Submandibular function recovery after IMRT in head and neck cancer: A prospective dose modelling study

Murthy, Vedang; Lewis, Shirley; Kannan, Sadhana; Khadanga, Chira Ranjan; Rangarajan, Venkatesh; Joshi, Kishore; Gandhi, Minakshi; Dey, Somdatta Ghosh; Rokde, Ganesh; Budrukkar, Ashwini; Gupta, Tejpal; Laskar, Sarbani Ghosh; Agarwal, Jai Prakash

doi:10.1016/j.radonc.2018.02.021

Cited by 15 publications

(6 citation statements)

References 27 publications

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“…Previous studies examining xerostomia have predominantly investigated RT regimens, RT dosimetric predictors, and QOL associations, 19‐27 but few have comprehensively identified other clinical, demographic, non–RT‐related risk factors of xerostomia easily accessible from electronic health records and have quantified their associations among OPC survivors. Therefore, the objective of this study was to identify risk factors for xerostomia among long‐term OPC survivors.…”

Section: Introductionmentioning

confidence: 99%

Determinants of patient‐reported xerostomia among long‐term oropharyngeal cancer survivors

Aggarwal

Hutcheson

Garden

et al. 2021

Cancer

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Background This study was conducted to identify clinicodemographic risk factors for xerostomia among long‐term oropharyngeal cancer (OPC) survivors. Methods This cross‐sectional study included 906 disease‐free, adult OPC survivors with a median survival duration at the time of survey of 6 years (range, 1‐16 years); self‐reported xerostomia scores were available for 877 participants. Study participants had completed curative treatment between January 2000 and December 2013 and responded to a survey administered from September 2015 to July 2016. The primary outcome variable was cancer patient–reported xerostomia measured with the MD Anderson Symptom Inventory Head and Neck Cancer Module. Clinicodemographic risk factors for moderate to severe xerostomia were identified via multivariable logistic regression. Results Moderate to severe xerostomia was reported by 343 of the respondents (39.1%). Female sex (odds ratio [OR], 1.82; 95% CI, 1.22‐2.71; P = .003; Bayesian false‐discovery probability [BFDP] = 0.568), high school or lower education (OR, 1.73; 95% CI, 1.19‐2.52; P = .004; BFDP = 0.636), and current cigarette smoking at the time of survey (OR, 2.56; 95% CI, 1.19‐5.47; P = .016; BFDP = 0.800) were risk factors for moderate to severe xerostomia, and bilateral intensity‐modulated radiotherapy (IMRT) combined with proton therapy and ipsilateral IMRT were protective. Conclusions In this large xerostomia study, modern radiotherapy was a protective factor, and continued cigarette smoking at the time of survey, female sex, and high school or lower education were identified as other contributing risk factors associated with moderate to severe xerostomia. Importantly, these findings need to be confirmed in prospective studies. These results can inform future research and targeted patient‐centered interventions to monitor and manage radiation therapy–associated xerostomia and preserve quality of life among patients with OPC.

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Section: Introductionmentioning

confidence: 99%

Determinants of patient‐reported xerostomia among long‐term oropharyngeal cancer survivors

Aggarwal

Hutcheson

Garden

et al. 2021

Cancer

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“…It is a fact that the mucosa of the oral cavity itself contains around 1000 smaller glands participating in the total gross production of around 0.5 up to 1.5 L of salivary fluids per day. It is therefore an important finding that our contouring strategy yields a significant reduction of the mean dose to the oral cavity as well as the submandibular glands which according to NTCP-modelling studies potentially reduces the risk of severe xerostomia [42]. While data is available suggesting that dosages above mean dosages of 39 Gy to submandibular glands are associated with significantly worse results for xerostomia, we have to point out that dosages lower than 39 Gy were achieved in our patient cohort.…”

Section: Discussionmentioning

confidence: 78%

Reduction of Elective Radiotherapy Treatment Volume in Definitive Treatment of Locally Advanced Head and Neck Cancer—Comparison of a Prospective Trial with a Revised Simulated Contouring Approach

Weissmann

Speer

Putz

et al. 2021

JCM

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Definitive radiochemotherapy of locally advanced head and neck squamous cell cancer (HNSCC) achieves high locoregional tumor control rates; but is frequently associated with long-term toxicity. A future direction could be a de-escalation strategy focusing on treated volume rather than radiotherapy dose. This analysis evaluates radiotherapy dose and volume parameters of patients treated with a standard contouring approach in a clinical trial context compared with a revised volume-reduced contouring approach. In this case, 30 consecutive patients from the CheckRad-CD8 trial treated at a single study center were included in this analysis. Treatment toxicity and quality of life were assessed at the end of radiotherapy. Standard treatment plans (ST) following state of the art contouring guidelines that were used for patient treatment and volume reduced treatment plans (VRT) according to a revised simulated approach were calculated for each patient. Planning target volumes (PTV) and mean doses to 38 organs-at-risk structures were compared. At the end of radiotherapy patients reported high rates of mucositis; dysphagia and xerostomia. In addition; patient reported quality of life as assessed by the EORTC QLQ-HN35 questionnaire deteriorated. Comparing the two contouring approaches; the elective PTV_56 Gy and the high risk PTV_63 Gy (shrinking field) were significantly smaller in the VRT group. Significant reduction of mean dose to structures of the oral cavity; the larynx as well as part of the swallowing muscles and the submandibular glands was achieved in the simulated VRT-plan. Treatment de-intensification by reduction of the irradiated volume could potentially reduce treatment volume and mean doses to organs at risk. The proposed contouring approach should be studied further in the context of a clinical trial.

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“…Murthy et al. suggested that SMG function declines after IMRT with a nadir at 12 months and there is incomplete recovery over time with continued improvement over 24 months ( 28 ). Thus, an extension of follow-up periods to 24 months is necessary to identify salivary glands’ hypofunction recovery.…”

Section: Discussionmentioning

confidence: 99%

Application of Diffusion Kurtosis Imaging in Evaluating Acute Xerostomia in Nasopharyngeal Carcinoma Treated With Induction Chemotherapy Plus Concurrent Chemoradiotherapy

et al. 2022

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PurposeThe aim of this study was to identify the efficacy of diffusion kurtosis imaging (DKI) in tracking and monitoring the dynamic change of parotid glands (PGs), submandibular glands (SMGs), sublingual glands (SLGs), and acute xerostomia in nasopharyngeal carcinoma (NPC) patients treated with induction chemotherapy (IC) plus concurrent chemoradiotherapy (CCRT).MethodsThe prospective study recruited 42 participants treated with IC+CCRT. All patients underwent DKI scanning six times: before IC, before RT, in the middle of the RT course, immediately after RT, and 1 and 3 months post-RT. Mean diffusion coefficient (MD) and mean kurtosis (MK) of PG, SMG, SLG, saliva flow rate measured under resting (uSFR) and stimulated condition (sSFR), and xerostomia questionnaire (XQ) scores were recorded.ResultsAt each time point, sSFR was significantly higher than uSFR (p < 0.05 for all). MD of the salivary glands and XQ scores increased over time while MK, uSFR, and sSFR decreased. After IC, the significant differences were detected in MD and MK of bilateral SMG and MK of the left SLG (p < 0.05 for all), but not in MD and MK of PG, uSFR, sSFR, and XQ scores. After RT, sSFR at 1m-RT decreased significantly (p = 0.03) while no significant differences were detected in uSFR and XQ scores. Moderate-strong correlations were detected in ΔMD-PG-R%, ΔMK-PG-R%, ΔMD-PG-L%, ΔMK-PG-L%, ΔMD-SMG-R%, ΔMK-SMG-R%, ΔMD-SMG-L%, ΔMK-SMG-L%, and ΔMD-SLG-R%, with correlation coefficients (p < 0.05 for all) ranging from 0.401 to 0.714. ΔuSFR% was correlated with ΔMD-SMG% (p = 0.01, r = −0.39), ΔMD-SLG% (p < 0.001, r = −0.532), and ΔMK-SMG% (p < 0.001, r = −0.493). ΔsSFR% correlated with ΔMD-PG% (p = 0.001, r = −0.509), ΔMD-SMG% (p = 0.015, r = −0.221), and ΔMK-PG% (p < 0.001, r = 0.524). ΔXQ% was only correlated with ΔMK-PG% (p = 0.004, r = 0.433).ConclusionDKI is a promising tool for tracking and monitoring the acute damage of PG, SMG, and SLG induced by IC+CCRT in NPC patients.

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Submandibular function recovery after IMRT in head and neck cancer: A prospective dose modelling study

Cited by 15 publications

References 27 publications

Determinants of patient‐reported xerostomia among long‐term oropharyngeal cancer survivors

Determinants of patient‐reported xerostomia among long‐term oropharyngeal cancer survivors

Reduction of Elective Radiotherapy Treatment Volume in Definitive Treatment of Locally Advanced Head and Neck Cancer—Comparison of a Prospective Trial with a Revised Simulated Contouring Approach

Application of Diffusion Kurtosis Imaging in Evaluating Acute Xerostomia in Nasopharyngeal Carcinoma Treated With Induction Chemotherapy Plus Concurrent Chemoradiotherapy

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