PMID- 14509515
OWN - NLM
STAT- MEDLINE
DCOM- 20031023
LR  - 20190827
IS  - 0364-2313 (Print)
IS  - 0364-2313 (Linking)
VI  - 27
IP  - 7
DP  - 2003 Jul
TI  - Salivary gland sparing and improved target irradiation by conformal and intensity 
      modulated irradiation of head and neck cancer.
PG  - 832-7
AB  - The goals of this study were to facilitate sparing of the major salivary glands 
      while adequately treating tumor targets in patients requiring comprehensive 
      bilateral neck irradiation (RT), and to assess the potential for improved 
      xerostomia. Since 1994 techniques of target irradiation and locoregional tumor 
      control with conformal and intensity modulated radiation therapy (IMRT) have been 
      developed. In patients treated with these modalities, the salivary flow rates 
      before and periodically after RT have been measured selectively from each major 
      salivary gland and the residual flows correlated with glands' dose volume 
      histograms (DVHs). In addition, subjective xerostomia questionnaires have been 
      developed and validated. The pattern of locoregional recurrence has been examined 
      from computed tomography (CT) scans at the time of recurrence, transferring the 
      recurrence volumes to the planning CT scans, and regenerating the dose 
      distributions at the recurrence sites. Treatment plans for target coverage and 
      dose homogeneity using static, multisegmental IMRT were found to be significantly 
      better than standard RT plans. In addition, significant parotid gland sparing was 
      achieved in the conformal plans. The relationships among dose, irradiated volume, 
      and the residual saliva flow rates from the parotid glands were characterized by 
      dose and volume thresholds. A mean radiation dose of 26 Gy was found to be the 
      threshold for preserved stimulated saliva flow. Xerostomia questionnaire scores 
      suggested that xerostomia was significantly reduced in patients irradiated with 
      bilateral neck, parotid-sparing RT, compared to patients with similar tumors 
      treated with standard RT. Examination of locoregional tumor recurrence patterns 
      revealed that the large majority of recurrences occurred inside targets, in areas 
      that had been judged to be at high risk and that had received RT doses according 
      to the perceived risk. Tangible gains in salivary gland sparing and target 
      coverage are being achieved, and an improvement in some measures of quality of 
      life is suggested by our findings. Additional reduction of xerostomia may be 
      achieved by further sparing of the salivary glands and the non-involved oral 
      cavity. A mean parotid gland dose of < or = 26 Gy should be a planning objective 
      if significant parotid function preservation is desired. The pattern of 
      recurrence suggests that careful escalation of the dose to areas judged to be at 
      highest risk may improve tumor control.
FAU - Eisbruch, Avraham
AU  - Eisbruch A
AD  - Department of Radiation Oncology, University of Michigan, 1500 Medical Center 
      Drive, Ann Arbor, Michigan 48109, USA. eisbruch@umich.edu
FAU - Ship, Jonathan A
AU  - Ship JA
FAU - Dawson, Laura A
AU  - Dawson LA
FAU - Kim, Hyungjin M
AU  - Kim HM
FAU - Bradford, Carol R
AU  - Bradford CR
FAU - Terrell, Jeffrey E
AU  - Terrell JE
FAU - Chepeha, Douglas B
AU  - Chepeha DB
FAU - Teknos, Theodore N
AU  - Teknos TN
FAU - Hogikyan, Norman D
AU  - Hogikyan ND
FAU - Anzai, Yoshimi
AU  - Anzai Y
FAU - Marsh, Lon H
AU  - Marsh LH
FAU - Ten Haken, Randall K
AU  - Ten Haken RK
FAU - Wolf, Gregory T
AU  - Wolf GT
LA  - eng
GR  - CA78165/CA/NCI NIH HHS/United States
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, U.S. Gov't, P.H.S.
PL  - United States
TA  - World J Surg
JT  - World journal of surgery
JID - 7704052
SB  - IM
MH  - Cohort Studies
MH  - Dose-Response Relationship, Radiation
MH  - Female
MH  - Head and Neck Neoplasms/mortality/*radiotherapy/surgery
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Neck Dissection/methods
MH  - Neoplasm Staging
MH  - Prognosis
MH  - Quality of Life
MH  - Radiation Dosage
MH  - *Radiotherapy Planning, Computer-Assisted
MH  - Radiotherapy, Conformal/adverse effects/*methods
MH  - Risk Assessment
MH  - Salivary Glands/*radiation effects
MH  - Survival Rate
MH  - Treatment Outcome
MH  - Xerostomia/epidemiology/*etiology
EDAT- 2003/09/26 05:00
MHDA- 2003/10/24 05:00
CRDT- 2003/09/26 05:00
PHST- 2003/09/26 05:00 [pubmed]
PHST- 2003/10/24 05:00 [medline]
PHST- 2003/09/26 05:00 [entrez]
AID - 10.1007/s00268-003-7105-6 [doi]
PST - ppublish
SO  - World J Surg. 2003 Jul;27(7):832-7. doi: 10.1007/s00268-003-7105-6.