of the Bichat fat pad in nasopharyngeal cancer
Authors: Alberto Cacciola, MD
Sara Lillo, MD
Silvana Parisi, MD
Consuelo Tamburella, MD
Anna Brogna, MSc
Gianluca Ferini, MD
Alfredo Blandino, MD
Fabio Minutoli, MD
Stefano Pergolizzi, MD
Publication date: 14-07-2022
Publisher: Springer Berlin Heidelberg
Keyword: Radiotherapy
Published in: Strahlentherapie und Onkologie / Issue 11/2022
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-022-01974-7

2024 ASCO Annual Meeting

Springer Medicine

Intensity-modulated radiotherapy does not induce volumetric changes of the Bichat fat pad in nasopharyngeal cancer

Abstract

Purpose

Methods

Results

Conclusion

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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