Ship J A, Eisbruch A, D'Hondt E, Jones R E
Department of Oral Medicine, Pathology, Surgery, University of Michigan School of Dentistry, Ann Arbor 48109-1078, USA.
J Dent Res. 1997 Mar;76(3):807-13. doi: 10.1177/00220345970760031401.
Many patients with head and neck cancers receive radiation therapy as part of their treatment which frequently causes considerable morbidity, including various degrees of permanent salivary gland dysfunction. Three-dimensional treatment planning [3-DTP] and conformational dose delivery constitute a new therapeutic modality that conforms the high-dose radiation volume to the shape of the tumor volume while minimizing the dose to tissue that is not at risk of containing cancer. The treatment volumes for head and neck tumors as well as parotid glands can be well-defined on cross-sectional CT imaging techniques. The purpose of this investigation is to determine if 3-DTP and conformational dose-delivery could minimize radiation dose and salivary gland dysfunction to contralateral parotid glands in patients with head and neck cancers. Eleven patients with head and neck cancers who required bilateral radiation therapy were treated with 3-DTP. Unstimulated and stimulated bilateral parotid saliva was collected prior to radiotherapy, weekly during treatment, and 1, 3, 6, and 12 months after the completion of radiotherapy. Treated parotid glands received an average dose of 5745 cGy, while spared glands received only 1986 cGy (p < 0.0001). Unstimulated and stimulated parotid flow rates decreased dramatically in treated glands after the initiation of radiotherapy, remained at extremely low rates without any improvements, and were significantly lower at 1 year after radiotherapy compared with baseline. Conversely, parotid flow rates in spared glands underwent mild changes during radiotherapy and were approximately 50% of baseline values. The results of this study suggest that with the use of 3-DTP, contralateral parotid gland function can be partially preserved for at least 1 year in patients with head and neck cancers requiring bilateral radiation.
许多头颈癌患者接受放射治疗作为其治疗的一部分，这经常会导致相当大的发病率，包括不同程度的永久性唾液腺功能障碍。三维治疗计划[3-DTP]和适形剂量递送构成了一种新的治疗方式，它使高剂量辐射体积与肿瘤体积的形状相匹配，同时将对无癌症风险组织的剂量降至最低。在横断面CT成像技术上，可以很好地界定头颈肿瘤以及腮腺的治疗体积。本研究的目的是确定3-DTP和适形剂量递送是否能将头颈癌患者对侧腮腺的辐射剂量和唾液腺功能障碍降至最低。11名头颈癌患者需要双侧放射治疗，接受了3-DTP治疗。在放疗前、治疗期间每周以及放疗完成后1、3、6和12个月收集双侧腮腺的非刺激性和刺激性唾液。接受治疗的腮腺平均剂量为5745 cGy，而未受照射的腮腺仅接受1986 cGy（p < 0.0001）。放疗开始后，接受治疗的腮腺的非刺激性和刺激性唾液流速急剧下降，一直保持在极低水平且没有任何改善，与基线相比，放疗后1年时显著更低。相反，未受照射的腮腺的唾液流速在放疗期间有轻微变化，约为基线值的50%。本研究结果表明，对于需要双侧放疗的头颈癌患者，使用3-DTP可以使对侧腮腺功能至少部分保留1年。
