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Radiation Oncology
Published in: Radiation Oncology 1/2015

Open Access 01-12-2015 | Research

Prospective longitudinal assessment of parotid gland function using dynamic quantitative pertechnate scintigraphy and estimation of dose–response relationship of parotid-sparing radiotherapy in head-neck cancers

Authors: Tejpal Gupta, Chandni Hotwani, Sadhana Kannan, Zubin Master, Venkatesh Rangarajan, Vedang Murthy, Ashwini Budrukkar, Sarbani Ghosh-Laskar, Jai Prakash Agarwal

Published in: Radiation Oncology | Issue 1/2015

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Abstract

Purpose

To estimate dose–response relationship using dynamic quantitative 99mTc-pertechnate scintigraphy in head-neck cancer patients treated with parotid-sparing conformal radiotherapy.

Methods

Dynamic quantitative pertechnate salivary scintigraphy was performed pre-treatment and subsequently periodically after definitive radiotherapy. Reduction in salivary function following radiotherapy was quantified by salivary excretion fraction (SEF) ratios. Dose–response curves were modeled using standardized methodology to calculate tolerance dose 50 (TD50) for parotid glands.

Results

Salivary gland function was significantly affected by radiotherapy with maximal decrease in SEF ratios at 3-months, with moderate functional recovery over time. There was significant inverse correlation between SEF ratios and mean parotid doses at 3-months (r = −0.589, p < 0.001); 12-months (r = −0.554, p < 0.001); 24-months (r = −0.371, p = 0.002); and 36-months (r = −0.350, p = 0.005) respectively. Using a post-treatment SEF ratio <45% as the scintigraphic criteria to define severe salivary toxicity, the estimated TD50 value with its 95% confidence interval (95% CI) for the parotid gland was 35.1Gy (23.6-42.6Gy), 41.3Gy (34.6-48.8Gy), 55.9Gy (47.4-70.0Gy) and 64.3Gy (55.8-70.0Gy) at 3, 12, 24, and 36-months respectively.

Conclusions

There is consistent decline in parotid function even after conformal radiotherapy with moderate recovery over time. Dynamic quantitative pertechnate scintigraphy is a simple, reproducible, and minimally invasive test of major salivary gland function.
Appendix
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Literature
1.
Pignon JP, Bourhis J, Domenge C, Designe L. Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta-analyses of updated individual data. MACH-NC Collaborative Group. Meta-Analysis of Chemotherapy on Head and Neck Cancer. Lancet. 2000;355:949–55.CrossRefPubMed
2.
Pignon JP, le Maitre A, Maillard E, Bourhis J, on behalf of the MACH-NC Collaborative Group. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17,346 patients. Radiother Oncol. 2009;92:4–14.CrossRefPubMed
3.
Dirix P, Nuyts S, Van den Bogaert W. Radiation-induced xerostomia in patients with head and neck cancer: a literature review. Cancer. 2006;107:2525–34.CrossRefPubMed
4.
Braam PM, Roesink JM, Raaijmakers CP, Busschers WB, Terhaard CH. Quality of life and salivary output in patients with head-and-neck cancer five years after radiotherapy. Radiat Oncol. 2007;2:3.CrossRefPubMedCentralPubMed
5.
Ramaekers BL, Joore MA, Grutters JP, van den Ende P, Jong J, Houben R, et al. The impact of late treatment-toxicity on generic health-related quality of life in head and neck cancer patients after radiotherapy. Oral Oncol. 2011;47:768–74.CrossRefPubMed
6.
Jensen SB, Pedersen AM, Vissink A, Andersen E, Brown CG, Davies AN, et al. A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: prevalence, severity and impact on quality of life. Support Care Cancer. 2010;18:1039–60.CrossRefPubMed
7.
Deasy JO, Moiseenko V, Marks L, Chao KS, Nam J, Eisbruch A. Radiotherapy dose-volume effects on salivary gland function. Int J Radiat Oncol Biol Phys. 2010;76:S58–63.CrossRefPubMedCentralPubMed
8.
Dawes C, Wood CM. The contribution of oral minor mucous gland secretions to the volume of whole saliva in man. Arch Oral Biol. 1973;18:337–42.CrossRefPubMed
9.
Eisbruch A, Ten Haken RK, Kim HM, Marsh LH, Ship JA. Dose, volume, and function relationships in parotid salivary glands following conformal and intensity-modulated irradiation of head and neck cancer. Int J Radiat Oncol Biol Phys. 1999;45:577–87.CrossRefPubMed
10.
Chao KS, Deasy JO, Markman J, Haynie J, Perez CA, Purdy JA, et al. A prospective study of salivary function sparing in patients with head-and-neck cancers receiving intensity-modulated or three-dimensional radiation therapy: initial results. Int J Radiat Oncol Biol Phys. 2001;49:907–16.CrossRefPubMed
11.
Roesink JM, Moerland MA, Battermann JJ, Hordijk GJ, Terhaard CH. Quantitative dose-volume response analysis of changes in parotid gland function after radiotherapy in the head-and-neck region. Int J Radiat Oncol Biol Phys. 2001;51:938–46.CrossRefPubMed
12.
van Rij CM, Oughlane-Heemsbergen WD, Ackerstaff AH, Lamers EA, Balm AJ, Rasch CR. Parotid gland sparing IMRT for head and neck cancer improves xerostomia related quality of life. Radiat Oncol. 2008;3:41.CrossRefPubMedCentralPubMed
13.
Vergeer MR, Doornaert PA, Rietveld DH, Leemans CR, Slotman BJ, Langendijk JA. Intensity-modulated radiotherapy reduces radiation-induced morbidity and improves health-related quality of life: results of a nonrandomized prospective study using a standardized follow-up program. Int J Radiat Oncol Biol Phys. 2009;74:1–8.CrossRefPubMed
14.
Rathod S, Gupta T, Ghosh-Laskar S, Murthy V, Budrukkar A, Agarwal J. Quality-of-life (QOL) outcomes in patients with head and neck squamous cell carcinoma (HNSCC) treated with intensity-modulated radiation therapy (IMRT) compared to three-dimensional conformal radiotherapy (3D-CRT): evidence from a prospective randomized study. Oral Oncol. 2013;49:634–42.CrossRefPubMed
15.
Scott-Brown M, Miah A, Harrington K, Nutting C. Evidence-based review: quality of life following head and neck intensity-modulated radiotherapy. Radiother Oncol. 2010;97:249–57.CrossRefPubMed
16.
Castelli J, Simon A, Louvel G, Henry O, Chajon E, Nassef M, et al. Impact of head and neck cancer adaptive radiotherapy to spare the parotid glands and decrease the risk of xerostomia. Radiat Oncol. 2015;10:6.CrossRefPubMedCentralPubMed
17.
Klutmann S, Bohuslavizki KH, Kroger S, Bleckmann C, Brenner W, Mester J, et al. Quantitative salivary gland scintigraphy. J Nucl Med Technol. 1999;27:20–6.PubMed
18.
Murthy V, Gupta T, Kadam A, Ghosh-Laskar S, Budrukkar A, Phurailatpam R, et al. Time trial: a prospective comparative study of the time-resource burden for three-dimensional conformal radiotherapy and intensity-modulated radiotherapy in head and neck cancers. J Cancer Res Ther. 2009;5:107–12.CrossRefPubMed
19.
Gupta T, Agarwal J, Jain S, Phurailatpam R, Kannan S, Ghosh-Laskar S, et al. Three-dimensional conformal radiotherapy (3D-CRT) versus intensity modulated radiation therapy (IMRT) in squamous cell carcinoma of the head and neck: a randomized controlled trial. Radiother Oncol. 2012;104:343–8.CrossRefPubMed
20.
Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys. 1995;31:1341–6.CrossRefPubMed
21.
Roesink JM, Moerland MA, Hoekstra A, Van Rijk PP, Terhaard CH. Scintigraphic assessment of early and late parotid gland function after radiotherapy for head-and-neck cancer: a prospective study of dose-volume response relationships. Int J Radiat Oncol Biol Phys. 2004;58:1451–60.CrossRefPubMed
22.
Lyman JT. Complication probability as assessed from dose-volume histograms. Radiat Res Suppl. 1985;8:S13–9.CrossRefPubMed
23.
Deasy JO. Comments on the use of the Lyman-Kutcher-Burman model to describe tissue response to nonuniform irradiation. Int J Radiat Oncol Biol Phys. 2000;47:1458–60.CrossRefPubMed
24.
Studer G, Linsenmeier C, Riesterer O, Najafi Y, Brown M, Yousefi B, et al. Late term tolerance in head neck cancer patients irradiated in the IMRT era. Radiat Oncol. 2013;8:259.CrossRefPubMedCentralPubMed
25.
Dijkema T, Raaijmakers CP, Ten Haken RK, Roesink JM, Braam PM, Houweling AC, et al. Parotid gland function after radiotherapy: the combined michigan and utrecht experience. Int J Radiat Oncol Biol Phys. 2010;78:449–53.CrossRefPubMedCentralPubMed
26.
Munter MW, Karger CP, Hoffner SG, Hof H, Thilmann C, Rudat V, et al. Evaluation of salivary gland function after treatment of head-and-neck tumors with intensity-modulated radiotherapy by quantitative pertechnetate scintigraphy. Int J Radiat Oncol Biol Phys. 2004;58:175–84.CrossRefPubMed
27.
Munter MW, Hoffner S, Hof H, Herfarth KK, Haberkorn U, Rudat V, et al. Changes in salivary gland function after radiotherapy of head and neck tumors measured by quantitative pertechnetate scintigraphy: comparison of intensity-modulated radiotherapy and conventional radiation therapy with and without Amifostine. Int J Radiat Oncol Biol Phys. 2007;67:651–9.CrossRefPubMed
28.
Rudat V, Munter M, Rades D, Grotes KA, Bajrovic A, Haberkorn U, et al. The effect of amifostine or IMRT to preserve the parotid function after radiotherapy of the head and neck region measured by quantitative salivary gland scintigraphy. Radiother Oncol. 2008;89:71–80.CrossRefPubMed
29.
Tenhunen M, Collan J, Kouri M, Kangasmaki A, Heikkonen J, Kairemo K, et al. Scintigraphy in prediction of the salivary gland function after gland-sparing intensity modulated radiation therapy for head and neck cancer. Radiother Oncol. 2008;87:260–7.CrossRefPubMed
30.
Kapanen M, Collan J, Saarilahti K, Heikkonen J, Kairemo K, Tenhunen M, et al. Accuracy requirements for head and neck intensity-modulated radiation therapy based on observed dose response of the major salivary glands. Radiother Oncol. 2009;93:109–14.CrossRefPubMed
31.
Chen WC, Lai CH, Lee TF, Hung CH, Liu KC, Tsai MF, et al. Scintigraphic assessment of salivary function after intensity-modulated radiotherapy for head and neck cancer: correlations with parotid dose and quality of life. Oral Oncol. 2013;49:42–8.CrossRefPubMed
32.
Semenenko VA, Li XA. Lyman-Kutcher-Burman NTCP model parameters for radiation pneumonitis and xerostomia based on combined analysis of published clinical data. Phys Med Biol. 2008;53:737–55.CrossRefPubMed
33.
Gensheimer MF, Liao JJ, Garden AS, Laramore GE, Parvathaneni U, et al. Submandibular gland-sparing radiation therapy for locally advanced oropharyngeal squamous cell carcinoma: patterns of failure and xerostomia outcomes. Radiat Oncol. 2014;9:255.CrossRefPubMedCentralPubMed
34.
Miah AB, Gulliford SL, Clark CH, Bhide SA, Zaidi SH, Newbold KL, et al. Dose–response analysis of parotid gland function: what is the best measure of xerostomia? Radiother Oncol. 2013;106:341–5.CrossRefPubMed
35.
Lee TF, Fang FM. Quantitative analysis of normal tissue effects in the clinic (QUANTEC) guideline validation using quality of life questionnaire datasets for parotid gland constraints to avoid causing xerostomia during head-and-neck radiotherapy. Radiother Oncol. 2013;106:352–8.CrossRefPubMed
36.
Lee TF, Chao PJ, Wang HY, Hsu HC, Chang P, Chen WC, et al. Normal tissue complication probability model parameter estimation for xerostomia in head and neck cancer patients based on scintigraphy and quality of life assessments. BMC Cancer. 2012;12:567.CrossRefPubMedCentralPubMed
Metadata
Title
Prospective longitudinal assessment of parotid gland function using dynamic quantitative pertechnate scintigraphy and estimation of dose–response relationship of parotid-sparing radiotherapy in head-neck cancers
Authors
Tejpal Gupta
Chandni Hotwani
Sadhana Kannan
Zubin Master
Venkatesh Rangarajan
Vedang Murthy
Ashwini Budrukkar
Sarbani Ghosh-Laskar
Jai Prakash Agarwal
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/s13014-015-0371-2

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