Quantitative dose-volume response analysis of changes in parotid gland function after radiotherapy in the head-and-neck region
Quantitative dose-volume response analysis of changes in parotid gland function after radiotherapy in the head-and-neck region
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DOI：
10.1016/s0360-3016(01)01717-5
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发表时间：
2001-11-15
影响因子：
7
通讯作者：
Terhaard, CHJ
中科院分区：
文献类型：
--
作者：
Roesink, JM;Moerland, MA;Terhaard, CHJ
目的：为了研究腮腺的辐射耐受性作为剂量和体积的函数radiated.Methods和Materials：108例原发性或术后放射治疗的各种恶性肿瘤在头部和颈部区域进行了前瞻性评价。在放疗前和放疗后6周、6个月和1年分别测量腮腺刺激血流率。腮腺剂量-体积直方图来自基于CT的治疗计划。用莱曼提出的正常组织并发症概率模型对数据进行拟合。结果：174例患者放疗前腮腺刺激流速平均为0.34mL/min，放疗后6周降至0.12mL/min，放疗后1年恢复至0.20mL/min。放射治疗后流速的降低与腮腺平均剂量显著相关。在腮腺平均剂量为35-45戈伊的患者中，将腮腺的照射体积从0%-40%增加到90-100%，导致放射后6周的流量比分别从约100%下降到小于10%。90%~ 100%组放疗后6个月血流比部分恢复至15%，1年血流比恢复至30%。正常组织并发症概率模型参数TD 50（导致并发症概率为50%的整个器官的剂量）在放疗后6周、6个月和1年分别为31、35和39戈伊。体积依赖性参数n约为1，这意味着平均腮腺剂量与观察到的并发症相关性最好。有没有陡峭的剂量反应曲线（m = 0.45，在一年后放疗）。结论：这项研究的剂量/体积/腮腺功能的关系揭示了放射治疗后的流量比和腮腺剂量和强大的体积依赖性之间的线性相关性。放疗后6个月和1年腮腺功能恢复。在放射计划中，应尝试达到平均腮腺剂量至少低于39戈伊（导致并发症概率为50%）。(C)2001 Elsevier Science Inc.
Purpose: To study the radiation tolerance of the parotid glands as a function of dose and volume irradiated.Methods and Materials: One hundred eight patients treated with primary or postoperative radiotherapy for various malignancies in the head-and-neck region were prospectively evaluated. Stimulated parotid flow rate was measured before radiotherapy and 6 weeks, 6 months, and I year after radiotherapy. Parotid gland dose-volume histograms were derived from CT-based treatment planning. The normal tissue complication probability model proposed by Lyman was fit to the data. A complication was defined as stimulated parotid flow rate < 25% of the preradiotherapy flow rate.Results: The mean stimulated preradiotherapy flow rate of 174 parotid glands was 0.34 mL/min. The mean flow rate reduced to 0.12 mL/min 6 weeks postradiotherapy, but recovered to a mean flow rate of 0.20 mL/min at I year after radiotherapy. Reduction in postradiotherapy flow rate correlated significantly with mean parotid dose. No threshold dose was found. Increasing the irradiated volume of parotid glands from 0%-40% to 90-100% in patients with a mean parotid dose of 35-45 Gy resulted in a decrease in flow ratio from, respectively, approximately 100% to less than 10% 6 weeks after radiation. The flow ratio of the 90%-100% group partially recovered to 15% at 6 months and to 30% at I year after radiotherapy. The normal tissue complication probability model parameter TD50 (the dose to the whole organ leading to a complication probability of 50%) was found to be 31, 35, and 39 Gy at 6 weeks, 6 months, and I year postradiotherapy, respectively. The volume dependency parameter n was around 1, which means that the mean parotid dose correlates best with the observed complications. There was no steep dose-response curve (m = 0.45 at I year post radiotherapy).Conclusions: This study on dose/volume/parotid gland function relationships revealed a linear correlation between postradiotherapy flow ratio and parotid gland dose and a strong volume dependency. No threshold dose was found. Recovery of parotid gland function was shown at 6 months and I year after radiotherapy. In radiation planning, attempts should be made to achieve a mean parotid gland dose at least below 39 Gy (leading to a complication probability of 50%). (C) 2001 Elsevier Science Inc.