Parotid gland-recovery after radiotherapy in the head and neck region-36 months follow-up of a prospective clinical study
Parotid gland-recovery after radiotherapy in the head and neck region-36 months follow-up of a prospective clinical study
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DOI：
10.1186/1748-717x-6-125
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发表时间：
2011-09-27
影响因子：
3.6
通讯作者：
Kuhnt, Thomas
中科院分区：
文献类型：
--
作者：
Hey, Jeremias;Setz, Juergen;Kuhnt, Thomas
背景资料：本研究的目的是评估腮腺的恢复潜力后，使用三维适形放射治疗（3D-CRT）或调强放疗（IMRT）保留一个单一的腮腺glands.Methods：在06/2002和10/2008之间，117例头颈部肿瘤患者被纳入本前瞻性，非随机临床研究。所有患者均接受了根治性治疗。通过测量放射治疗开始、期间和结束时以及治疗后1、6、12、24和36个月的刺激唾液流量来评估唾液腺功能。将测量值转换为流速，并相对于治疗前的流速进行标准化。平均剂量（D（平均值））计算从剂量体积直方图的基础上计算机断层扫描的腮腺。结果：患者分组根据D（平均值）的备用腮腺具有最低的辐射照射：Ⅰ- D组（平均值）< 26戈伊（n = 36），Ⅱ- D组（平均值）26-40戈伊（n = 45），Ⅲ- D组（平均值）> 40戈伊（n = 36）. 15/117例（13%）患者接受调强放疗。通过使用IMRT与3D-CRT相比，保留腮腺的D（平均值）可显著降低（D（平均值）IMRT与3D-CRT：21.7 vs. 34.4戈伊，p < 0.001）。24和36个月后，相对唾液流率（RFSR）作为腮腺平均剂量的函数，I组分别为66%和74%，II组为56%和49%，III组为31%和24%。多元线性回归分析显示，腮腺剂量和肿瘤部位是RT结束后12和36个月的独立决定因素。I组和II组患者腮腺功能在RT结束后12、24和36个月恢复。如果可以实现至少一个腮腺的D（平均值）< 26戈伊，则这足以达到RT前唾液流速的完全恢复。不同部位的放射剂量对腮腺的D值有显著影响，从而影响腮腺的唾液流量和恢复。
Background: The aim of the present study was to evaluate the recovery potential of the parotid glands after using either 3D-conformal-radiotherapy (3D-CRT) or intensity-modulated radiotherapy (IMRT) by sparing one single parotid gland.Methods: Between 06/2002 and 10/2008, 117 patients with head and neck cancer were included in this prospective, non-randomised clinical study. All patients were treated with curative intent. Salivary gland function was assessed by measuring stimulated salivary flow at the beginning, during and at the end of radiotherapy as well as 1, 6, 12, 24, and 36 months after treatment. Measurements were converted to flow rates and normalized relative to rates before treatment. Mean doses (D(mean)) were calculated from dose-volume histograms based on computed tomographies of the parotid glands.Results: Patients were grouped according to the D(mean) of the spared parotid gland having the lowest radiation exposure: Group I - D(mean) < 26 Gy (n = 36), group II - D(mean) 26-40 Gy (n = 45), and group III - D(mean) > 40 Gy (n = 36). 15/117 (13%) patients received IMRT. By using IMRT as compared to 3D-CRT the D(mean) of the spared parotid gland could be significantly reduced (D(mean) IMRT vs. 3D-CRT: 21.7 vs. 34.4 Gy, p < 0.001). The relative salivary flow rates (RFSR) as a function of the mean parotid dose after 24 and 36 months was in group I 66% and 74%, in group II 56% and 49%, and in group III 31% and 24%, respectively. Multiple linear regression analyses revealed that the parotid gland dose and the tumor site were the independent determinants 12 and 36 months after the end of RT. Patients of group I and II parotid gland function did recover at 12, 24, and 36 months after the end of RT.Conclusions: If a D(mean) < 26 Gy for at least one parotid gland can be achieved then this is sufficient to reach complete recovery of pre-RT salivary flow rates. The radiation volume which depends on tumor site did significantly impact on the D(mean) of the parotids, and thus on the saliva flow and recovery of parotid gland.