Medical School of Chinese PLA, 28 Fuxing Road, Beijing 100853, China.
Department of Radiation Oncology, China-Japan Friendship Hospital, 2 Yinghuayuan Dongjie, Beijing 100029, China.
Biomed Res Int. 2019 Jul 14;2019:2401743. doi: 10.1155/2019/2401743. eCollection 2019.
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.
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.
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%.
Comprehensive protection of salivary glands minimized xerostomia in head-and-neck cancer patients treated by helical tomotherapy, without increasing early LR recurrence risk.
本研究旨在分析螺旋断层放疗对头颈部癌患者双侧腮腺（PG-T）、对侧颌下腺（cSMG）和口腔附属唾液腺（OC）进行综合保护的效果。
共纳入 175 例经组织学证实的头颈部癌患者，采用螺旋断层放疗。在治疗计划中，将 PG-T、cSMG 和 OC 的剂量限制在尽可能低的水平。评估唾液流量率和口干问卷。使用单变量和多变量模型评估口干与其他临床因素之间的相关性。使用 Cox 分析评估唾液腺剂量对局部区域（LR）复发的影响。ROC 曲线用于确定每个腺体的平均剂量阈值。
中位随访时间为 25 个月（19-36 个月）。OC 平均剂量、PG-T 平均剂量、cSMG 平均剂量、年龄、临床分期（II 期和 III 期与 IV 期）以及未刺激和刺激唾液流量与口干显著相关。OC 平均剂量、cSMG 平均剂量、年龄和临床分期是调整 PG-T 平均剂量、未刺激和刺激唾液流量后口干的预测因素。当 PG-T、cSMG 和 OC 的平均剂量分别保持在 29.12Gy、29.29Gy 和 31.44Gy 以下时，口干显著减少。放疗后 18 个月，早期 LR 复发率仅为 4%。
螺旋断层放疗对头颈部癌患者进行综合保护唾液腺，可最大程度减少口干，而不会增加早期 LR 复发风险。
