Sparing the parotid glands and surgically transferred submandibular gland with helical tomotherapy in post-operative radiation of head and neck cancer: A planning study

Introduction: Radiation therapy has long played an integral role in the manage¬ment of locally advanced head and neck cancer (HNC), both for organ preservation and to improve tumor control in the postoperative setting. The aim of this research is to investigate the effects of adaptive radiotherapy on dosimetric, clinical, and toxicity outcomes for patients with head and neck cancer undergoing radiation therapy treatment. Many sources have reported volume reductions in the primary target, nodal volumes, and parotid glands over treatment, which may result in unintended dosimetric changes affecting the side effect profile and even efficacy of the treatment. Adaptive radiotherapy (ART) is an interesting treatment paradigm that has been developed to directly adjust to these changes.Material and methods: This research contains the results of 15 studies, including clinical trials, randomized prospective and retrospective studies. The researches analyze the impact of radiation therapy on changes in tumor volume and the relationship with planned radiation dose delivery, as well as the possibility of using adaptive radiotherapy in response to identified changes. Also, medical articles and abstracts that are closely related to the title of adaptive radiotherapy were researched.Results: The application of ART significantly improved the quality of life of patients with head and neck cancer, as well as two-year locoregional control of the disease. The average time to apply ART is the middle of the treatment course approximately 17 to 20 fractions of the treatment.Conclusion: Based on systematic review of the literature, evidence based changes in target volumes and dose reduction at OAR, adaptive radiotherapy is recommended treatment for most of the patients with head and neck cancer with the support of image-guided radiotherapy.

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Cone-beam computed tomography dose monitoring during intensity-modulated radiotherapy in head and neck cancer: parotid glands

Clinical & Translational Oncology ◽

10.1007/s12094-012-0946-4 ◽

2012 ◽

Vol 15 (5) ◽

pp. 412-415 ◽

Cited By ~ 10

Author(s):

A. Fiorentino ◽

M. Cozzolino ◽

R. Caivano ◽

P. Pedicini ◽

C. Chiumento ◽

...

Keyword(s):

Computed Tomography ◽

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Cone Beam Computed Tomography ◽

Intensity Modulated Radiotherapy ◽

Cone Beam ◽

Parotid Glands ◽

Intensity Modulated ◽

Dose Monitoring

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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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