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Impact of head and neck cancer adaptive radiotherapy to spare the parotid glands and decrease the risk of xerostomia
BACKGROUND: Large anatomical variations occur during the course of intensity-modulated radiation therapy (IMRT) for locally advanced head and neck cancer (LAHNC). The risks are therefore a parotid glands (PG) overdose and a xerostomia increase. The purposes of the study were to estimate: - the PG ov...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4311461/ https://www.ncbi.nlm.nih.gov/pubmed/25573091 http://dx.doi.org/10.1186/s13014-014-0318-z |
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author | Castelli, Joel Simon, Antoine Louvel, Guillaume Henry, Olivier Chajon, Enrique Nassef, Mohamed Haigron, Pascal Cazoulat, Guillaume Ospina, Juan David Jegoux, Franck Benezery, Karen de Crevoisier, Renaud |
author_facet | Castelli, Joel Simon, Antoine Louvel, Guillaume Henry, Olivier Chajon, Enrique Nassef, Mohamed Haigron, Pascal Cazoulat, Guillaume Ospina, Juan David Jegoux, Franck Benezery, Karen de Crevoisier, Renaud |
author_sort | Castelli, Joel |
collection | PubMed |
description | BACKGROUND: Large anatomical variations occur during the course of intensity-modulated radiation therapy (IMRT) for locally advanced head and neck cancer (LAHNC). The risks are therefore a parotid glands (PG) overdose and a xerostomia increase. The purposes of the study were to estimate: - the PG overdose and the xerostomia risk increase during a “standard” IMRT (IMRT(std)); - the benefits of an adaptive IMRT (ART) with weekly replanning to spare the PGs and limit the risk of xerostomia. MATERIAL AND METHODS: Fifteen patients received radical IMRT (70 Gy) for LAHNC. Weekly CTs were used to estimate the dose distributions delivered during the treatment, corresponding either to the initial planning (IMRT(std)) or to weekly replanning (ART). PGs dose were recalculated at the fraction, from the weekly CTs. PG cumulated doses were then estimated using deformable image registration. The following PG doses were compared: pre-treatment planned dose, per-treatment IMRT(std) and ART. The corresponding estimated risks of xerostomia were also compared. Correlations between anatomical markers and dose differences were searched. RESULTS: Compared to the initial planning, a PG overdose was observed during IMRT(std) for 59% of the PGs, with an average increase of 3.7 Gy (10.0 Gy maximum) for the mean dose, and of 8.2% (23.9% maximum) for the risk of xerostomia. Compared to the initial planning, weekly replanning reduced the PG mean dose for all the patients (p < 0.05). In the overirradiated PG group, weekly replanning reduced the mean dose by 5.1 Gy (12.2 Gy maximum) and the absolute risk of xerostomia by 11% (p < 0.01) (30% maximum). The PG overdose and the dosimetric benefit of replanning increased with the tumor shrinkage and the neck thickness reduction (p < 0.001). CONCLUSION: During the course of LAHNC IMRT, around 60% of the PGs are overdosed of 4 Gy. Weekly replanning decreased the PG mean dose by 5 Gy, and therefore by 11% the xerostomia risk. |
format | Online Article Text |
id | pubmed-4311461 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-43114612015-01-31 Impact of head and neck cancer adaptive radiotherapy to spare the parotid glands and decrease the risk of xerostomia Castelli, Joel Simon, Antoine Louvel, Guillaume Henry, Olivier Chajon, Enrique Nassef, Mohamed Haigron, Pascal Cazoulat, Guillaume Ospina, Juan David Jegoux, Franck Benezery, Karen de Crevoisier, Renaud Radiat Oncol Research BACKGROUND: Large anatomical variations occur during the course of intensity-modulated radiation therapy (IMRT) for locally advanced head and neck cancer (LAHNC). The risks are therefore a parotid glands (PG) overdose and a xerostomia increase. The purposes of the study were to estimate: - the PG overdose and the xerostomia risk increase during a “standard” IMRT (IMRT(std)); - the benefits of an adaptive IMRT (ART) with weekly replanning to spare the PGs and limit the risk of xerostomia. MATERIAL AND METHODS: Fifteen patients received radical IMRT (70 Gy) for LAHNC. Weekly CTs were used to estimate the dose distributions delivered during the treatment, corresponding either to the initial planning (IMRT(std)) or to weekly replanning (ART). PGs dose were recalculated at the fraction, from the weekly CTs. PG cumulated doses were then estimated using deformable image registration. The following PG doses were compared: pre-treatment planned dose, per-treatment IMRT(std) and ART. The corresponding estimated risks of xerostomia were also compared. Correlations between anatomical markers and dose differences were searched. RESULTS: Compared to the initial planning, a PG overdose was observed during IMRT(std) for 59% of the PGs, with an average increase of 3.7 Gy (10.0 Gy maximum) for the mean dose, and of 8.2% (23.9% maximum) for the risk of xerostomia. Compared to the initial planning, weekly replanning reduced the PG mean dose for all the patients (p < 0.05). In the overirradiated PG group, weekly replanning reduced the mean dose by 5.1 Gy (12.2 Gy maximum) and the absolute risk of xerostomia by 11% (p < 0.01) (30% maximum). The PG overdose and the dosimetric benefit of replanning increased with the tumor shrinkage and the neck thickness reduction (p < 0.001). CONCLUSION: During the course of LAHNC IMRT, around 60% of the PGs are overdosed of 4 Gy. Weekly replanning decreased the PG mean dose by 5 Gy, and therefore by 11% the xerostomia risk. BioMed Central 2015-01-09 /pmc/articles/PMC4311461/ /pubmed/25573091 http://dx.doi.org/10.1186/s13014-014-0318-z Text en © Castelli et al.; licensee BioMed Central. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Castelli, Joel Simon, Antoine Louvel, Guillaume Henry, Olivier Chajon, Enrique Nassef, Mohamed Haigron, Pascal Cazoulat, Guillaume Ospina, Juan David Jegoux, Franck Benezery, Karen de Crevoisier, Renaud Impact of head and neck cancer adaptive radiotherapy to spare the parotid glands and decrease the risk of xerostomia |
title | Impact of head and neck cancer adaptive radiotherapy to spare the parotid glands and decrease the risk of xerostomia |
title_full | Impact of head and neck cancer adaptive radiotherapy to spare the parotid glands and decrease the risk of xerostomia |
title_fullStr | Impact of head and neck cancer adaptive radiotherapy to spare the parotid glands and decrease the risk of xerostomia |
title_full_unstemmed | Impact of head and neck cancer adaptive radiotherapy to spare the parotid glands and decrease the risk of xerostomia |
title_short | Impact of head and neck cancer adaptive radiotherapy to spare the parotid glands and decrease the risk of xerostomia |
title_sort | impact of head and neck cancer adaptive radiotherapy to spare the parotid glands and decrease the risk of xerostomia |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4311461/ https://www.ncbi.nlm.nih.gov/pubmed/25573091 http://dx.doi.org/10.1186/s13014-014-0318-z |
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