Skip to main content
Top
Published in: European Journal of Medical Research 1/2023

Open Access 01-12-2023 | Radiotherapy | Research

The application of 3D-printed oral stents in intensity-modulated radiotherapy for oropharyngeal cancer and their dosimetric effect on organs at risk

Authors: Jungang Ma, Zhuo Chen, Shuixia Liu, Wei Hu, Kunpu Su, Rong He, Peng Zhou, He Xiao, Jia Ju, Qianying Hou, Yinying Zhou, Bin Wang

Published in: European Journal of Medical Research | Issue 1/2023

Login to get access

Abstract

Background

This study investigates the accuracy of 3D-printed dental stents in intensity-modulated radiotherapy (IMRT) for oropharyngeal cancer (OPC) and their dosimetric effects on normal tissues.

Methods

We selected 60 patients with OPC who underwent IMRT in the Department of Oncology, Special Medical Center of Army Medical University. These patients were randomly assigned into 3D-printed oral stent, simple glass bottle, and nonstent groups (20 patients/group). The positioning error was analyzed with the onboard imaging system once a week after 5 fractions of IMRT. The conformity index (CI), homogeneity index (HI), radiation dose of organs at risk (OARs), and oral mucosal reaction were compared among the three groups.

Results

No significant difference was observed in the conformity and uniformity of the target dose and the dose received by the spinal cord, larynx, and bilateral parotid glands among the three groups (P > 0.05). Meanwhile, the dose received by the upper cheek, hard palate, and soft palate of patients was significantly lower in the 3D-printed oral stent group than in the nonstent group (P < 0.05) but insignificantly different between the 3D-printed oral stent and simple glass bottle groups (P > 0.05). When compared with the nonstent group, the simple glass bottle group showed a markedly lower dose received by the upper cheek (P < 0.05) and an insignificantly different dose received by the hard palate and soft palate (P > 0.05). According to Common Terminology Criteria for Adverse Events v.5.0, the adverse response rate of the hard palate mucosa was lower in the 3D-printed oral stent group than in the simple glass bottle and nonstent groups (P < 0.05).

Conclusions

For OPC patients undergoing IMRT, the application of 3D-printed oral stents can significantly reduce the exposure dose of the upper cheek and hard palate and decrease the occurrence of adverse events such as oral mucositis although it cannot affect the positioning error.
Literature
1.
go back to reference Lorenzoni V, Chaturvedi AK, Vignat J, Laversanne M, Bray F, Vaccarella S. The Current Burden of Oropharyngeal Cancer: a global assessment based on GLOBOCAN 2020. Cancer Epidemiol Biomarkers Prev. 2022;31(11):2054–62.CrossRefPubMed Lorenzoni V, Chaturvedi AK, Vignat J, Laversanne M, Bray F, Vaccarella S. The Current Burden of Oropharyngeal Cancer: a global assessment based on GLOBOCAN 2020. Cancer Epidemiol Biomarkers Prev. 2022;31(11):2054–62.CrossRefPubMed
2.
go back to reference Huber MA, Tantiwongkosi B. Oral and oropharyngeal cancer. Med Clin North Am. 2014;98(6):1299–321.CrossRefPubMed Huber MA, Tantiwongkosi B. Oral and oropharyngeal cancer. Med Clin North Am. 2014;98(6):1299–321.CrossRefPubMed
3.
go back to reference Ding J, Tu W, Hu H, Shi H, Kong Y. Design of individualized oral radiotherapy stent based on 3D printing technique. Zhongguo Yi Liao Qi Xie Za Zhi. 2017;41(6):458–9.PubMed Ding J, Tu W, Hu H, Shi H, Kong Y. Design of individualized oral radiotherapy stent based on 3D printing technique. Zhongguo Yi Liao Qi Xie Za Zhi. 2017;41(6):458–9.PubMed
4.
go back to reference Geiger JL, Ku JA. Postoperative treatment of oropharyngeal cancer in the era of human papillomavirus. Curr Treat Options Oncol. 2019;20(3):20.CrossRefPubMed Geiger JL, Ku JA. Postoperative treatment of oropharyngeal cancer in the era of human papillomavirus. Curr Treat Options Oncol. 2019;20(3):20.CrossRefPubMed
5.
go back to reference Wilke CT, Zaid M, Chung C, Fuller CD, Mohamed ASR, Skinner H, Phan J, Gunn GB, Morrison WH, Garden AS, Frank SJ, Rosenthal DI, Chambers MS, et al. Design and fabrication of a 3D-printed oral stent for head and neck radiotherapy from routine diagnostic imaging. 3D Print Med. 2017;3(1):12.CrossRefPubMedPubMedCentral Wilke CT, Zaid M, Chung C, Fuller CD, Mohamed ASR, Skinner H, Phan J, Gunn GB, Morrison WH, Garden AS, Frank SJ, Rosenthal DI, Chambers MS, et al. Design and fabrication of a 3D-printed oral stent for head and neck radiotherapy from routine diagnostic imaging. 3D Print Med. 2017;3(1):12.CrossRefPubMedPubMedCentral
6.
go back to reference Meng Z, Garcia MK, Hu C, Chiang J, Chambers M, Rosenthal DI, Peng H, Zhang Y, Zhao Q, Zhao G, Liu L, Spelman A, Palmer JL, et al. Randomized controlled trial of acupuncture for prevention of radiation-induced xerostomia among patients with nasopharyngeal carcinoma. Cancer. 2012;118(13):3337–44.CrossRefPubMed Meng Z, Garcia MK, Hu C, Chiang J, Chambers M, Rosenthal DI, Peng H, Zhang Y, Zhao Q, Zhao G, Liu L, Spelman A, Palmer JL, et al. Randomized controlled trial of acupuncture for prevention of radiation-induced xerostomia among patients with nasopharyngeal carcinoma. Cancer. 2012;118(13):3337–44.CrossRefPubMed
7.
go back to reference Santiago A. An intraoral stent for the direction of radiation beam therapy. J Prosthet Dent. 1965;15(5):938–44.CrossRefPubMed Santiago A. An intraoral stent for the direction of radiation beam therapy. J Prosthet Dent. 1965;15(5):938–44.CrossRefPubMed
8.
go back to reference Doi H, Tanooka M, Ishida T, Moridera K, Ichimiya K, Tarutani K, Kitajima K, Fujiwara M, Kishimoto H, Kamikonya N. Utility of intraoral stents in external beam radiotherapy for head and neck cancer. Rep Pract Oncol Radiother. 2017;22(4):310–8.CrossRefPubMedPubMedCentral Doi H, Tanooka M, Ishida T, Moridera K, Ichimiya K, Tarutani K, Kitajima K, Fujiwara M, Kishimoto H, Kamikonya N. Utility of intraoral stents in external beam radiotherapy for head and neck cancer. Rep Pract Oncol Radiother. 2017;22(4):310–8.CrossRefPubMedPubMedCentral
9.
go back to reference Wang H, Wang C, Tung S, Dimmitt AW, Wong PF, Edson MA, Garden AS, Rosenthal DI, Fuller CD, Gunn GB, Takiar V, Wang XA, Luo D, et al. Improved setup and positioning accuracy using a three-point customized cushion/mask/bite-block immobilization system for stereotactic reirradiation of head and neck cancer. J Appl Clin Med Phys. 2016;17(3):180–9.CrossRefPubMedPubMedCentral Wang H, Wang C, Tung S, Dimmitt AW, Wong PF, Edson MA, Garden AS, Rosenthal DI, Fuller CD, Gunn GB, Takiar V, Wang XA, Luo D, et al. Improved setup and positioning accuracy using a three-point customized cushion/mask/bite-block immobilization system for stereotactic reirradiation of head and neck cancer. J Appl Clin Med Phys. 2016;17(3):180–9.CrossRefPubMedPubMedCentral
10.
go back to reference Qin WJ, Luo W, Lin SR, Sun Y, Li FM, Liu XQ, Ma J, Lu TX. Sparing normal oral tissues with individual dental stent in radiotherapy for primary nasopharyngeal carcinoma patients. Ai Zheng. 2007;26(3):285–9.PubMed Qin WJ, Luo W, Lin SR, Sun Y, Li FM, Liu XQ, Ma J, Lu TX. Sparing normal oral tissues with individual dental stent in radiotherapy for primary nasopharyngeal carcinoma patients. Ai Zheng. 2007;26(3):285–9.PubMed
11.
go back to reference Deshpande TS, Blanchard P, Wang L, Foote RL, Zhang X, Frank SJ. Radiation-related alterations of taste function in patients with head and neck cancer: a systematic review. Curr Treat Options Oncol. 2018;19(12):72.CrossRefPubMedPubMedCentral Deshpande TS, Blanchard P, Wang L, Foote RL, Zhang X, Frank SJ. Radiation-related alterations of taste function in patients with head and neck cancer: a systematic review. Curr Treat Options Oncol. 2018;19(12):72.CrossRefPubMedPubMedCentral
12.
go back to reference Wang RR, Olmsted LW. A direct method for fabricating tongue-shielding stent. J Prosthet Dent. 1995;74(2):171–3.CrossRefPubMed Wang RR, Olmsted LW. A direct method for fabricating tongue-shielding stent. J Prosthet Dent. 1995;74(2):171–3.CrossRefPubMed
13.
go back to reference Reitemeier B, Reitemeier G, Schmidt A, Schaal W, Blochberger P, Lehmann D, Herrmann T. Evaluation of a device for attenuation of electron release from dental restorations in a therapeutic radiation field. J Prosthet Dent. 2002;87(3):323–7.CrossRefPubMed Reitemeier B, Reitemeier G, Schmidt A, Schaal W, Blochberger P, Lehmann D, Herrmann T. Evaluation of a device for attenuation of electron release from dental restorations in a therapeutic radiation field. J Prosthet Dent. 2002;87(3):323–7.CrossRefPubMed
14.
go back to reference Pan JJ, Zheng BH, Zhang Y, Chen CB, Li JL, Zhang XC. Measurement of setup error in conformal radiotherapy for nasopharyngeal carcinoma. Ai Zheng. 2006;25(1):115–8.PubMed Pan JJ, Zheng BH, Zhang Y, Chen CB, Li JL, Zhang XC. Measurement of setup error in conformal radiotherapy for nasopharyngeal carcinoma. Ai Zheng. 2006;25(1):115–8.PubMed
15.
go back to reference Pham QV, Lavallee AP, Foias A, Roberge D, Mitrou E, Wong P. Radiotherapy immobilization mask molding through the use of 3D-printed head models. Technol Cancer Res Treat. 2018;17:1533033818809051.CrossRefPubMedPubMedCentral Pham QV, Lavallee AP, Foias A, Roberge D, Mitrou E, Wong P. Radiotherapy immobilization mask molding through the use of 3D-printed head models. Technol Cancer Res Treat. 2018;17:1533033818809051.CrossRefPubMedPubMedCentral
16.
go back to reference Liu XQ, Luo W, Lin SR, Liu MZ. Placement repeatability of individual oral stent used in radiotherapy of nasopharyngeal carcinoma. Ai Zheng. 2009;28(10):1103–7.PubMed Liu XQ, Luo W, Lin SR, Liu MZ. Placement repeatability of individual oral stent used in radiotherapy of nasopharyngeal carcinoma. Ai Zheng. 2009;28(10):1103–7.PubMed
17.
go back to reference Chen GFFL, San GP, Wang BB, Chen WJ, Jiang F. Analysis of the positioning error of the occluder as the oral stent for head and neck tumor radiotherapy. Zhe Jiang Med J. 2015;17:2148–9. Chen GFFL, San GP, Wang BB, Chen WJ, Jiang F. Analysis of the positioning error of the occluder as the oral stent for head and neck tumor radiotherapy. Zhe Jiang Med J. 2015;17:2148–9.
18.
go back to reference Shao HMWX, Yu CH, Zheng YM, Wang JH, Zhou C. Study on the position repeatability of simple and individualized oral stent with cork in radiotherapy of head and neck tumor. Modern Practical Medicine. 2012;24:762–3. Shao HMWX, Yu CH, Zheng YM, Wang JH, Zhou C. Study on the position repeatability of simple and individualized oral stent with cork in radiotherapy of head and neck tumor. Modern Practical Medicine. 2012;24:762–3.
19.
go back to reference Cleland S, Crowe SB, Chan P, Chua B, Dawes J, Kenny L, Lin CY, McDowall WR, Obereigner E, Poroa T, Stewart K, Kairn T. Development of a customisable 3D-printed intra-oral stent for head-and-neck radiotherapy. Tech Innov Patient Support Radiat Oncol. 2022;23:1–7.CrossRefPubMedPubMedCentral Cleland S, Crowe SB, Chan P, Chua B, Dawes J, Kenny L, Lin CY, McDowall WR, Obereigner E, Poroa T, Stewart K, Kairn T. Development of a customisable 3D-printed intra-oral stent for head-and-neck radiotherapy. Tech Innov Patient Support Radiat Oncol. 2022;23:1–7.CrossRefPubMedPubMedCentral
20.
go back to reference Liu J, Sun L, Xu W, Wang Q, Yu S, Sun J. Current advances and future perspectives of 3D printing natural-derived biopolymers. Carbohydr Polym. 2019;207:297–316.CrossRefPubMed Liu J, Sun L, Xu W, Wang Q, Yu S, Sun J. Current advances and future perspectives of 3D printing natural-derived biopolymers. Carbohydr Polym. 2019;207:297–316.CrossRefPubMed
21.
go back to reference Al-Rawi SAI, Abouelenein H, Khalil MM, Alabdei HH, Sulaiman AA, Al-Nuaimi DS, Nagdy MEE. Evaluation of conformity and homogeneity indices consistency throughout the course of head and neck cancer treatment with and without using adaptive volumetric modulated arc radiation therapy. Adv Radiat Oncol. 2022;7(5): 100905.CrossRefPubMedPubMedCentral Al-Rawi SAI, Abouelenein H, Khalil MM, Alabdei HH, Sulaiman AA, Al-Nuaimi DS, Nagdy MEE. Evaluation of conformity and homogeneity indices consistency throughout the course of head and neck cancer treatment with and without using adaptive volumetric modulated arc radiation therapy. Adv Radiat Oncol. 2022;7(5): 100905.CrossRefPubMedPubMedCentral
22.
go back to reference Isobe I, Mori Y, Kaneda N, Hashizume C, Ishiguchi T, Suzuki K. Dosimetric comparison of hypofractionated multi-beam intensity-modulated radiation therapy and volumetric modulated arc therapy with flattened beam and flattening-filter-free beam for skull base meningioma adjacent to optic pathways. Cureus. 2020;12(6): e8690.PubMedPubMedCentral Isobe I, Mori Y, Kaneda N, Hashizume C, Ishiguchi T, Suzuki K. Dosimetric comparison of hypofractionated multi-beam intensity-modulated radiation therapy and volumetric modulated arc therapy with flattened beam and flattening-filter-free beam for skull base meningioma adjacent to optic pathways. Cureus. 2020;12(6): e8690.PubMedPubMedCentral
23.
go back to reference Goel A, Tripathi A, Chand P, Singh SV, Pant MC, Nagar A. Use of positioning stents in lingual carcinoma patients subjected to radiotherapy. Int J Prosthodont. 2010;23(5):450–2.PubMed Goel A, Tripathi A, Chand P, Singh SV, Pant MC, Nagar A. Use of positioning stents in lingual carcinoma patients subjected to radiotherapy. Int J Prosthodont. 2010;23(5):450–2.PubMed
24.
go back to reference Tino RLM, Yeo A, Kyriakou E, Kron T, Brandt M. Additive manufacturing in radiation oncology: a review of clinical practice, emerging trends and research opportunities. Int J Extrem Manuf. 2020;2: 012003.CrossRef Tino RLM, Yeo A, Kyriakou E, Kron T, Brandt M. Additive manufacturing in radiation oncology: a review of clinical practice, emerging trends and research opportunities. Int J Extrem Manuf. 2020;2: 012003.CrossRef
25.
go back to reference Singhvi MS, Zinjarde SS, Gokhale DV. Polylactic acid: synthesis and biomedical applications. J Appl Microbiol. 2019;127(6):1612–26.CrossRefPubMed Singhvi MS, Zinjarde SS, Gokhale DV. Polylactic acid: synthesis and biomedical applications. J Appl Microbiol. 2019;127(6):1612–26.CrossRefPubMed
26.
go back to reference de Albuquerque TL, Marques Junior JE, de Queiroz LP, Ricardo ADS, Rocha MVP. Polylactic acid production from biotechnological routes: a review. Int J Biol Macromol. 2021;186:933–51.CrossRefPubMed de Albuquerque TL, Marques Junior JE, de Queiroz LP, Ricardo ADS, Rocha MVP. Polylactic acid production from biotechnological routes: a review. Int J Biol Macromol. 2021;186:933–51.CrossRefPubMed
27.
go back to reference Katsura K, Utsunomiya S, Abe E, Sakai H, Kushima N, Tanabe S, Yamada T, Hayakawa T, Yamanoi Y, Kimura S, Wada S, Aoyama H, Hayashi T. A study on a dental device for the prevention of mucosal dose enhancement caused by backscatter radiation from dental alloy during external beam radiotherapy. J Radiat Res. 2016;57(6):709–13.CrossRefPubMedPubMedCentral Katsura K, Utsunomiya S, Abe E, Sakai H, Kushima N, Tanabe S, Yamada T, Hayakawa T, Yamanoi Y, Kimura S, Wada S, Aoyama H, Hayashi T. A study on a dental device for the prevention of mucosal dose enhancement caused by backscatter radiation from dental alloy during external beam radiotherapy. J Radiat Res. 2016;57(6):709–13.CrossRefPubMedPubMedCentral
28.
go back to reference Bruno JS, Miranda-Silva W, Guedes VDS, Parahyba CJ, Moraes FY, Fregnani ER. Digital workflow for producing oral positioning radiotherapy stents for head and neck cancer. J Prosthodont. 2020;29(5):448–52.CrossRefPubMed Bruno JS, Miranda-Silva W, Guedes VDS, Parahyba CJ, Moraes FY, Fregnani ER. Digital workflow for producing oral positioning radiotherapy stents for head and neck cancer. J Prosthodont. 2020;29(5):448–52.CrossRefPubMed
Metadata
Title
The application of 3D-printed oral stents in intensity-modulated radiotherapy for oropharyngeal cancer and their dosimetric effect on organs at risk
Authors
Jungang Ma
Zhuo Chen
Shuixia Liu
Wei Hu
Kunpu Su
Rong He
Peng Zhou
He Xiao
Jia Ju
Qianying Hou
Yinying Zhou
Bin Wang
Publication date
01-12-2023
Publisher
BioMed Central
Keyword
Radiotherapy
Published in
European Journal of Medical Research / Issue 1/2023
Electronic ISSN: 2047-783X
DOI
https://doi.org/10.1186/s40001-023-01333-x

Other articles of this Issue 1/2023

European Journal of Medical Research 1/2023 Go to the issue