Parotid-gland-sparing 3D conformal radiotherapy in patients with bilateral radiotherapy of the head and neck region--results in clinical practice

Oral Oncol. 2009 Feb;45(2):e11-7. doi: 10.1016/j.oraloncology.2008.04.004. Epub 2008 Jul 14.

Abstract

The aim was to improve the prediction rate of hyposalivation after using a modern 3D-conformal-radiotherapy-technique (3D-CRT) by sparing of the contralateral parotid gland. Between June 2002 and October 2006, 107 patients (90 male, 17 female, average age: 58 years) with squamous cell carcinoma of the head and neck were included in a prospective, non-randomized study. All patients were treated using 3D-CRT. Parotid function was assessed by measuring stimulated salivary flow before, during and at the end of radiotherapy, as well as 1, 6 and 12 months after radiotherapy. Measurements were converted to flow rates and normalized relative to that before treatment. Mean doses (D(mean)) were calculated from dose-volume histograms (DVHs) based on computed tomographies (CTs) for the left and right parotid gland separately. Patients were grouped according to the D(mean) of the lowest irradiated parotid gland. Group I included all patients who received a D(mean)<26Gy (n=23), group II D(mean) 26-40Gy (n=38) and group III D(mean)>40Gy (n=46). By the time of 6 months after irradiation, salivary flow rates decreased continuously during the therapy. In group I the flow rate decreased to 59%, in group II to 40% and in group III to 14%, p<0.05. One year after irradiation a recovery effect could be measured in all groups. A sufficient saliva flow rate can be proven if one parotid gland is spared with a D(mean) dose <26Gy. Approximately, one quarter of the participants showed a significant improvement.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Carcinoma, Squamous Cell / radiotherapy*
  • Dose-Response Relationship, Radiation
  • Female
  • Head and Neck Neoplasms / radiotherapy*
  • Humans
  • Male
  • Middle Aged
  • Parotid Gland / radiation effects*
  • Radiation Injuries / prevention & control*
  • Radiotherapy / adverse effects
  • Radiotherapy Dosage
  • Radiotherapy, Conformal / methods*
  • Xerostomia / etiology
  • Xerostomia / prevention & control*