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Radiation Oncology
Published in: Radiation Oncology 1/2013

Open Access 01-12-2013 | Research

Salivary gland-sparing other than parotid-sparing in definitive head-and-neck intensity-modulated radiotherapy does not seem to jeopardize local control

Authors: Enrique Chajon, Caroline Lafond, Guillaume Louvel, Joël Castelli, Danièle Williaume, Olivier Henry, Franck Jégoux, Elodie Vauléon, Jean-Pierre Manens, Elisabeth Le Prisé, Renaud de Crevoisier

Published in: Radiation Oncology | Issue 1/2013

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Abstract

Background

The objective was to analyze locoregional (LR) failure patterns in patients with head-and-neck cancer (HNC) treated using intensity-modulated radiotherapy (IMRT) with whole salivary gland-sparing: parotid (PG), submandibular (SMG), and accessory salivary glands represented by the oral cavity (OC).

Methods

Seventy consecutive patients with Stage I-II (23%) or III/IV (77%) HNC treated by definitive IMRT were included. For all LR failure patients, the FDG-PET and CT scans documenting recurrence were rigidly registered to the initial treatment planning CT. Failure volumes (Vf) were delineated based on clinical, radiological, and histological data. The percentage of Vf covered by 95% of the prescription isodose (Vf-V95) was analyzed. Failures were classified as “in-field” if Vf–V95 ≥ 95%, “marginal” if 20% < Vf-V95 < 95%, and “out-of-field” if Vf-V95 ≤20%. Correlation between Vf-V95 and mean doses (Dmean) in the PG, SMG, and OC was assessed using Spearman’s rank-order correlation test. The salivary gland dose impact on the LR recurrence risk was assessed by Cox analysis.

Results

The median follow-up was 20 months (6–35). Contralateral and ipsilateral PGs were spared in 98% and 54% of patients, respectively, and contralateral and ipsilateral SMG in 26% and 7%, respectively. The OC was spared to a dose ≤40 Gy in 26 patients (37%). The 2-year LR control rate was 76.5%. One recurrence was “marginal”, and 12 were “in-field”. No recurrence was observed in vicinity of spared structures. Vf-V95 was not significantly correlated with Dmean in PG, SMG, and OC. The LR recurrence risk was not increased by lower Dmean in the salivary glands, but by T (p = 0.04) and N stages (p = 0.03).

Conclusion

Over 92% of LR failures occurred “in-field” within the high dose region when using IMRT with a whole salivary gland-sparing strategy. Sparing SMG and OC in addition to PG thus appears a safe strategy.
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Metadata
Title
Salivary gland-sparing other than parotid-sparing in definitive head-and-neck intensity-modulated radiotherapy does not seem to jeopardize local control
Authors
Enrique Chajon
Caroline Lafond
Guillaume Louvel
Joël Castelli
Danièle Williaume
Olivier Henry
Franck Jégoux
Elodie Vauléon
Jean-Pierre Manens
Elisabeth Le Prisé
Renaud de Crevoisier
Publication date
01-12-2013
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2013
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/1748-717X-8-132

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