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Parotid Sparing Study in Head and Neck Cancer Patients Receiving Bilateral Radiation Therapy: One-year Results
J.A. Ship
Department of Oral Medicine, Pathology, Surgery, University of Michigan School of Dentistry, 1011 N. University, Room 2010, Ann Arbor, Michigan 48109-1078
A. Eisbruch
Department of Radiation Oncology, University of Michigan Medical Center, Ann Arbor, Michigan
E. D'Hondt
Department of Oral Medicine, Pathology, Surgery, University of Michigan School of Dentistry, 1011 N. University, Room 2010, Ann Arbor, Michigan 48109-1078
R.E. Jones
Department of Oral Medicine, Pathology, Surgery, University of Michigan School of Dentistry, 1011 N. University, Room 2010, Ann Arbor, Michigan 48109-1078, 0dessa Brown Children's Clinic, Seattle, WA
Many patients with head and neck cancers receive radiation therapy as part of their treatment which frequently causes considerable morbidity, including various degrees of permanent salivary gland dysfunction. Three-dimensional treatment planning [3-DTP] and conformational dose delivery constitute a new therapeutic modality that conforms the high-dose radiation volume to the shape of the tumor volume while minimizing the dose to tissue that is not at risk of containing cancer. The treatment volumes for head and neck tumors as well as parotid glands can be well-defined on cross-sectional CT imaging techniques. The purpose of this investigation is to determine if 3-DTP and conformational dose-delivery could minimize radiation dose and salivary gland dysfunction to contralateral parotid glands in patients with head and neck cancers. Eleven patients with head and neck cancers who required bilateral radiation therapy were treated with 3-DTP. Unstimulated and stimulated bilateral parotid saliva was collected prior to radiotherapy, weekly during treatment, and 1, 3, 6, and 12 months after the completion of radiotherapy. Treated parotid glands received an average dose of 5745 cGy, while spared glands received only 1986 cGy (p < 0.0001). Unstimulated and stimulated parotid flow rates decreased dramatically in treated glands after the initiation of radiotherapy, remained at extremely low rates without any improvements, and were significantly lower at 1 year after radiotherapy compared with baseline. Conversely, parotid flow rates in spared glands underwent mild changes during radiotherapy and were approximately 50% of baseline values. The results of this study suggest that with the use of 3-DTP, contralateral parotid gland function can be partially preserved for at least 1 year in patients with head and neck cancers requiring bilateral radiation.
Key Words: salivary gland function • three-dimensional treatment planning • parotid sparing • head and neck cancer
REFERENCES
- American Joint Committee on Cancer (1988). Manual for staging of cancer. 3rd ed. Philadelphia: J.B. Lippincott.
- Atkinson JC, Wu AJ (1994). Salivary gland dysfunction: Causes, symptoms, treatment. J Am Dent Assoc 125:409-416.[Abstract]
- Baum BJ ( 1981). Evaluation of stimulated parotid saliva flow rates in different age groups. J Dent Res 60:1292-1296.
- Dawes C. (1974). Rhythms in salivary flow rate and composition. Int J Chronobiol 2:253-279.[Medline]
[Order article via Infotrieve]
- Dreizen S., Brown LR, Daly TE, Drane JB (1977). Prevention of xerostomia related dental caries in irradiated cancer patients. J Dent Res 36:99-104.
- DuMouchel W. (1987). A data analysis advisor. Technical report. Cambridge, MA: BBN Software Products Corporation.
- Eneroth CM, Henrickson CO, Jakobsson PA (1972). Effect of fractionated radiotherapy on salivary gland function. Cancer 30:1147-1153.
- Fox PC, Busch KA, Baum BJ ( 1987). Subjective reports on xerostomia and objective measurements of salivary gland performance. J Am Dent Assoc 115:581-584.[Abstract]
- Franzen L., Funegard U., Ericson T., Henriksson R. (1992). Parotid gland function during and following radiotherapy of malignancies in the head and neck: A consecutive study on salivary flow rates and patient discomfort. Eur J Cancer 28:457-462.[CrossRef][Medline]
[Order article via Infotrieve]
- Greenspan D. (1990). Oral complications of cancer therapies. Management of salivary dysfunction. NCI Monographs 9:159-161.
- Hazuka MB, Martel MK, Marsh L., Lichter AS, Wolf GT ( 1993). Preservation of parotid function after external beam irradiation in head and neck cancer patients: a feasibility study using 3-dimensional (3-D) treatment planning. Int J Radiation Oncology Biol Phys 27:731-737.[Medline]
[Order article via Infotrieve]
- Heft MW, Baum BJ ( 1984). Unstimulated and stimulated parotid salivary flow rate in individuals of different ages. J Dent Res 63:1182-1185.
- Johnson JT, Ferretti GA, Nethery WJ, Valdez IH, Fox PC, Ng D., et al. (1993). Oral pilocarpine for post-irradiation xerostomia in patients with head and neck cancer. N Engl J Med 329:390-395.[Abstract/Free Full Text]
- Jones R., Takeuchi T., Eisbruch A., D'Hondt EG, Hazuka M., Ship JA ( 1996). Ipsilateral parotid sparing study in head and neck cancer patients receiving radiation therapy: 1 year results. Oral Surg Oral Med Oral Pathol Oral Radiol Endo 81:642-648.
- Larson DL, Lindberg RD, Lane E., Goepfert H. (1983). Major complications of radiotherapy in cancer of the oral cavity and oralpharynx. A 10 year retrospective study. Am J Surg 146:531-536.[CrossRef][Medline]
[Order article via Infotrieve]
- LeVeque FG, Montgomery M., Potter D., Zimmer MB, Rieke JW, Steiger BW, et al. (1993). A multicenter, randomized, double-blind, placebo-controlled, dose-titration study of oral pilocarpine for treatment of radiation-induced xerostomia in head and neck cancer patients. J Clin Oncol 6:1124-1131.
- Mandel ID (1989). The role of saliva in maintaining oral homeostasis. J Am Dent Assoc 119:298-304.[Abstract]
- Marks JE, Davis CC, Gottsman VL, Purdy JE, Lee F. (1981). The effects of radiation on parotid salivary function. Int J Oncol Biol Phys 7:1013-1019.
- Mira JG, Wescott WB, Starcke EN, Shannon IL (1981). Some factors influencing salivary function when treating with radiotherapy. Int J Radiat Oncol Biol Phys 7:535-541.[Medline]
[Order article via Infotrieve]
- Mor V., Laliberte L., Morris JN, Wiemann M. (1984). The Kamofsky Performance Status Scale: An examination of its reliability and validity in a research setting. Cancer 53:2002-2007.
- Mossman K., Shatzman A., Chencharick J. (1982). Long-term effects of radiotherapy on taste and salivary function in man. Int J Radiat Oncol Bio Phys 8:991-997.[Medline]
[Order article via Infotrieve]
- Parsons JT (1994). Time-dose-volume relation in radiation therapy. In: Management of head and neck cancer. A multidisciplinary approach. Million RR, Cassisi NJ, editors. Philadelphia, PA: Lippincott Co., pp. 173-243.
- Semba SE, Mealey BL, Hallmon WW (1994). The head and neck radiotherapy patient: Part 1-Oral manifestations of radiation therapy. Compend Contin Educ Dent 15:250-261.
- Ship JA, Fox PC, Baum BJ ( 1991). How much saliva is enough? Normal function defined. J Am Dent Assoc 122:63-69.[Abstract]
- Stephens LC, Ang KK, Schultheiss TE, King GK, Brock WA, Peters LJ (1986). Target cell and mode of radiation injury in rhesus salivary glands. Radiother Oncol 7:165-174.[Medline]
[Order article via Infotrieve]
- Stephens LC, Schultheiss TE, Price RE, Ang KK, Peters LJ, et al. (1991). Radiation apoptosis of serous acinar cells of salivary and lacrimal glands. Cancer 67:1539-1543.
- Tylenda CA, Ship JA, Fox PC, Baum BJ ( 1988). Evaluation of submandibular salivary flow rate in different age groups. J Dent Res 67:1225-1228.
- Valdez IH, Atkinson JC, Ship JA, Fox PC (1993). Major salivary gland function in patients with radiation-induced xerostomia: flow rates and sialochemistry. Int J Radiation Oncol Biol Phys 25:41-47.[Medline]
[Order article via Infotrieve]
- Whelton H. (1996). Introduction: The anatomy and physiology of salivary glands: In: Saliva and oral health. Edgar WM, O'Mullane DM, editors. London: British Dental Association, pp. 1-9.
- Wingo PA, Tong T., Bolden S. (1995). Cancer statistics, 1995. CA Cancer J Clin 45:8-30.[Abstract/Free Full Text]
- Young JA, Van Lennep EW (1979). Transport in salivary and salt glands. In: Membrane transport in biology. Giebisch G, Tosteson DC, Ussing HH, editors. Berlin: Springer-Verlag, pp. 563-592.
Journal of Dental Research, Vol. 76, No. 3,
807-813 (1997)
DOI: 10.1177/00220345970760031401
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