Assessment of Risk of Xerostomia After Whole-Brain Radiation Therapy and Association With Parotid Dose

Wang, Kyle; Pearlstein, Kevin A.; Moon, Dominic H.; Mahbooba, Zahra; Deal, Allison M.; Wang, Yue; Sutton, Stephanie R.; Motley, Britni B.; Judy, Gregory D.; Holmes, Jordan A.; Sheets, Nathan; Kasibhatla, Mohit S.; Pacholke, Heather D.; Shen, Colette J.; Zagar, Timothy M.; Marks, Lawrence B.; Chera, Bhishamjit S.

doi:10.1001/jamaoncol.2018.4951

Cited by 25 publications

(21 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In conclusion, a recent study has shown that xerostomia occurred significantly at the end of WBRT and appeared to be persistent [31]. Therefore, an effort to minimize parotid gland damage in WBRT is necessary.…”

Section: Discussionmentioning

confidence: 86%

Whole brain radiotherapy using four-field box technique with tilting baseplate for parotid gland sparing

Park

Yea

2019

Radiat Oncol J

View full text Add to dashboard Cite

The aim of this study is to evaluate the efficacy and feasibility of four-field box whole brain radiotherapy (FB-WBRT) with tilting baseplate by comparing bilateral WBRT (B-WBRT). Methods and Materials: Between March 2016 and September 2018, 20 patients with brain metastases underwent WBRT using the four-field box technique. WBRT is performed with a dose of 30 Gy in 10 fractions daily. Two computed tomography simulations per person were performed. One was in the traditional supine position for B-WBRT and the other by applying the tilting acrylic supine baseplate to elevate the head by 40° for FB-WBRT. The B-WBRT used the field-in-field technique, which is the most commonly used method in our institution. The FB-WBRT comprised anterior, posterior, and bilateral beams. A wedge was applied in anterior and posterior fields to compensate for skull convexity. Results: The average of Dmean of both parotid glands was 10.2 Gy (range, 3.8 to 17.8 Gy) in B-WBRT and 5.4 Gy (range, 2.0 to 11.7 Gy) in FB-WBRT (p < 0.05). Compared to B-WBRT, FB-WBRT reduced the mean dose of the right and left parotid glands from 10.1 Gy to 4.9 Gy and from 10.4 Gy to 5.8 Gy, respectively (p < 0.05). Further, V 5 , V 10 , V 15 , V 20 , and V 25 for the parotid gland decreased significantly in FB-WBRT (p < 0.05). The Dmax and Dmean of lens decreased according to the dose-volume histogram. Conclusion: Compared to B-WBRT, FB-WBRT with a tilting baseplate is a simple and effective method that takes feature of noncoplanar beam to protect the parotid gland.

show abstract

Section: Discussionmentioning

confidence: 86%

Whole brain radiotherapy using four-field box technique with tilting baseplate for parotid gland sparing

Park

Yea

2019

Radiat Oncol J

View full text Add to dashboard Cite

show abstract

“…Problems with the dry mouth were also observed in alcoholics [38], cigarette smokers [39] and drug addicts [40,41,42,43]. The third main cause is radiation therapy of patients that develop cancer in head and neck area [44,45,46,47]. Irradiation causes degeneration of the salivary glands tissue causing reduction of saliva secretion.…”

Section: Xerostomia: Etiology Of Salivary Glands Dysfunctionsmentioning

confidence: 99%

Artificial Saliva: Challenges and Future Perspectives for the Treatment of Xerostomia

Łysik

Niemirowicz-Laskowska

Bucki

et al. 2019

IJMS

View full text Add to dashboard Cite

The chronic sensation of a dry mouth is a disease condition called xerostomia and affects a large part of the population. Xerostomia is associated with decreased secretion, or more often, qualitative changes in saliva proteins and immunoglobulin concentrations that develop as a result of salivary gland dysfunction. Several reasons causing dry mouth were described, and usually, they include taking medications, diseases or radiotherapy. In some situations, when it is difficult to use salivary stimulants or salivary gland damage is irreversible, the only option might seem to be saliva substitutes. The paper presents the most important aspects considering saliva preparations. The rheological and lubricating properties and the reconstruction of the complex saliva structure has been the main purpose of research. The biological properties of saliva preparations were also widely discussed. As part of the work, the antimicrobial effect of three commercial saliva preparations was tested. Finally, inadequate antimicrobial properties against the strains isolated from the oral cavity were demonstrated. The development of salivary substitutes, in particular, the improvement of antimicrobial properties, can be achieved using nanotechnology, including drug delivery systems containing nanocarriers.

show abstract

“…The proportion of patients who self-reported to be bothered quite a bit or bothered very much by xerostomia at 1 month was 50% in those with parotid V20Gy at least 47%, compared with only 4% in those with parotid V20Gy not more than 47% ( P < .001). 65 The xerostomia score was 23 points (95% CI 16–30, P < .001) at 1 month and declined over time but remained elevated with a score of 14 points (95% CI 7–21, P = .03) at 6 months. At 3 months, this difference was 50% versus 0% ( P = .001).…”

Section: Radiotherapymentioning

confidence: 91%

“…These data provide evidence with a validated xerostomia measure that keeping the parotid gland V20 not more than 47% may decrease the rate of xerostomia in patients receiving whole-brain radiation. 65 Importantly, sparing the parotid gland may be done with modifications in the lateral fields which do not compromise the dose to the brain.…”

Section: Radiotherapymentioning

confidence: 99%

Multidisciplinary patient-centered management of brain metastases and future directions

Palmer

Trifiletti

Gondi

et al. 2020

Neuro-Oncology Advances

View full text Add to dashboard Cite

The incidence of brain metastasis is increasing as improvements in systemic therapy lead to increased survival. This provides new and challenging clinical decisions for patients who are trying to balance the risk of recurrence or progression with treatment-related side effects, and it requires appropriate management strategies from multidisciplinary teams. Improvements in prognostic assessment and systemic therapy with increasing activity in the brain allow for individualized care to better guide the use of local therapies and/or systemic therapy. Here, we review the current landscape of brain-directed therapy for the treatment of brain metastasis in the context of recent improved systemic treatment options. We also discuss emerging treatment strategies including targeted therapies for patients with actionable mutations, immunotherapy, modern whole-brain radiation therapy, radiosurgery, surgery, and clinical trials.

show abstract

Assessment of Risk of Xerostomia After Whole-Brain Radiation Therapy and Association With Parotid Dose

Cited by 25 publications

References 31 publications

Whole brain radiotherapy using four-field box technique with tilting baseplate for parotid gland sparing

Whole brain radiotherapy using four-field box technique with tilting baseplate for parotid gland sparing

Artificial Saliva: Challenges and Future Perspectives for the Treatment of Xerostomia

Multidisciplinary patient-centered management of brain metastases and future directions

Contact Info

Product

Resources

About