The effect of concomitant chemotherapy on parotid gland function following head and neck IMRT
The effect of concomitant chemotherapy on parotid gland function following head and neck IMRT
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DOI：
10.1016/j.radonc.2013.03.006
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发表时间：
2013-03-01
影响因子：
5.7
通讯作者：
Nutting, Christopher M.
中科院分区：
文献类型：
--
作者：
Miah, Aisha B.;Gulliford, Sarah L.;Nutting, Christopher M.
目的：探讨局部晚期头颈部鳞状细胞癌患者行保腮腺调强放疗（IMRT）后伴化疗是否会增加高度口干的发生率。材料和方法：在2项前瞻性研究中，比较采用IMRT或联合化疗-IMRT （c-IMRT）治疗的患者高级别（>= G2）急性（CTCAEv3.0）和晚期（LENTSOMA和RTOG）口干的发生率。采用非线性logistic回归分析报道腮腺平均耐受剂量（D-50）。结果：单纯IMRT 36例，联合IMRT 60例。患者在原发部位和累及淋巴结组每日30次接受65 Gy，在选择性淋巴结组每日30次接受54 Gy，腮腺的平均剂量具有可比性。在IMRT的第1天和第29天同时给予顺铂100 mg/m(2)。两组患者>= G2主观口干的发生率相似；急性-64.7% (IMRT) vs 60.3% (c-IMRT), p = 0.83；晚期43% (IMRT) vs . 34% (c-IMRT), p = 0.51。1年后，IMRT组腮腺唾液流量的恢复更高（64% vs 50%），但无统计学意义（p = 0.15）。IMRT组1年无腮腺唾液流的D-50为23.2 Gy (95% CI: 17.7-28.7)， c-IMRT组为21.1 Gy（11.8-30.3）。结论：与单纯IMRT相比，合并c-IMRT不会增加急性或晚期口干症的发生率。2013爱思唯尔爱尔兰有限公司版权所有。
Purpose: To determine whether concomitant chemotherapy increases the incidence of high grade xerostomia following parotid-sparing intensity-modulated radiotherapy (IMRT) in patients with locally advanced head and neck squamous cell cancer.Materials and methods: The incidence of high grade ( >= G2) acute (CTCAEv3.0) and late (LENTSOMA and RTOG) xerostomia was compared between patients treated with either IMRT or concomitant chemo-IMRT (c-IMRT) in 2 prospective studies. Parotid gland mean tolerance doses (D-50) were reported using non-linear logistic regression analysis.Results: Thirty-six patients received IMRT alone and 60 patients received c-IMRT. Patients received 65 Gy in 30 daily fractions to the primary site and involved nodal groups and 54 Gy in 30 fractions to elective nodal groups, mean doses to the parotid glands were, comparable. Concomitant cisplatin 100 mg/m(2) was administered on days 1 and 29 of IMRT. The incidence of >= G2 subjective xerostomia was similar in both groups; acute-64.7% (IMRT) versus 60.3% (c-IMRT), p = 0.83; late-43% (IMRT) versus 34% (c-IMRT), p = 0.51. Recovery of parotid salivary flow at 1 year was higher with IMRT (64% vs 50%), but not statistically significant (p = 0.15). D-50 for absence of parotid saliva flow at 1 year was 23.2 Gy (95% CI: 17.7-28.7) for IMRT and 21.1 Gy (11.8-30.3) for c-IMRT.Conclusion: Concomitant c-IMRT does not increase the incidence of acute or late xerostomia relative to IMRT alone. (C) 2013 Elsevier Ireland Ltd. All rights reserved.