Department of Radiation Oncology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
Int J Radiat Oncol Biol Phys. 2012 Oct 1;84(2):443-8. doi: 10.1016/j.ijrobp.2011.11.070. Epub 2012 Jul 25.
This study evaluated the ability of helical tomotherapy to spare the function of the parotid glands in patients with head-and-neck cancer by analyzing dose-volume histograms, salivary gland scintigraphy, and quality of life assessment.
Data from 76 consecutive patients treated with helical tomotherapy (Hi-Art Tomotherapy) at the University Hospital Brussel were analyzed. During planning, priority was given to planning target volume (PTV) coverage: ≥ 95% of the dose must be delivered to ≥ 95% of the PTV. Elective nodal regions received 54 Gy (1.8 Gy/fraction). A dose of 70.5 Gy (2.35 Gy/fraction) was prescribed to the primary tumor and pathologic lymph nodes (simultaneous integrated boost scheme). Objective scoring of salivary excretion was performed by salivary gland scintigraphy. Subjective scoring of salivary gland function was evaluated by the European Organization for Research and Treatment of Cancer quality of life questionnaires Quality of Life Questionnaire-C30 (QLQ-C30) and Quality of Life Questionnaire-Head and Neck 35 (H&N35).
Analysis of dose-volume histograms (DVHs) showed excellent coverage of the PTV. The volume of PTV receiving 95% of the prescribed dose (V95%) was 99.4 (range, 96.3-99.9). DVH analysis of parotid gland showed a median value of the mean parotid dose of 32.1 Gy (range, 17.5-70.3 Gy). The median parotid volume receiving a dose <26 Gy was 51.2%. Quality of life evaluation demonstrated an initial deterioration of almost all scales and items in QLQ-C30 and QLQ-H&N35. Most items improved in time, and some reached baseline values 18 months after treatment.
DVH analysis, scintigraphic evaluation of parotid function, and quality of life assessment of our patient group showed that helical tomotherapy makes it possible to preserve parotid gland function without compromising disease control. We recommend mean parotid doses of <34 Gy and doses <26 Gy to a maximum 47% of the parotid volume as planning goals. Intensity-modulated radiotherapy should be considered as standard treatment in patients with head-and-neck cancer.
通过分析剂量-体积直方图、唾液腺闪烁显像和生活质量评估，评估螺旋断层放疗（Helical Tomotherapy，Hi-Art Tomotherapy）在头颈部癌患者中保护腮腺功能的能力。
对在布鲁塞尔大学医院接受螺旋断层放疗（Hi-Art Tomotherapy）治疗的 76 例连续患者的数据进行了分析。在计划中，优先考虑计划靶区（PTV）覆盖：≥95%的剂量必须给予≥95%的 PTV。选择性淋巴结区域接受 54 Gy（1.8 Gy/次）。原发性肿瘤和病理淋巴结（同时整合增敏方案）给予 70.5 Gy（2.35 Gy/次）的剂量。唾液腺闪烁显像对唾液排泄进行客观评分。欧洲癌症研究与治疗组织（European Organization for Research and Treatment of Cancer）生活质量问卷-30 项（Quality of Life Questionnaire-C30，QLQ-C30）和头颈部 35 项（Head and Neck 35，H&N35）生活质量问卷评估唾液腺功能的主观评分。
剂量-体积直方图（DVH）分析显示 PTV 覆盖良好。PTV 接受处方剂量 95%的体积（V95%）为 99.4（范围，96.3-99.9）。腮腺的 DVH 分析显示，平均腮腺剂量的中位数为 32.1 Gy（范围，17.5-70.3 Gy）。接受剂量<26 Gy 的腮腺中位体积为 51.2%。生活质量评估显示，QLQ-C30 和 QLQ-H&N35 中的几乎所有量表和项目最初都恶化。大多数项目随着时间的推移而改善，有些项目在治疗后 18 个月达到基线值。
我们患者组的 DVH 分析、腮腺功能闪烁显像评估和生活质量评估表明，螺旋断层放疗可以在不影响疾病控制的情况下保护腮腺功能。我们建议将平均腮腺剂量<34 Gy 和剂量<26 Gy 作为计划目标，给予腮腺体积的最大值<47%。对于头颈部癌患者，应考虑采用调强放疗作为标准治疗。
