Division of Radiation Oncology, Department of Oral and Maxillofacial Surgery, the Shanghai Ninth Peoples Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Int J Radiat Oncol Biol Phys. 2011 Dec 1;81(5):1479-87. doi: 10.1016/j.ijrobp.2010.07.1990. Epub 2010 Oct 8.
To observe the recovery of saliva output and effect on xerostomia grade after intensity-modulated radiotherapy (IMRT) with or without contralateral submandibular gland (cSMG) sparing and to assess the impact of salivary gland dosimetry on this recovery among patients with head-and-neck cancer.
Between May 2007 and May 2008, 52 patients with head-and-neck cancer received definitive (n=5 patients) and postoperative (n=47 patients) IMRT at our institution, with at least one parotid gland spared. Of these patients, 26 patients with a low risk of recurrence in the cSMG region underwent IMRT and had their cSMGs spared (cSMG-sparing group). The remaining 26 high-risk patients had no cSMGs spared (cSMG-unspared group). Xerostomia grades and salivary flow rates were monitored at five time points (before IMRT and at 2, 6, 12, and 18 months after IMRT).
Average mean doses and mean volumes receiving 30 Gy (V30) of the cSMGs were lower in the cSMG-sparing group than in the cSMG-unspared group (mean dose, 20.4 Gy vs. 57.4 Gy; mean V30, 14.7% vs. 99.8%, respectively). Xerostomia grades at 2 and 6 months post-IMRT were also significantly lower among patients in the cSMG-sparing group than in the cSMG-unspared group, but differences were not significant at 12 and 18 months after IMRT. Patients in the cSMG-sparing group had significantly better mean unstimulated salivary flow rates at each time point post- IMRT as well as better mean stimulated salivary flow rates at 2 months post-IMRT.
Recovery of saliva output and grade of xerostomia post-IMRT in patients whose cSMGs were spared were much better than in patients whose cSMGs were not spared. The influence of the mean doses to the cSMG and parotid gland on the recovery of saliva output was equivalent to that of the mean V30 to the glands.
观察调强放疗（IMRT）中是否保留对侧下颌下腺（cSMG）对唾液分泌恢复和口干程度的影响，并评估唾液腺剂量学对头颈部癌症患者恢复的影响。
2007 年 5 月至 2008 年 5 月，我院收治 52 例头颈部癌症患者，行根治性（n=5 例）和术后（n=47 例）IMRT，至少保留一侧腮腺。其中 26 例 cSMG 区域复发风险低的患者行 IMRT 并保留 cSMG（cSMG 保留组）。其余 26 例高危患者未保留 cSMG（cSMG 未保留组）。在五个时间点（IMRT 前和 IMRT 后 2、6、12 和 18 个月）监测口干程度和唾液流率。
cSMG 保留组的 cSMG 平均剂量和 30 Gy（V30）的平均体积均低于 cSMG 未保留组（平均剂量：20.4 Gy vs. 57.4 Gy；平均 V30：14.7% vs. 99.8%）。cSMG 保留组患者在 IMRT 后 2 个月和 6 个月的口干程度也明显低于 cSMG 未保留组，但在 IMRT 后 12 个月和 18 个月时差异无统计学意义。cSMG 保留组患者在 IMRT 后各时间点的平均未刺激唾液流率均显著较高，且 IMRT 后 2 个月的平均刺激唾液流率也较高。
与未保留 cSMG 的患者相比，保留 cSMG 的患者的唾液分泌和口干程度在 IMRT 后恢复得更好。cSMG 和腮腺的平均剂量对唾液分泌恢复的影响与腺体的平均 V30 相当。
