Does radiation dose to the salivary glands and oral cavity predict patient-rated xerostomia and sticky saliva in head and neck cancer patients treated with curative radiotherapy?

Background: The study objective was to assess the development of xerophthalmia [dry eye syndrome (DES) or keratoconjunctivitis sicca] in head and neck cancer patients undergoing radiotherapy.Methods: Twenty two head and neck cancer patients requiring more than 60 Gy of curative radiotherapy/chemoradiotherapy and ten patients requiring radiotherapy/ chemoradiotherapy for treating cancers in the non head and neck regions (like breast, oesophagus, prostate, cervix and rectal cancers) were also enrolled in the study. The development of DES was studied at the beginning (day 0, before the start of radiotherapy) at day 21 (after completion of 30 Gy) and on completion of the treatment (> 60 Gy). As a comparative cohort, people with non head and neck cancer needing curative radiotherapy were also evaluated for comparison.Results: There was no difference in degree of DES between the Head and Neck cancer cohorts and non head and neck group at the beginning of treatment. However there was a statistically significant difference (p < 0.001) between the two groups at both mid and end of RT time point. Inter comparison between the various time points in the head and neck cancer group showed that the incidence of DES increased with the radiation exposure and was significant (pre to mid p < 0.001; and mid to end p < 0.005). A negative (r = -0.262) correlation was seen between DES and distance.Conclusions: The study showed that lesser the distance from the epicenter of the radiation to the orbital rim more was the severity of DES.

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Reducing Xerostomia by Comprehensive Protection of Salivary Glands in Intensity-Modulated Radiation Therapy with Helical Tomotherapy Technique for Head-and-Neck Cancer Patients: A Prospective Observational Study

BioMed Research International ◽

10.1155/2019/2401743 ◽

2019 ◽

Vol 2019 ◽

pp. 1-9

Author(s):

Feng Teng ◽

Wenjun Fan ◽

Yanrong Luo ◽

Zhongjian Ju ◽

Hanshun Gong ◽

...

Keyword(s):

Radiation Therapy ◽

Head And Neck Cancer ◽

Head And Neck ◽

Salivary Glands ◽

Cancer Patients ◽

Neck Cancer ◽

Helical Tomotherapy ◽

Clinical Stage ◽

Flow Rates ◽

Saliva Flow

Objective. This study aimed to analyze the effects of comprehensive protection of bilateral parotid glands (PG-T), contralateral submandibular gland (cSMG), and accessory salivary glands in the oral cavity (OC) by helical tomotherapy for head-and-neck cancer patients. Methods. Totally 175 patients with histologically confirmed head-and-neck cancer treated with helical tomotherapy were recruited. The doses delivered to PG-T, cSMG, and OC were constrained to be as low as possible in treatment planning. The saliva flow rates and xerostomia questionnaire were evaluated. Correlation between xerostomia and other clinical factors were assessed using univariate and multivariate models. The impact of salivary gland dose on locoregional (LR) recurrence was assessed by Cox analysis. ROC curve was used to determine the threshold of mean dose for each gland. Results. The median follow-up was 25 (19–36) months. The OC mean dose, PG-T mean dose, cSMG mean dose, age, clinical stage (II and III versus IV), and both unstimulated and stimulated saliva flow rates were significantly correlated with xerostomia. The OC mean dose, cSMG mean dose, age, and clinical stage were predictors of xerostomia after adjusting PG-T mean dose, and unstimulated and stimulated saliva flow rates. Xerostomia was significantly decreased when the mean doses of PG-T, cSMG, and OC were kept below 29.12Gy, 29.29Gy, and 31.44Gy, respectively. At 18 months after radiation therapy, early LR recurrence rate was only 4%. Conclusion. Comprehensive protection of salivary glands minimized xerostomia in head-and-neck cancer patients treated by helical tomotherapy, without increasing early LR recurrence risk.

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WE-E-BRE-09: Investigation of the Association Between Radiation-Induced Pain and Radiation Dose in Head and Neck Cancer Patients

Medical Physics ◽

10.1118/1.4889438 ◽

2014 ◽

Vol 41 (6Part29) ◽

pp. 505-506

Author(s):

H Gay ◽

J Oh ◽

A Apte ◽

P Dyk ◽

D Mullen ◽

...

Keyword(s):

Head And Neck Cancer ◽

Radiation Dose ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Radiation Induced

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Racial disparities in outcome among head and neck cancer patients in the United States: An analysis using SEER-Medicare linked database.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.6051 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 6051-6051 ◽

Cited By ~ 3

Author(s):

Ikumi Suzuki ◽

Kevin J. Cullen ◽

Ranee Mehra ◽

Søren Bentzen ◽

Olga G. Goloubeva

Keyword(s):

United States ◽

Overall Survival ◽

Head And Neck Cancer ◽

African Americans ◽

Oral Cavity ◽

Head And Neck ◽

Cancer Patients ◽

Ethnic Groups ◽

Neck Cancer ◽

The United States

6051 Background: Despite overall decline in cancer mortality, African Americans suffer from higher mortality in most cancer types including cancers of the head and neck. These differences likely result from a complex interplay of clinical and non-clinical factors. We aim to estimate disparities in overall survival across racial groups in HNSCC in the United States. Methods: This study used SEER-Medicare linked database. We identified all patients aged 66 years or older diagnosed with HNSCC as their first cancer from 1992 to 2011. We excluded those in HMO, diagnosed by death certificate or autopsy, non-SCC, unknown race, and missing month and/or year of diagnosis. Further exclusions included metastatic disease, salivary gland cancers, receiving no treatment in the first 180 days, and unknown stage. Analytic data set included oropharynx, oral cavity, nasopharynx, hypopharynx, and larynx. Primary treatment was defined as any treatment modality received within 180 days after diagnosis. Overall survival (OS) parameters were estimated across ethnic groups by the Cox regression model stratified by site and stage of cancer at diagnosis, adjusted for clinical and demographic characteristics, and propensity score weighted. Results: Our study population included 15, 547 patients. Median OS was 3.5 years (95% CI: 3.4-3.7) across all ethnic groups. African Americans (AA) had inferior outcome with median OS of 2.0 years (95% CI: 1.9-2.3) compared to 3.7 years (95% CI: 3.6-3.8) for Caucasian Americans (CA) (p < 0.0001). This difference was seen despite AA patients receiving comparable treatments and presenting at similar stage of disease, except for cancers of the oral cavity where AA were more likely to present with advanced disease (67% versus 47%; P < 0.001). The difference was most pronounced in the oropharynx where median OS was 1.9 years (95% CI: 1.7-2.1) for AA and 3.8 years (95% CI: 3.5-4.1) in CA (P < 0.0001). AA also had consistently worse OS over time from 1992 to 2011. This study clearly demonstrated AA have inferior outcomes despite similar treatments, comorbidities, age at diagnosis, stage at presentation, tumor location, year of diagnosis and sex. Conclusions: The current study demonstrates inferior overall survival for African American head and neck cancer patients independent of primary site and treatment modalities.

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Deterioration of Intended Target Volume Radiation Dose Due to Anatomical Changes in Patients with Head-and-Neck Cancer

Cancers ◽

10.3390/cancers13174253 ◽

2021 ◽

Vol 13 (17) ◽

pp. 4253

Author(s):

Olga Hamming-Vrieze ◽

Simon van Kranen ◽

Iris Walraven ◽

Arash Navran ◽

Abrahim Al-Mamgani ◽

...

Keyword(s):

Head And Neck Cancer ◽

Radiation Dose ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Patient Selection ◽

Patient Characteristics ◽

Target Volume ◽

Adaptive Radiotherapy ◽

Clinical Patient

Delivered radiation dose can differ from intended dose. This study quantifies dose deterioration in targets, identifies predictive factors, and compares dosimetric to clinical patient selection for adaptive radiotherapy in head-and-neck cancer patients. One hundred and eighty-eight consecutive head-and-neck cancer patients treated up to 70 Gy were analyzed. Daily delivered dose was calculated, accumulated, and compared to the planned dose. Cutoff values (1 Gy/2 Gy) were used to assess plan deterioration in the highest/lowest dose percentile (D1/D99). Differences in clinical factors between patients with/without dosimetric deterioration were statistically tested. Dosimetric deterioration was evaluated in clinically selected patients for adaptive radiotherapy with CBCT. Respectively, 16% and 4% of patients had deterioration over 1 Gy in D99 and D1 in any of the targets, this was 5% (D99) and 2% (D1) over 2 Gy. Factors associated with deterioration of D99 were higher baseline weight/BMI, weight gain early in treatment, and smaller PTV margins. The sensitivity of visual patient selection with CBCT was 22% for detection of dosimetric changes over 1 Gy. Large dose deteriorations in targets occur in a minority of patients. Clinical prediction based on patient characteristics or CBCT is challenging and dosimetric selection tools seem warranted to identify patients in need for ART, especially in treatment with small PTV margins.

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