Regional radiation dose susceptibility within the parotid gland: Effects on salivary loss and recovery
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia V6T 1Z1 (Canada)
- Oral Oncology/Dentistry, British Columbia Cancer Agency–Vancouver Centre, Vancouver, British Columbia V5Z 4E6 (Canada)
- Department of Radiation Medicine and Applied Sciences, University of California–San Diego, La Jolla, California 92093 (United States)
- Department of Medical Physics, British Columbia Cancer Agency–Vancouver Centre, Vancouver, British Columbia V5Z 4E6 (Canada)
- Radiation Oncology, British Columbia Cancer Agency–Vancouver Centre, Vancouver, British Columbia V5Z 4E6 (Canada)
Purpose: Xerostomia is one of the most likely late toxic effects of radiotherapy treatment in patients with head-and-neck cancers. Modern treatment techniques can incorporate knowledge of complication risk into treatment plans. To this end, the authors attempt to quantify the regional radiotherapy dose-dependence of salivary output loss and recovery in a prospective study. Methods: Salivary output was collected from patients undergoing radiotherapy treatment for head-and-neck cancers at the BC Cancer Agency between February 2008 and May 2013. Regional dose-dependence (i.e., dose susceptibility) of loss and recovery is quantified using nonparametric (Spearman’s rank correlation coefficients, local linear regression) and parametric (least-sum of squares, least-median of squares) techniques. Results: Salivary flow recovery was seen in 79 of 102 patients considered (p < 0.0001, Wilcoxon sign rank test). Output loss was strongly correlated with left- and right parotid combined dose φ = min (D{sub L}, 45 Gy) + min (D{sub R}, 45 Gy), and can be accurately predicted. Median early loss (three months) was 72% of baseline, while median overall loss (1 yr) was 56% of baseline. Fitting an exponential model to whole parotid yields dose sensitivities A{sub 3m} = 0.0604 Gy{sup −1} and A{sub 1y} = 0.0379 Gy{sup −1}. Recovery was not significantly associated with dose. Hints of lateral organ sub-segment dose–response dimorphism were observed. Conclusions: Sub-segmentation appears to predict neither loss nor recovery with any greater precision than whole parotid mean dose, though it is not any worse. Sparing the parotid to a combined dose φ of <50 Gy is recommended for a patient to keep ≈40% of baseline function and thus avoid severe xerostomia at 12 months post-treatment. It seems unlikely that a population’s mean recovery will exceed 20%–30% of baseline output at 1 yr after radiotherapy treatment using current (whole-organ based) clinical guidelines.
- OSTI ID:
- 22413530
- Journal Information:
- Medical Physics, Vol. 42, Issue 4; Other Information: (c) 2015 American Association of Physicists in Medicine; Country of input: International Atomic Energy Agency (IAEA); ISSN 0094-2405
- Country of Publication:
- United States
- Language:
- English
Similar Records
Metabolic Imaging Biomarkers of Postradiotherapy Xerostomia
Three-dimensional conformal radiotherapy for locally advanced (Stage II and worse) head-and-neck cancer: Dosimetric and clinical evaluation