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Dose, Volume, And Function Relationships In Parotid Salivary Glands Following Conformal And Intensity-modulated Irradiation Of Head And Neck Cancer.

A. Eisbruch, R. Ten Haken, H. Kim, L. Marsh, J. Ship
Published 1999 · Medicine

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PURPOSE To determine the relationships between the three-dimensional dose distributions in parotid glands and their saliva production, and to find the doses and irradiated volumes that permit preservation of the salivary flow following irradiation (RT). METHODS AND MATERIALS Eighty-eight patients with head and neck cancer irradiated with parotid-sparing conformal and multisegmental intensity modulation techniques between March 1994 and August 1997 participated in the study. The mean dose and the partial volumes receiving specified doses were determined for each gland from dose-volume histograms (DVHs). Nonstimulated and stimulated saliva flow rates were selectively measured from each parotid gland before RT and at 1, 3, 6, and 12 months after the completion of RT. The data were fit using a generalized linear model and the normal tissue complication probability (NTCP) model of Lyman-Kutcher. In the latter model, a "severe complication" was defined as salivary flow rate reduced to < or =25% pre-RT flow at 12 months. RESULTS Saliva flow rates data were available for 152 parotid glands. Glands receiving a mean dose below or equal to a threshold (24 Gy for the unstimulated and 26 Gy for the stimulated saliva) showed substantial preservation of the flow rates following RT and continued to improve over time (to median 76% and 114% of pre-RT for the unstimulated and stimulated flow rates, respectively, at 12 months). In contrast, most glands receiving a mean dose higher than the threshold produced little saliva with no recovery over time. The output was not found to decrease as mean dose increased, as long as the threshold dose was not reached. Similarly, partial volume thresholds were found: 67%, 45%, and 24% gland volumes receiving more than 15 Gy, 30 Gy, and 45 Gy, respectively. The partial volume thresholds correlated highly with the mean dose and did not add significantly to a model predicting the saliva flow rate from the mean dose and the time since RT. The NTCP model parameters were found to be TD50 (the tolerance dose for 50% complications rate for whole organ irradiated uniformly) = 28.4 Gy, n (volume dependence parameter) = 1, and m (the slope of the dose/response relationship) = 0.18. Clinical factors including age, gender, pre-RT surgery, chemotherapy, and certain medical conditions were not found to be significantly associated with the salivary flow rates. Medications (diuretics, antidepressants, and narcotics) were found to adversely affect the unstimulated but not the stimulated flow rates. CONCLUSIONS Dose/volume/function relationships in the parotid glands are characterized by dose and volume thresholds, steep dose/response relationships when the thresholds are reached, and a maximal volume dependence parameter in the NTCP model. A parotid gland mean dose of < or =26 Gy should be a planning goal if substantial sparing of the gland function is desired.
This paper references
10.2307/2344614
Generalized Linear Models
J. Nelder (1972)
10.1080/09553009214550911
Contrasting dose-rate effects of gamma-irradiation on rat salivary gland function.
A. Vissink (1992)
10.2307/2347392
Generalized Linear Models, 2nd Edn.
P. Cheek (1990)
10.2307/2289625
Analysis of Binary Data (2nd ed.).
D. Steffey (1990)
10.1016/S0167-8140(86)80096-2
Target cell and mode of radiation injury in rhesus salivary glands.
L. C. Stephens (1986)
10.1016/0360-3016(91)90171-Y
Tolerance of normal tissue to therapeutic irradiation.
B. Emami (1991)
10.1016/S1079-2104(96)80068-0
Ipsilateral parotid sparing study in head and neck cancer patients who receive radiation therapy: results after 1 year.
R. Jones (1996)
10.1016/0360-3016(81)90152-8
The effects of radiation of parotid salivary function.
J. E. Marks (1981)
10.14219/JADA.ARCHIVE.1991.0098
How Much Saliva is Enough
J. Ship (1991)
10.1016/S0360-3016(98)00196-5
Radiation pneumonitis as a function of mean lung dose: an analysis of pooled data of 540 patients.
S. L. Kwa (1998)
10.1177/00220345840630100101
Basic Biological Sciences Unstimulated and Stimulated Parotid Salivary Flow Rate in Individuals of Different Ages
M. Heft (1984)
10.2214/AJR.130.1.145
Alterations in whole saliva flow rate induced by fractionated radiotherapy.
W. Wescott (1978)
10.1016/0360-3016(94)00471-4
Analysis of clinical complication data for radiation hepatitis using a parallel architecture model.
A. Jackson (1995)
10.1016/S1053-4296(99)80055-1
Optimization and clinical use of multisegment intensity-modulated radiation therapy for high-dose conformal therapy.
B. A. Fraass (1999)
10.1016/0022-3913(90)90182-C
Medication side effects of dental interest.
T. Matthews (1990)
10.1016/0360-3016(93)90156-P
Modeling of normal tissue response to radiation: the critical volume model.
A. Niemierko (1993)
10.1016/0360-3016(88)90098-3
Treatment volume and tissue tolerance.
H. Withers (1988)
10.1016/0167-8140(94)90006-X
The early changes in salivary gland function during and after radiotherapy given for head and neck cancer.
M. Leslie (1994)
10.1016/0360-3016(86)90358-5
Oral side effects of head and neck irradiation: correlation between clinical manifestations and laboratory data.
A. Kuten (1986)
10.2307/3583506
Complication probability as assessed from dose-volume histograms.
J. Lyman (1985)
10.1016/0360-3016(93)90143-J
Major salivary gland function in patients with radiation-induced xerostomia: flow rates and sialochemistry.
I. H. Valdez (1993)
Radiation-induced xerostomia in cancer patients
S. Dreizen (1976)
10.1016/S0022-5193(89)80141-9
Fitting bent lines to data, with applications to allometry.
R. Chappell (1989)
10.1093/BIOMET/73.1.13
Longitudinal data analysis using generalized linear models
K. Liang (1986)
10.1016/0167-8140(93)90264-9
Probability of radiation-induced complications in normal tissues with parallel architecture under conditions of uniform whole or partial organ irradiation.
E. Yorke (1993)
10.1016/S0167-8140(87)80186-X
Inter-tumor heterogeneity and radiation dose-control curves.
G. Zagars (1987)
10.1016/S0360-3016(96)00264-7
Parotid gland sparing in patients undergoing bilateral head and neck irradiation: techniques and early results.
A. Eisbruch (1996)
10.1201/9781420050363.CH1
Three-Dimensional Radiation-Therapy Treatment Planning
S. Webb (1993)
10.1002/1097-0142(197607)38:1<273::AID-CNCR2820380141>3.0.CO;2-8
Radiation‐induced xerostomia in cancer patients. Effect on salivary and serum electrolytes
S. Dreizen (1976)
10.1016/S0360-3016(98)00082-0
Comprehensive irradiation of head and neck cancer using conformal multisegmental fields: assessment of target coverage and noninvolved tissue sparing.
A. Eisbruch (1998)
10.1016/0360-3016(81)90140-1
Some factors influencing salivary function when treating with radiotherapy.
J. Mira (1981)
10.1016/0360-3016(91)90172-Z
Fitting of normal tissue tolerance data to an analytic function.
C. Burman (1991)
10.1016/0360-3016(95)02052-7
A computer-controlled conformal radiotherapy system. I: Overview.
B. A. Fraass (1995)
10.1016/0030-4220(86)90007-1
Changes in the protein composition of whole saliva during radiotherapy in patients with oral or pharyngeal cancer.
T. Makkonen (1986)
10.1016/0360-3016(89)90972-3
Calculation of complication probability factors for non-uniform normal tissue irradiation: the effective volume method.
G. Kutcher (1989)
10.1016/0360-3016(93)90398-F
Use of Veff and iso-NTCP in the implementation of dose escalation protocols.
R. Ten Haken (1993)
10.1002/JSO.2930480203
The effect of head and neck cancer treatment on whole salivary flow
M. Marunick (1991)
10.1016/0360-3016(94)00421-G
Late effects of radiation therapy in the head and neck region.
J. Cooper (1995)
10.1016/0964-1955(94)90002-7
Parotid saliva composition during and after irradiation of head and neck cancer.
U. Funegård (1994)
10.1177/00220345770560062201
Effect of Radiotherapy on Whole Saliva Flow
I. Shannon (1977)
10.2307/2986993
Analysis of Binary Data
A. Lancaster (1971)
10.1016/S0959-8049(05)80076-0
Parotid gland function during and following radiotherapy of malignancies in the head and neck. A consecutive study of salivary flow and patient discomfort.
L. Franzén (1992)
10.1002/1097-0142(197211)30:5<1147::AID-CNCR2820300502>3.0.CO;2-0
Effect of fractionated radiotherapy on salivary gland function
C. M. Eneroth (1972)
10.1016/0360-3016(93)90403-I
Preservation of parotid function after external beam irradiation in head and neck cancer patients: a feasibility study using 3-dimensional treatment planning.
M. Hazuka (1993)
10.1016/0360-3016(94)90409-X
Expanding the use and effectiveness of dose-volume histograms for 3-D treatment planning. I: Integration of 3-D dose-display.
M. Kessler (1994)
10.1016/0360-3016(92)90651-W
The use of 3-D dose volume analysis to predict radiation hepatitis.
T. Lawrence (1991)
10.1177/00220345810600070101
Clinical Science
B. Baum (1981)



This paper is referenced by
10.1016/J.CANRAD.2004.06.002
Les contraintes aux organes risque en radiothrapie par modulation d'intensit des cancers ORL
P. Maingon (2004)
10.1053/J.SEMINONCOL.2004.12.005
Toxicity and compliance of subcutaneous amifostine in patients undergoing postoperative intensity-modulated radiation therapy for head and neck cancer.
W. Thorstad (2004)
Effect of pilocarpine during radiation therapy: results of RTOG 97-09, a phase III randomized study in head and neck cancer patients.
C. Scarantino (2006)
Biologically conformal radiation therapy and Monte Carlo dose calculations in the clinic
B. Vanderstraeten (2007)
10.1016/J.IJROBP.2006.11.012
Impact of intensity-modulated radiotherapy on health-related quality of life for head and neck cancer patients: matched-pair comparison with conventional radiotherapy.
P. Graff (2007)
10.1016/j.oraloncology.2008.06.006
Unknown primary head and neck cancer treated with intensity-modulated radiation therapy: to what extent the volume should be irradiated.
Heming Lu (2009)
10.1118/1.1508110
Intensity modulated arc deliveries approximated by a large number of fixed gantry position sliding window dynamic multileaf collimator fields.
M. Mackenzie (2002)
10.1017/S1460396918000201
A planning study to optimise a simultaneously integrated boost treatment of larynx cancer with seven intensity-modulated radiation therapy (IMRT) beams
M. Er-raoudi (2018)
10.1007/s005200100284
Management of oral disease prior to radiation therapy
M. Schiødt (2002)
10.1055/s-0030-1255330
Radiotherapy for head and neck cancer.
S. Yeh (2010)
Improving Feature-based Non-rigid Registration for Applications in Radiotherapy
Eliana Vásquez Osorio (2012)
10.1016/S0360-3016(01)02607-4
Leaf position optimization for step-and-shoot IMRT.
W. De Gersem (2001)
10.1016/J.RADONC.2003.08.002
A comparison of forward and inverse treatment planning for intensity-modulated radiotherapy of head and neck cancer.
W. Baer (2003)
10.21236/ada468461
Intensity Modulated Radiation Treatment of Prostate Cancer Guided by High Field MR Spectroscopic Imaging
L. Xing (2005)
10.1097/01.coc.0000158826.88179.75
Late Xerostomia After Intensity-Modulated Radiation Therapy Versus Conventional Radiotherapy
H. Pacholke (2005)
10.1016/J.IJROBP.2006.06.013
Xerostomia and quality of life after intensity-modulated radiotherapy vs. conventional radiotherapy for early-stage nasopharyngeal carcinoma: initial report on a randomized controlled clinical trial.
E. H. Pow (2006)
10.1093/jjco/hyp113
Radiation-induced parotid gland changes in oral cancer patients: correlation between parotid volume and saliva production.
Keiko Teshima (2010)
10.1002/hed.21406
Intensity‐modulated radiotherapy for locally advanced cancers of the larynx and hypopharynx
M. Daly (2011)
10.1002/lary.21873
The protective efficacy of basic fibroblast growth factor in radiation‐induced salivary gland dysfunction in mice
T. Kojima (2011)
10.1002/mp.13718
MultiRBE: treatment planning for protons with selective radiobiological effectiveness.
Daniel Sánchez-Parcerisa (2019)
10.1016/J.CANRAD.2011.11.002
Irradiation panencéphalique des métastases cérébrales : la technique d’irradiation influence la dose aux glandes parotides
G. Loos (2012)
10.1634/theoncologist.2011-0396
Intensity-modulated radiation therapy with concurrent carboplatin and paclitaxel for locally advanced head and neck cancer: toxicities and efficacy.
G. Vlacich (2012)
10.1007/978-3-540-75863-1_16
Adverse Late Effects of Radiation Treatment in the Pancreas
Suzanne Russo (2014)
10.21037/apm.2020.02.36
Sticky stuff: xerostomia in patients undergoing head and neck radiotherapy-prevalence, prevention, and palliative care.
J. Snider (2020)
10.1053/j.semnuclmed.2012.04.005
The evolving role of positron emission tomography-computed tomography in organ-preserving treatment of head and neck cancer.
M. Garg (2012)
10.1007/3-540-30356-1_24
IMRT for Carcinomas of the Oropharynx and Oral Cavity
R. Schmidt-Ullrich (2006)
10.1016/J.REMN.2010.02.012
Gammagrafía salival cuantitativa en pacientes con cáncer de cabeza y cuello tratados con radioterapia
Amelia Jimenez-Heffernan (2010)
10.1201/B10945-18
External Beam Radiation Therapy in Thyroid Cancer
Walter H. Choi (2011)
10.1016/j.ijrobp.2010.07.1990
Impact of salivary gland dosimetry on post-IMRT recovery of saliva output and xerostomia grade for head-and-neck cancer patients treated with or without contralateral submandibular gland sparing: a longitudinal study.
Z. Wang (2011)
10.1016/j.radonc.2012.10.010
Adaptive radiotherapy for head and neck cancer--dosimetric results from a prospective clinical trial.
D. Schwartz (2013)
10.1016/j.meddos.2012.10.002
Effect of MLC leaf position, collimator rotation angle, and gantry rotation angle errors on intensity-modulated radiotherapy plans for nasopharyngeal carcinoma.
Sen Bai (2013)
10.1093/annonc/mdp268
Clinical and dosimetric factors associated with a prolonged feeding tube requirement in patients treated with chemoradiotherapy (CRT) for head and neck cancers.
A. Gokhale (2010)
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