Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Radiation Oncology
Published in: Radiation Oncology 1/2015

Open Access 01-12-2015 | Research

Parotid gland shrinkage during IMRT predicts the time to Xerostomia resolution

Authors: Giuseppe Sanguineti, Francesco Ricchetti, Binbin Wu, Todd McNutt, Claudio Fiorino

Published in: Radiation Oncology | Issue 1/2015

Login to get access

Abstract

Purpose

To assess the impact of mid-treatment parotid gland shrinkage on long term xerostomia during IMRT for oropharyngeal SCC.

Methods and materials

All patients treated with IMRT at a single Institution from November 2007 to June 2010 and undergoing weekly CT scans were selected. Parotid glands were contoured retrospectively on the mid treatment CT scan. For each parotid gland, the percent change relative to the planning volume was calculated and combined as weighted average. Patients were considered to be xerostomic if developed GR2+ dry mouth according to CTCAE v3.0. Predictors of the time to xerostomia resolution or downgrade to 1 were investigated at both uni- and multivariate analysis.

Results

85 patients were selected. With a median follow up of 35.8 months (range: 2.4-62.6 months), the actuarial rate of xerostomia is 26.2% (SD: 5.3%) and 15.9% (SD: 5.3%) at 2 and 3 yrs, respectively. At multivariate analysis, mid-treatment shrink along with weighted average mean parotid dose at planning and body mass index are independent predictors of the time to xerostomia resolution. Patients were pooled in 4 groups based on median values of both mid-treatment shrink (cut-off: 19.6%) and mean WA parotid pl-D (cut-off: 35.7 Gy). Patients with a higher than median parotid dose at planning and who showed poor shrinkage at mid treatment are the ones with the outcome significantly worse (3-yr rate of xerostomia ≈ 50%) than the other three subgroups (3-yr rate of xerostomia ≈ 10%).

Conclusion

For a given planned dose, patients whose parotids significantly shrink during IMRT are less likely to be long-term supplemental fluids dependent.
Literature
1.
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.PubMedCrossRef
2.
Deasy JO, Moiseenko V, Marks L, Chao KSC, Nam J, Eisbruch A. Radiotherapy dose-volume effects on salivary gland function. Int J Radiat Oncol Biol Phys. 2010;76:S58–63.PubMedCentralPubMedCrossRef
3.
Nutting CM, Morden JP, Harrington KJ, Urbano TG, Bhide SA, Clarck C, et al. Parotid-sparing intensity modulated versus conventional radiotherapy in head and neck cancer (PARSPORT): a phase 3 multicentre randomised controlled trial. Lancet Oncol. 2011;12:127–36.PubMedCentralPubMedCrossRef
4.
Ricchetti F, Wu B, McNutt T, Wang T, Forastiere A, Marer S, et al. Volumetric change of selected organs at risk during IMRT for oropharyngeal cancer. Int J Radiat Oncol Biol Phys. 2011;80:161–8.PubMedCrossRef
5.
Sanguineti G, Ricchetti F, Thomas O, Wu B, McNutt T. Pattern and predictors of volumetric change of parotid glands during intensity modulated radiotherapy. Br J Radiol. 2013;86(1031):20130363.
6.
Vasquez Osorio EM, Hoogeman MS, Al-Mamgani A, Teguh DN, Levendag PC, Hejimen BJ. Local anatomic changes in parotid and submandibular glands during radiotherapy for oropharynx cancer and correlation with dose, studied in detail with nonrigid registration. Int J Radiat Oncol Biol Phys. 2008;70:875–82.PubMedCrossRef
7.
Lee C, Langen KM, Lu W, Hainerl J, Schnarr E, Ruchala KJ, et al. Assessment of parotid gland dose changes during head and neck cancer radiotherapy using daily megavoltage computed tomography and deformable image registration. Int J Radiat Oncol Biol Phys. 2008;71:1563–71.PubMedCrossRef
8.
Belli ML, Scalco E, Sanguineti G, Fiorino C, Broggi S, Dinapoli N, et al. Early changes of parotid density and volume predict modifications at the end of therapy and intensity of acute xerostomia. Strahlenther Onkol. 2014;11:1001–7.CrossRef
9.
Sanguineti G, Ricchetti F, McNutt T, Wu B, Fiorino C. Dosimetric predictors of dysphonia after intensity-modulated radiotherapy for oropharyngeal carcinoma. Clin Oncol (R Coll Radiol). 2014;26(1):32–8.CrossRef
10.
Hunter KU, Fernandes LL, Vineberg KA, McShan D, Antonuk AE, Cornwall C, et al. Parotid glands dose-effect relationships based on their actually delivered doses: implications for adaptive replanning in radiation therapy of head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2013;87(4):676–82.PubMedCentralPubMedCrossRef
11.
Scalco E, Fiorino C, Cattaneo GM, Sanguineti G, Rizzo G. Texture analysis for the assessment of structural changes in parotid glands induced by radiotherapy. Radiother Oncol. 2013;109(3):384–7.PubMedCrossRef
12.
Teshima K, Murakami R, Yoshida R, Nakayama H, Hiraki A, Hirai T, et al. Histopathological changes in parotid and submandibular glands of patients treated with preoperative chemoradiation therapy for oral cancer. J Radiat Res. 2012;53(3):492–6.PubMed
13.
Mathus-Vliegen EM, Nikkel D, Brand HS. Oral aspects of obesity. Int Dent J. 2007;57(4):249–56.PubMed
14.
Little M, Schipper M, Feng FY, Vineberg K, Cornwell C, Murdoch-Kinch CA, et al. Reducing xerostomia after chemo-IMRT for head-and-neck cancer: beyond sparing the parotid glands. Int J Radiat Oncol Biol Phys. 2012;83(3):1007–14.PubMedCentralPubMedCrossRef
15.
Ortholan C, Chamorey E, Benezery K, Thariat J, Dassonville O, Poissonet G, et al. Modeling of salivary production recovery after radiotherapy using mixed models: Determination of optimal dose constraint for IMRT planning and construction of convenient tools to predict salivary function. Int J Radiat Oncol Biol Phys. 2009;73:178–86.PubMedCrossRef
16.
Jensen K, Lambertsen K, Torkov P, Dahl M, Jensen AB, Grau C. Patient assessed symptoms are poor predictors of objective findings: results from a cross sectional study in patients treated with radiotherapy for pharyngeal cancer. Acta Oncol. 2007;46:1159–68.PubMedCrossRef
Metadata
Title
Parotid gland shrinkage during IMRT predicts the time to Xerostomia resolution
Authors
Giuseppe Sanguineti
Francesco Ricchetti
Binbin Wu
Todd McNutt
Claudio Fiorino
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/s13014-015-0331-x

Other articles of this Issue 1/2015

Radiation Oncology 1/2015 Go to the issue

Research

Increased survival with the combination of stereotactic radiosurgery and gefitinib for non-small cell lung cancer brain metastasis patients: a nationwide study in Taiwan

Research

Cellular uptake and in vitro antitumor efficacy of composite liposomes for neutron capture therapy

Research

Reproducibility of deep inspiration breath hold for prone left-sided whole breast irradiation

Review

Modern radiation therapy and potential fertility preservation strategies in patients with cervical cancer undergoing chemoradiation

Research

Impact of waiting time after surgery and overall time of postoperative radiochemotherapy on treatment outcome in glioblastoma multiforme

Review

Live cell imaging at the Munich ion microbeam SNAKE – a status report