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Radiation Oncology
Published in: Radiation Oncology 1/2015

Open Access 01-12-2015 | Research

Impact of head and neck cancer adaptive radiotherapy to spare the parotid glands and decrease the risk of xerostomia

Authors: Joel Castelli, Antoine Simon, Guillaume Louvel, Olivier Henry, Enrique Chajon, Mohamed Nassef, Pascal Haigron, Guillaume Cazoulat, Juan David Ospina, Franck Jegoux, Karen Benezery, Renaud de Crevoisier

Published in: Radiation Oncology | Issue 1/2015

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Abstract

Background

Large anatomical variations occur during the course of intensity-modulated radiation therapy (IMRT) for locally advanced head and neck cancer (LAHNC). The risks are therefore a parotid glands (PG) overdose and a xerostomia increase.
The purposes of the study were to estimate:
- the PG overdose and the xerostomia risk increase during a “standard” IMRT (IMRTstd);
- the benefits of an adaptive IMRT (ART) with weekly replanning to spare the PGs and limit the risk of xerostomia.

Material and methods

Fifteen patients received radical IMRT (70 Gy) for LAHNC. Weekly CTs were used to estimate the dose distributions delivered during the treatment, corresponding either to the initial planning (IMRTstd) or to weekly replanning (ART). PGs dose were recalculated at the fraction, from the weekly CTs. PG cumulated doses were then estimated using deformable image registration. The following PG doses were compared: pre-treatment planned dose, per-treatment IMRTstd and ART. The corresponding estimated risks of xerostomia were also compared. Correlations between anatomical markers and dose differences were searched.

Results

Compared to the initial planning, a PG overdose was observed during IMRTstd for 59% of the PGs, with an average increase of 3.7 Gy (10.0 Gy maximum) for the mean dose, and of 8.2% (23.9% maximum) for the risk of xerostomia. Compared to the initial planning, weekly replanning reduced the PG mean dose for all the patients (p < 0.05). In the overirradiated PG group, weekly replanning reduced the mean dose by 5.1 Gy (12.2 Gy maximum) and the absolute risk of xerostomia by 11% (p < 0.01) (30% maximum). The PG overdose and the dosimetric benefit of replanning increased with the tumor shrinkage and the neck thickness reduction (p < 0.001).

Conclusion

During the course of LAHNC IMRT, around 60% of the PGs are overdosed of 4 Gy. Weekly replanning decreased the PG mean dose by 5 Gy, and therefore by 11% the xerostomia risk.
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Metadata
Title
Impact of head and neck cancer adaptive radiotherapy to spare the parotid glands and decrease the risk of xerostomia
Authors
Joel Castelli
Antoine Simon
Guillaume Louvel
Olivier Henry
Enrique Chajon
Mohamed Nassef
Pascal Haigron
Guillaume Cazoulat
Juan David Ospina
Franck Jegoux
Karen Benezery
Renaud de Crevoisier
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2015
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/s13014-014-0318-z

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