Amosson Chad M, Teh Bin S, Van T John, Uy Nathan, Huang Eugene, Mai Wei-Yuan, Frolov Anna, Woo Shiao Y, Chiu J Kam, Carpenter L Steven, Lu Hsin H, Grant Walter H, Butler E Brian
Department of Radiology/Section of Radiation Oncology, Baylor College of Medicine and The Methodist Hospital, Houston, TX 77030, USA.
Int J Radiat Oncol Biol Phys. 2003 May 1;56(1):136-44. doi: 10.1016/s0360-3016(03)00093-2.
To evaluate the predictors of xerostomia in the treatment of head-and-neck cancers treated with intensity-modulated radiation therapy (IMRT), using the simultaneous modulated accelerated radiation therapy (SMART) boost technique. Dosimetric parameters of the parotid glands are correlated to subjective salivary gland function.
Between January 1996 and June 2000, 30 patients with at least 6 months follow-up were evaluated for subjective xerostomia after being treated definitively for head-and-neck cancer with the SMART boost technique. Threshold limits for the ipsilateral and contralateral parotid glands were 35 Gy and 25 Gy, respectively. Dosimetric parameters to the parotid glands were evaluated. The median follow-up time was 38.5 months (mean 39.9 months). The results of the dosimetric parameters and questionnaire were statistically correlated.
Xerostomia was assessed with a 10-question subjective salivary gland function questionnaire. The salivary gland function questionnaire (questions 1, 2, 3, 4, 6, and 9) correlated significantly with the dosimetric parameters (mean and maximum doses and volume and percent above tolerance) of the parotid glands. These questions related to overall comfort, eating, and abnormal taste. Questions related to thirst, difficulty with speech or sleep, and the need to carry water daily did not correlate statistically with the dosimetric parameters of the parotid glands.
Questions regarding overall comfort, eating, and abnormal taste correlated significantly with the dosimetric parameters of the parotid glands. Questions related to thirst, difficulty with speech or sleep, and the need to carry water daily did not correlate statistically with the dosimetric parameters of the parotid glands. Dosimetric sparing of the parotid glands improved subjective xerostomia. IMRT in the treatment of head-and-neck cancer can be exploited to preserve the parotid glands and decrease xerostomia. This is feasible even with an accelerated treatment regimen like the SMART boost. More patients need to be evaluated using IMRT to identify relevant dosimetric parameters.
采用同步调强加速放疗（SMART）推量技术，评估头颈部癌调强放疗（IMRT）治疗中口干症的预测因素。腮腺的剂量学参数与主观唾液腺功能相关。
1996年1月至2000年6月期间，对30例接受头颈部癌SMART推量技术根治性治疗且随访至少6个月的患者进行主观口干症评估。同侧和对侧腮腺的阈值分别为35 Gy和25 Gy。评估腮腺的剂量学参数。中位随访时间为38.5个月（平均39.9个月）。对剂量学参数结果和问卷进行统计学相关性分析。
采用一份包含10个问题的主观唾液腺功能问卷评估口干症。唾液腺功能问卷（问题1、2、3、4、6和9）与腮腺的剂量学参数（平均剂量、最大剂量、体积及超过耐受剂量的百分比）显著相关。这些问题涉及总体舒适度、进食和异常味觉。与口渴、言语或睡眠困难以及每日需携带水相关的问题与腮腺的剂量学参数无统计学相关性。
关于总体舒适度、进食和异常味觉的问题与腮腺的剂量学参数显著相关。与口渴、言语或睡眠困难以及每日需携带水相关的问题与腮腺的剂量学参数无统计学相关性。腮腺的剂量学保护可改善主观口干症。IMRT可用于头颈部癌治疗中保护腮腺并减少口干症。即使采用如SMART推量这样的加速治疗方案，这也是可行的。需要更多患者接受IMRT评估以确定相关剂量学参数。
