Preservation of parotid function with uncomplicated conformal radiotherapy

Maes, André; Weltens, Caroline; Flamen, Patrick; Lambin, Philippe; Bogaerts, Ria; Li, Xuan; Baetens, Jan; Hermans, Robert; Bogaert, Walter Van den

doi:10.1016/s0167-8140(02)00013-0

Cited by 117 publications

(54 citation statements)

References 30 publications

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“…A lack of concordance between objective endpoints of xerostomia, such as salivary flow and xerostomia-related questionnaires assessing patient-rated xerostomia, has been reported. 5,[28][29][30] In addition, the physician-rated RTOG toxicity score system, although it is used widely, has a potential lack of sensitivity, because it has not been validated prospectively. Therefore, patient-rated xerostomia was considered the most important endpoint.…”

Section: Discussionmentioning

confidence: 99%

Radiotherapy alone, versus radiotherapy with amifostine 3 times weekly, versus radiotherapy with amifostine 5 times weekly

Jellema

Slotman

Müller

et al. 2006

Cancer

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BACKGROUND. The main objective of this study was to investigate whether nondaily intravenous administration of amifostine was as effective as daily intravenous administration with regard to the reduction of the incidence of Grade 2 or greater xerostomia in patients with head and neck cancer. METHODS. Ninety‐one patients who received bilateral irradiation for head and neck cancer were included. Thirty patients received no amifostine (AMI‐0), 31 patients received amifostine at a dose of 200 mg/m2 3 times weekly (AMI‐3), and 30 patients received amifostine at a dose of 200 mg/m2 daily (5 times weekly) (AMI‐5). Acute and late xerostomia and quality of life (QOL) were assessed at baseline, 6 weeks later, and at 6‐month intervals from 6 months to 24 months postradiotherapy. RESULTS. Grade 2 or greater late xerostomia differed significantly at 6 months (AMI‐0 74% vs. AMI‐3 67% vs. AMI‐5 52%; P = .03), but not thereafter. During follow‐up, patient‐rated xerostomia deteriorated more in AMI‐0 patients (mean difference score:, 52 for AMI‐0 compared with 25 for AMI‐3, and 29 for AMI‐5; P = .01). Nausea and emesis were reported most frequently as side effect, but Grade 2 or greater toxicity was observed in only 4 patients. However, 28% of patients discontinued amifostine before the end of radiotherapy. CONCLUSIONS. Long‐term, patient‐rated xerostomia was less for the AMI‐3 and AMI‐5 groups through 2‐year follow‐up, but no difference was noted between the AMI‐3 and AMI‐5 groups. For late xerostomia according to the Radiation Therapy Oncology Group criteria, the same effect was observed at 6 months, but not thereafter. Cancer 2006. © 2006 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Radiotherapy alone, versus radiotherapy with amifostine 3 times weekly, versus radiotherapy with amifostine 5 times weekly

Jellema

Slotman

Müller

et al. 2006

Cancer

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“…This finding motivates reducing the doses to the salivary glands to as low levels as possible. Data on dose response in the parotid glands are accumulating [10,[52][53][54][55]. The common finding with all these data is that a relationship seems to exist between the mean doses to the glands and their residual salivary output.…”

Section: Less Normal Tissue Morbidity With Imrtmentioning

confidence: 94%

Intensity-Modulated Radiation Therapy for Head and Neck Carcinoma

et al. 2007

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After completing this course, the reader will be able to:1. Outline innovations related to targeted radiation therapy.2. Describe trials proving an advantage using IMRT.3. Assess treatment planning modalities and how IMRT fields are designed.4. Evaluate when there is a toxicity advantage for IMRT.5. Discern when conventional radiotherapy should be used instead of IMRT.Access and take the CME test online and receive 1 AMA PRA Category 1 Credit ™ at CME.TheOncologist.com CME CME ABSTRACT Intensity-modulated radiation therapy (IMRT) for head and neck tumors refers to a new approach that aims at increasing the radiation dose gradient between the target tissues and the surrounding normal tissues at risk, thus offering the prospect of increasing the locoregional control probability while decreasing the complication rate. As a prerequisite, IMRT requires a proper selection and delineation of target volumes. For the latter, recent data indicate the potential of functional imaging to complement anatomic imaging modalities. Nonrandomized clinical series in paranasal sinuses and pharyngolaryngeal carcinoma have shown that IMRT was able to achieve a very high rate of locoregional control with less morbidity, such as dry-eye syndrome, xerostomia, and swallowing dysfunction. The promising results of IMRT are likely to be achieved when many treatment conditions are met, for example, optimal selection and delineation of the target volumes and organs at risk, appropriate physical quality control of the irradiation, and accurate patient setup with the use of onboard imaging. Because of the complexity of the various tasks, it is thus likely that these conditions will only be

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“…Besides University of Michigan, other centers have collected and analyzed similar data; these include datasets from Netherlands (11), from Washington University at St. Louis (12), from Helsinksi University Central Hospital in Finland and from University Hospital Gasthuisberg in Belgium (13,14). These studies differ from the current one in a number of aspects, including methods for measuring saliva and the length of follow-up period.…”

Section: Introductionmentioning

confidence: 99%

The impact of dose on parotid salivary recovery in head and neck cancer patients treated with radiation therapy

Taylor

Haken

et al. 2007

International Journal of Radiation Oncology*Biology*Physics

196

121

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Purpose-A common side effect experienced by head and neck cancer patients after radiotherapy (RT) is impairment of the parotid glands' ability to produce saliva. Our purpose is to investigate the relationship between radiation dose and saliva changes in the two years following treatment.Methods and Materials-The study population includes 142 patients treated with conformal or intensity modulated radiotherapy. Saliva flow rates from 266 parotid glands are measured before and 1, 3, 6, 12, 18 and 24 months after treatment. Measurements are collected separately from each gland under both stimulated and unstimulated conditions. Bayesian nonlinear hierarchical models were developed and fit to the data.Results-Parotids receiving higher radiation produce less saliva. The largest reduction is at 1-3 months after RT followed by gradual recovery. When mean doses are lower (e.g. <25Gy), the modelpredicted average stimulated saliva recovers to pre-treatment levels at 12 months and exceeds it at 18 and 24 months. For higher doses (e.g. >30Gy), the stimulated saliva does not return to original levels after two years. Without stimulation, at 24 months, the predicted saliva is 86% of pre-treatment levels for 25Gy and <31% for >40Gy. We do not find evidence to support that the over-production of stimulated saliva at 18 and 24 months after low dose in one parotid gland is due to low saliva production from the other parotid gland.Conclusions-Saliva production is impacted significantly by radiation, but with doses <25-30Gy, recovery is substantial and returns to pre-treatment levels two years after RT.

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Preservation of parotid function with uncomplicated conformal radiotherapy

Cited by 117 publications

References 30 publications

Radiotherapy alone, versus radiotherapy with amifostine 3 times weekly, versus radiotherapy with amifostine 5 times weekly

Radiotherapy alone, versus radiotherapy with amifostine 3 times weekly, versus radiotherapy with amifostine 5 times weekly

Intensity-Modulated Radiation Therapy for Head and Neck Carcinoma

The impact of dose on parotid salivary recovery in head and neck cancer patients treated with radiation therapy

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