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Ma J, Chen Z, Liu S, Hu W, Su K, He R, Zhou P, Xiao H, Ju J, Hou Q, Zhou Y, Wang B. The application of 3D-printed oral stents in intensity-modulated radiotherapy for oropharyngeal cancer and their dosimetric effect on organs at risk. Eur J Med Res 2023; 28:367. [PMID: 37736754 PMCID: PMC10515031 DOI: 10.1186/s40001-023-01333-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/29/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND This study investigates the accuracy of 3D-printed dental stents in intensity-modulated radiotherapy (IMRT) for oropharyngeal cancer (OPC) and their dosimetric effects on normal tissues. METHODS We selected 60 patients with OPC who underwent IMRT in the Department of Oncology, Special Medical Center of Army Medical University. These patients were randomly assigned into 3D-printed oral stent, simple glass bottle, and nonstent groups (20 patients/group). The positioning error was analyzed with the onboard imaging system once a week after 5 fractions of IMRT. The conformity index (CI), homogeneity index (HI), radiation dose of organs at risk (OARs), and oral mucosal reaction were compared among the three groups. RESULTS No significant difference was observed in the conformity and uniformity of the target dose and the dose received by the spinal cord, larynx, and bilateral parotid glands among the three groups (P > 0.05). Meanwhile, the dose received by the upper cheek, hard palate, and soft palate of patients was significantly lower in the 3D-printed oral stent group than in the nonstent group (P < 0.05) but insignificantly different between the 3D-printed oral stent and simple glass bottle groups (P > 0.05). When compared with the nonstent group, the simple glass bottle group showed a markedly lower dose received by the upper cheek (P < 0.05) and an insignificantly different dose received by the hard palate and soft palate (P > 0.05). According to Common Terminology Criteria for Adverse Events v.5.0, the adverse response rate of the hard palate mucosa was lower in the 3D-printed oral stent group than in the simple glass bottle and nonstent groups (P < 0.05). CONCLUSIONS For OPC patients undergoing IMRT, the application of 3D-printed oral stents can significantly reduce the exposure dose of the upper cheek and hard palate and decrease the occurrence of adverse events such as oral mucositis although it cannot affect the positioning error.
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Affiliation(s)
- Jungang Ma
- Department of Oncology, Daping Hospital, Army Medical University, 10 Changjiang Branch Road, Chongqing, 400042, China
| | - Zhuo Chen
- Department of Oncology, Daping Hospital, Army Medical University, 10 Changjiang Branch Road, Chongqing, 400042, China
| | - Shuixia Liu
- Department of Oncology, Daping Hospital, Army Medical University, 10 Changjiang Branch Road, Chongqing, 400042, China
| | - Wei Hu
- Department of Oncology, Daping Hospital, Army Medical University, 10 Changjiang Branch Road, Chongqing, 400042, China
| | - Kunpu Su
- Department of Oncology, Daping Hospital, Army Medical University, 10 Changjiang Branch Road, Chongqing, 400042, China
| | - Rong He
- Department of Oncology, Daping Hospital, Army Medical University, 10 Changjiang Branch Road, Chongqing, 400042, China
| | - Peng Zhou
- Department of Oncology, Daping Hospital, Army Medical University, 10 Changjiang Branch Road, Chongqing, 400042, China
| | - He Xiao
- Department of Oncology, Daping Hospital, Army Medical University, 10 Changjiang Branch Road, Chongqing, 400042, China
| | - Jia Ju
- Department of Oncology, Daping Hospital, Army Medical University, 10 Changjiang Branch Road, Chongqing, 400042, China
| | - Qianying Hou
- Department of Oncology, Daping Hospital, Army Medical University, 10 Changjiang Branch Road, Chongqing, 400042, China
| | - Yinying Zhou
- Department of Critical Care MedicineDaping Hospital, Army Medical University, Chongqing, 400042, China
| | - Bin Wang
- Department of Oncology, The Seventh People's Hospital of Chongqing (Affiliated Central Hospital of Chongqing University of Technology), Lijiatuo Street, Chongqing, 400054, China.
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2
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Jung S, Kim B, Lee SY, Chang WI, Son J, Park JM, Choi CH, Lee JH, Wu HG, Kim JI, Kim JH. Novel tongue-positioning device to reduce tongue motions during radiation therapy for head and neck cancer: Geometric and dosimetric evaluation. PLoS One 2023; 18:e0291712. [PMID: 37733674 PMCID: PMC10513285 DOI: 10.1371/journal.pone.0291712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/04/2023] [Indexed: 09/23/2023] Open
Abstract
This study aimed to assess the performance of a tongue-positioning device in interfractional tongue position reproducibility by cone-beam computed tomography (CBCT). Fifty-two patients treated with radiation therapy (RT) while using a tongue positioning device were included in the study. All patients were treated with 28 or 30 fractions using the volumetric modulated arc therapy technique. CBCT images were acquired at the 1st, 7th, 11th, 15th, 19th, 23th, and 27th fractions. Tongues on planning computed tomography (pCT) and CBCT images were contoured in the treatment planning system. Geometric differences in the tongue between pCT and CBCT were assessed by the Dice similarity coefficient (DSC) and averaged Hausdorff distance (AHD). Two-dimensional in vivo measurements using radiochromic films were performed in 13 patients once a week during sessions. The planned dose distributions were compared with the measured dose distributions using gamma analysis with criteria of 3%/3 mm. In all patients, the mean DSC at the 1st fraction (pCT versus 1st CBCT) was 0.80 while the mean DSC at the 27th fraction (pCT versus 27th CBCT) was 0.77 with statistical significance (p-value = 0.015). There was no statistically significant difference in DSC between the 1st fraction and any other fraction, except for the 27th fraction. There was statistically significant difference in AHD between the 1st fraction and the 19th, 23th, and 27th fractions (p-value < 0.05). In vivo measurements showed an average gamma passing rate of 90.54%. There was no significant difference between measurements at the 1st week and those at other weeks. The tongue geometry during RT was compared between pCT and CBCT. In conclusion, the novel tongue-positioning device was found to minimize interfractional variations in position and shape of the tongue.
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Affiliation(s)
- Seongmoon Jung
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Nuclear Engineering, Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea
| | - Bitbyeol Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sung Young Lee
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Won Ick Chang
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jaeman Son
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jong Min Park
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chang Heon Choi
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Joo Ho Lee
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hong-Gyun Wu
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung-in Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin Ho Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea
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3
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Villani D, Faria K, Kauark-Fontes E, Ribeiro C, Mascarenhas Y, Ribeiro A, Vechiato-Filho A, Menegussi G, Vasconcelos K, Santos-Silva A, Brandão T. Protocol determination for OSL in vivo measurements of absorbed dose in the oral mucosa in oral cancer patients: A pilot study. Radiat Phys Chem Oxf Engl 1993 2022. [DOI: 10.1016/j.radphyschem.2022.110729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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4
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Sakamoto M, Konishi K, Ohira K, Hirata M, Wakabayashi K, Aramaki S, Kokubo R, Nakamura K. A newly developed patient fixation system using a dedicated mouthpiece and dental impression materials for head and neck radiotherapy: a preliminary study. JOURNAL OF RADIATION RESEARCH 2022; 63:749-757. [PMID: 35818301 PMCID: PMC9494543 DOI: 10.1093/jrr/rrac044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/21/2022] [Indexed: 06/15/2023]
Abstract
We evaluated the basic characteristics and efficacy of our newly developed patient fixation system for head and neck radiotherapy that uses a dedicated mouthpiece and dental impression materials. The present investigation demonstrated that with this system, the changes in the absorbed dose to water depending on the material of the mouthpiece were small, with a maximum of 0.32% for a 10-MV photon beam. For the dental impression material, we selected a silicone material with the lowest Hounsfield unit (HU) value that had little effect on the generation of artifacts and the quality of the X-ray beam. Multiphase magnetic resonance imaging (MRI) revealed that the head-up and -down motions in the thermoplastic shell without the mouthpiece were 5.76 ± 1.54 mm, whereas the motion with the mouthpiece decreased significantly to 1.72 ± 0.92 mm (P = 0.006). Similarly, the head-left and -right motion displacement decreased from 6.32 ± 1.86 mm without the mouthpiece to 1.80 ± 0.42 mm with the mouthpiece (P = 0.003). Regarding the tongue depressor function of the mouthpiece, the median distance from the hard palate to the surface of the tongue was 28.42 mm. The present results indicate that the new immobilization device developed herein that uses a mouthpiece and a thermoplastic shell is useful for suppressing patients' head motions and tongue positions.
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Affiliation(s)
- Masataka Sakamoto
- Corresponding author. Department of Radiology, Hamamatsu University Hospital, Handayama 120-1, Higashi-ku, Hamamatsu 431-3192, JAPAN. Tel: +81-053-435-2111; E-mail:
| | - Kenta Konishi
- Department of Radiation Oncology, Hamamatsu University School of Medicine, Handayama 1-20-1, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Keiichi Ohira
- Department of Radiation Oncology, Hamamatsu University School of Medicine, Handayama 1-20-1, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Masanori Hirata
- Department of Radiation Oncology, Hamamatsu University School of Medicine, Handayama 1-20-1, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Kohei Wakabayashi
- Department of Radiation Oncology, Hamamatsu University School of Medicine, Handayama 1-20-1, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Shuhei Aramaki
- Department of Radiation Oncology, Hamamatsu University School of Medicine, Handayama 1-20-1, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Ryo Kokubo
- Department of Radiation Oncology, Hamamatsu University School of Medicine, Handayama 1-20-1, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Katsumasa Nakamura
- Department of Radiology, Hamamatsu University Hospital, Handayama 1-20-1, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
- Department of Radiation Oncology, Hamamatsu University School of Medicine, Handayama 1-20-1, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
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5
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Radiotherapy of tongue cancer using an intraoral stent: a pilot study. JOURNAL OF RADIOTHERAPY IN PRACTICE 2022. [DOI: 10.1017/s1460396921000078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractAim:The aim was to evaluate the feasibility of an intraoral stent (10 and 20 mm thickness) in radiotherapy of tongue cancer, and to measure the reduction in acute mucositis in the palate.Materials and method:There were six patients in the intervention group, and seven patients in the control group. Target coverage was measured by the minimum dose covering 98% of the clinical target volume (CTV). Data were collected from the planning CT and daily cone-beam computer tomography (CBCT).Results:The 10 and 20 mm stent yielded a mean distance of 26 and 36 mm, respectively, between the tongue and the hard palate. We found comparable dose coverage of the CTV in the treatment plan, and on the CBCT. The stent reduced mean dose to the hard palate by 61.0% (p = 0.002). Dose to the soft palate was not reduced (p = 0.18). Average Common Terminology Criteria for Adverse Events (CTCAE) mucositis scores of the hard palate were 0 and 0.8 in the intervention and control group, respectively. The mucositis scores of the soft palate were 1.2 and 1.8.Findings:Use of an intraoral stent substantially reduced the dose to the hard palate. CTV coverage was maintained. We did not find any significant reduction in visually scored radiation-induced mucositis.
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Jonovic K, Özcan M, Husain NAH, Mätzener KJ, Ciernik IF. Evaluation of radiodensity and dimensional stability of polymeric materials used for oral stents during external beam radiotherapy of head and neck carcinomas. Clin Transl Radiat Oncol 2022; 36:31-39. [PMID: 35762007 PMCID: PMC9233185 DOI: 10.1016/j.ctro.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose Intraoral stents protect the healthy tissues from ionizing radiation during external beam radiotherapy reducing mucositis, hyposalivation and osteoradionecrosis. This study investigated the radiodensity and dimensional stability of polymeric materials for suitability in construction of intraoral stents and aimed to provide clinical guidelines. Methods Specimens were fabricated using 4 material types namely, resin composite (ProTemp-PRO), polymethylmethacrylate (PMMA) (Enamel Temp Plus-ETP, Palapress-PAL, TAB 2000-TAB), polycaprolactone (Orfit-ORF) and silicone (Adisil-ADI, Lab Putty-LAB, Memosil2-MEM, Optosil-OPT, President Plus-PRE, Siolaplast A-SIA). They were randomly assigned to measure their radiodensity in Hounsfield Units (HU) (12x12x11mm3) (Nradiodensity = 66; n = 6) using a computer tomograph (CBCT, Toshiba Aquillon LB scanner) at baseline and after 6 weeks. The scanning protocol was applied with and without single energy metal artifact reduction (SEMAR) scans using a slice thickness of 1 and 5 mm. The same materials have been tested for their dimensional stability (µm3) at baseline, 1, 6, 12, 24 h, 3 and 6 weeks (14 × 4 × 2 mm3) (Ndimension = 55; n = 5 per material) using stereolithography (STL) files generated by a lab scanner (L2i, Imetric4D, Courgenay, Switzerland) and analyzed using a matching software (Geomagic ControlX 2020, 3D Systems). Data were analyzed using a paired t-test (alpha = 0.05). Results Radiodensity values (HU) were significantly affected by the material classification (p < 0.05). Polycaprolactone (43.6) presented significantly lower HU values followed by PMMA (91.3-414.9) than those of silicone materials (292.8-874.5). In terms of dimensional stability (µm3), PMMA materials (Δ:1.53-2.68) and resin composite (Δ:2.89) were significantly more dimensionally stable compared to those of silicone materials (Δ:13.64-6.63) and polycaprolactone (Δ:-0.76) and (p < 0.05). Conclusion For fabricating intraoral stents, when reduced radiodensity values are required polycaprolactone could be recommended as it fulfils the requirements for reduced radiodensity and dimensional stability. Among all silicone materials, OPT and MEM can be recommended based on the low HU and dimensional stability.
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Affiliation(s)
- Katarina Jonovic
- University of Zürich, Division of Dental Materials, Center for Dental and Oral Medicine, Zürich, Switzerland.,University of Zurich, School of Medicine and Dentistry, Medical Faculty, Zurich, Switzerland
| | - Mutlu Özcan
- University of Bern, School of Dental Medicine, Department of Reconstructive Dentistry and Gerodontology, Bern, Switzerland
| | - Nadin Al-Haj Husain
- University of Bern, School of Dental Medicine, Department of Reconstructive Dentistry and Gerodontology, Bern, Switzerland.,Radiation Oncology, Dessau City Hospital, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - Kiren Jan Mätzener
- University of Bern, School of Dental Medicine, Department of Reconstructive Dentistry and Gerodontology, Bern, Switzerland
| | - Ilja Frank Ciernik
- University of Zurich, School of Medicine and Dentistry, Medical Faculty, Zurich, Switzerland.,Radiation Oncology, Dessau City Hospital, Brandenburg Medical School Theodor Fontane, Dessau, Germany
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7
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Development of a customisable 3D-printed intra-oral stent for head-and-neck radiotherapy. Tech Innov Patient Support Radiat Oncol 2022; 23:1-7. [PMID: 35813156 PMCID: PMC9260300 DOI: 10.1016/j.tipsro.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/25/2022] [Accepted: 06/13/2022] [Indexed: 11/20/2022] Open
Abstract
Advanced radiotherapy techniques have improved head-and-neck treatments. More improvements are possible with intra-oral stents stabilising sensitive anatomy. MRI imaging shows new modular 3D printed stents provide stable displacement. Modular stents achieve positive outcomes within standard treatment workflow.
Intra-oral stents (including mouth-pieces and bite blocks) can be used to displace adjacent non-involved oral tissue and reduce radiation side effects from radiotherapy treatments for head-and-neck cancer. In this study, a modular and customisable 3D printed intra-oral stent was designed, fabricated and evaluated, to utilise the advantages of the 3D printing process without the interruption of clinical workflow associated with printing time. The stent design used a central mouth-opening and tongue-depressing main piece, with optional cheek displacement pieces in three different sizes, plus an anchor point for moulding silicone to fit individual patients’ teeth. A magnetic resonance imaging (MRI) study of one healthy participant demonstrated the tissue displacement effects of the stent, while providing a best-case indication of its comfort.
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8
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Stopping-power ratio of mouthpiece materials for charged-particle therapy in head and neck cancer. Radiol Phys Technol 2021; 15:83-88. [PMID: 34822100 PMCID: PMC8888382 DOI: 10.1007/s12194-021-00643-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 11/09/2022]
Abstract
In this study, the stopping-power ratios (SPRs) of mouthpiece materials were measured and the errors in the predicted SPRs based on conversion table values were further investigated. The SPRs of the five mouthpiece materials were predicted from their computed tomography (CT) numbers using a calibrated conversion table. Independently, the SPRs of the materials were measured from the Bragg peak shift of a carbon-ion beam passing through the materials. The errors in the SPRs of the materials were determined as the difference between the predicted and measured values. The measured SPRs (errors) of the Nipoflex 710™ and Bioplast™ ethylene–vinyl acetate copolymers (EVAs) were 0.997 (0.023) and 0.982 (0.007), respectively. The SPRs of the vinyl silicon impression material, light-curable resin, and bis-acrylic resin were 1.517 (0.134), 1.161 (0.068), and 1.26 (0.101), respectively. Among the five tested materials, the EVAs had the lowest SPR errors, indicating the highest human-tissue equivalency.
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9
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Singh A, Rosen EB, Randazzo JD, Estilo CL, Gelblum DY, Huryn JM. Intraoral radiation stents-Primer for clinical use in head and neck cancer therapy. Head Neck 2021; 43:4010-4017. [PMID: 34480818 DOI: 10.1002/hed.26848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/16/2021] [Accepted: 08/17/2021] [Indexed: 11/10/2022] Open
Abstract
Intraoral radiation stents (IRS) are prosthetic devices that assist in the effective delivery of radiation to tumor tissues and aim to avoid unnecessary radiation to adjacent healthy tissues, thus limiting postradiotherapy toxicities. They are used to protect or displace vital structures, assist in positioning of the treatment beam for effective administration of radiotherapy, carry a radioactive material, shield healthy tissues of the oral cavity, and/or maintain the desired mouth opening during radiotherapy. With close collaboration between radiation oncologist and oral health care provider, several IRS can be fabricated by the latter for appropriate targeting and delivery of planned radiation dose and optimized treatment results. Modification of these IRS based on individual patient need is recommended to maximize prosthesis utility. The purpose of this review is to discuss the various types of IRS and highlight their clinical utility and benefits in patients receiving radiation therapy in the head and neck cancers.
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Affiliation(s)
- Annu Singh
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Evan B Rosen
- Dental Oncology and Maxillofacial Prosthetics, Miami Cancer Institute, Miami, Florida, USA
| | - Joseph D Randazzo
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Cherry L Estilo
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Daphna Y Gelblum
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Joseph M Huryn
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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10
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Cleland S, Chan P, Chua B, Crowe SB, Dawes J, Kenny L, Lin C, Obereigner E, Peet SC, Trapp JV, Poroa T, Kairn T. Dosimetric evaluation of a patient-specific 3D-printed oral positioning stent for head-and-neck radiotherapy. Phys Eng Sci Med 2021; 44:887-899. [PMID: 34110611 DOI: 10.1007/s13246-021-01025-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/03/2021] [Indexed: 12/21/2022]
Abstract
As head-and-neck radiotherapy treatments become more complex and sophisticated, and the need to control and stabilise the positioning of intra-oral anatomy becomes more important, leading the increasing use of oral positioning stents during head-and-neck radiotherapy simulation and delivery. As an alternative to the established practice of creating oral positioning stents using wax, this study investigated the use of a 3D printing technique. An Ender 5 3D printer (Creality 3D, Shenzhen, China) was used, with PLA+ "food-safe" polylactic acid filament (3D Fillies, Dandenong South, Australia), to produce a low-density 3D printed duplicate of a conventional wax stent. The physical and dosimetric effects of the two stents were evaluated using radiochromic film in a solid head phantom that was modified to include flexible parts. The Varian Eclipse treatment planning system (Varian Medical Systems, Palo Alto, USA) was used to calculate the dose from two different head-and-neck treatment plans for the phantom with each of the two stents. Examination of the resulting four dose distributions showed that both stents effectively pushed sensitive oral tissues away from the treatment targets, even though most of the phantom was solid. Film measurements confirmed the accuracy of the dose calculations from the treatment planning system, despite the steep density gradients in the treated volume, and demonstrated that the 3D print could be a suitable replacement for the wax stent. This study demonstrated a useful method for dosimetrically testing novel oral positioning stents. We recommend the development of flexible phantoms for future studies.
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Affiliation(s)
- Susannah Cleland
- Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.,Queensland University of Technology, Brisbane, QLD, 4001, Australia.,Herston Bifabrication Institute, Metro North Hospital and Health Service, Herston, QLD, 4029, Australia.,Radiation Oncology Princess Alexandra Hospital Raymond Terrace, South Brisbane, QLD, 4101, Australia
| | - Philip Chan
- Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.,University of Queensland, Brisbane, QLD, 4072, Australia
| | - Benjamin Chua
- Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.,University of Queensland, Brisbane, QLD, 4072, Australia
| | - Scott B Crowe
- Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.,Queensland University of Technology, Brisbane, QLD, 4001, Australia.,Herston Bifabrication Institute, Metro North Hospital and Health Service, Herston, QLD, 4029, Australia.,University of Queensland, Brisbane, QLD, 4072, Australia
| | - Jodi Dawes
- Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia
| | - Lizbeth Kenny
- Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.,University of Queensland, Brisbane, QLD, 4072, Australia
| | - Charles Lin
- Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.,University of Queensland, Brisbane, QLD, 4072, Australia
| | - Elise Obereigner
- Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.,Herston Bifabrication Institute, Metro North Hospital and Health Service, Herston, QLD, 4029, Australia
| | - Samuel C Peet
- Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.,Queensland University of Technology, Brisbane, QLD, 4001, Australia
| | - Jamie V Trapp
- Queensland University of Technology, Brisbane, QLD, 4001, Australia
| | - Tania Poroa
- Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.,Herston Bifabrication Institute, Metro North Hospital and Health Service, Herston, QLD, 4029, Australia
| | - Tanya Kairn
- Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia. .,Queensland University of Technology, Brisbane, QLD, 4001, Australia. .,Herston Bifabrication Institute, Metro North Hospital and Health Service, Herston, QLD, 4029, Australia. .,University of Queensland, Brisbane, QLD, 4072, Australia.
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11
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Are intraoral stents effective in reducing oral toxicities caused by radiotherapy? A systematic review and meta-analysis. J Prosthet Dent 2021; 128:1380-1386. [PMID: 33879318 DOI: 10.1016/j.prosdent.2021.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 11/22/2022]
Abstract
STATEMENT OF PROBLEM Intraoral stents have been provided to minimize acute and chronic toxicities induced by radiotherapy, including oral mucositis, salivary changes, trismus, radiation-related caries, and osteoradionecrosis. However, a systematic review and meta-analysis is necessary to determine their effectiveness. PURPOSE The purpose of this systematic review and meta-analysis was to determine the effectiveness of intraoral stent use and determine whether these prosthetic devices can reduce radiation dosage to nontargeted oral tissues and adverse effects related to head and neck radiation. MATERIAL AND METHODS Two independent reviewers made a systematic search for articles published from January 2010 to March 2020 in 3 databases, supplemented by a manual search. Studies were included if they were clinical trials (randomized controlled trials, both prospective and retrospective), published in English, and evaluated radiation dose and oral adverse side effects (acute or chronic) induced by radiotherapy of participants with and without intraoral stents. RESULTS The search strategy identified 201 studies; of which, 9 were included. A total of 251 participants were evaluated; of whom, 168 (77.3%) used intraoral stents and 57 (22.7%) were treated with radiotherapy without a prosthetic device. A statistically significant difference was found regarding the use of intraoral stents for preventing oral mucositis (P<.001), salivary changes (P=.003), and trismus (P<.02). A funnel plot showed asymmetry among the differences of means in all selected studies. CONCLUSIONS Intraoral stents have a positive effect on preventing oral mucositis. Further clinical trials are needed to address the flaws identified in the present systematic review.
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Srivastava A, Chambers MS, Aponte-Wesson R. Bilabial-protruding, mouth-opening and tongue-depressing stent for proton radiation therapy. J Prosthet Dent 2021; 128:1109-1113. [PMID: 33814095 DOI: 10.1016/j.prosdent.2021.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 11/29/2022]
Abstract
Custom intraoral radiation devices protect normal tissues, minimizing the adverse effects of radiation therapy. These devices also help immobilize the target by placing the patient's head in a precise, repeatable position. This clinical report describes the fabrication and benefits of a modified mouth opening, tongue depressing radiation stent with bilabial protrusion of the lips that was used in proton radiation therapy for a malignancy of the upper lip.
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Affiliation(s)
- Akanksha Srivastava
- Clinical Assistant Professor, Department of Restorative Dentistry and Prosthodontics, The University of Texas School of Dentistry, Houston, Texas.
| | - Mark S Chambers
- Professor and Deputy Department Chair, Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ruth Aponte-Wesson
- Associate Professor, Department of Head and Neck Surgery, Section of Oral Oncology and Maxillofacial Prosthodontics, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Alves LDB, Menezes ACS, Pereira DL, Santos MTC, Antunes HS. Benefits of intraoral stents in patients with head and neck cancer undergoing radiotherapy: Systematic review. Head Neck 2021; 43:1652-1663. [PMID: 33527582 DOI: 10.1002/hed.26620] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/28/2020] [Accepted: 01/15/2021] [Indexed: 12/24/2022] Open
Abstract
Intraoral stents aim to reduce the oral complications associated with head and neck cancers radiotherapy. The aim of this study is to determine the benefits associated with these devices. A systematic review was conducted in PubMed, Web of Science, and Scopus databases selecting full articles published in English, Portuguese, or Spanish until June 6, 2020 (PROSPERO registration: CRD42020185065). The studies were evaluated by Hadorn and Somerfield criteria and guidelines were established. Nineteen studies were identified suggesting the use of intraoral stent for radiotherapy for patients with cancer on/near the mandible to reduce oral mucositis, trismus, xerostomia (LoE III), and dose in healthy structures (LoE IV) and for cancer on/near the maxilla to reduce oral mucositis and dose in healthy structures (LoE IV). Despite the limited scientific evidence, several benefits associated with the use of intraoral stent for radiotherapy of the head and neck neoplasia have been reported.
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Affiliation(s)
- Lísia D B Alves
- Multi-Professional Residency, Dentistry Section, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Ana C S Menezes
- Multi-Professional Residency, Dentistry Section, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Débora L Pereira
- Clinical Research Division, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Marco T C Santos
- Multi-Professional Residency, Radiation Oncology Service, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Héliton S Antunes
- Clinical Research Division, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
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Grant SR, Williamson TD, Stieb S, Shah SJ, David Fuller C, Rosenthal DI, Frank SJ, Garden AS, Morrison WH, Phan J, Moreno AC, Reddy JP, Cardoso RC, Liu AY, Wu RY, Gunn GB. A Dosimetric Comparison of Oral Cavity Sparing in the Unilateral Treatment of Early Stage Tonsil Cancer: IMRT, IMPT, and Tongue-Deviating Oral Stents. Adv Radiat Oncol 2020; 5:1359-1363. [PMID: 33305099 PMCID: PMC7718552 DOI: 10.1016/j.adro.2020.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/11/2020] [Accepted: 08/18/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction Tongue-deviating oral stents (TDOS) are commonly used during unilateral neck radiation therapy to reduce unnecessary dose to nontarget oral structures. Their benefit in the setting of highly conformal treatment techniques, however, is not defined. The goal of this study was to investigate the potential benefit of TDOS use on dosimetric parameters in unilateral intensity modulated radiation therapy (IMRT) and intensity modulated proton therapy (IMPT). Methods A total of 16 patients with T1-2 tonsil cancer treated at a single institution were selected, of which 8 were simulated/treated with a TDOS and 8 without a TDOS. All received definitive unilateral IMRT to a dose of 66 Gy in 30 fx. IMPT plans were generated for each patient for study purposes and optimized according to standard institutional practice. Results For IMRT plans, the presence of a TDOS (vs without) was associated with a significantly lower oral mucosa mean dose (31.4 vs 35.3 Gy; P = .020) and V30 (42.7% vs 57.1%; P = .025). For IMPT plans, the presence of TDOS (vs without) was not associated with any improvement in oral mucosa mean dose (18.3 vs 19.9 Gy; P = .274) or V30 (25.0% vs 26.2%; P = .655). IMPT plans without TDOS compared with IMRT plans with TDOS demonstrated reduced oral mucosa mean dose (P < .001) and V30 (P < .001). Conclusion The use of a TDOS for the unilateral treatment of well-lateralized tonsil cancers was associated with oral mucosa sparing for IMRT, but not for IMPT. Moreover, mucosa sparing was improved for IMPT plans without a TDOS compared to IMRT plans with a TDOS.
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Affiliation(s)
- Stephen R Grant
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tyler D Williamson
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sonja Stieb
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shalin J Shah
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - C David Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Adam S Garden
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - William H Morrison
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jack Phan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Amy C Moreno
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jay P Reddy
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Richard C Cardoso
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Amy Y Liu
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Richard Y Wu
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - G Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Chen D, Chen X, Chen X, Jiang N, Jiang L. The efficacy of positioning stents in preventing Oral complications after head and neck radiotherapy: a systematic literature review. Radiat Oncol 2020; 15:90. [PMID: 32345309 PMCID: PMC7189514 DOI: 10.1186/s13014-020-01536-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 04/14/2020] [Indexed: 02/08/2023] Open
Abstract
Background Positioning stent in head and neck radiotherapy seems to have benefit to prevent oral complications but it hasn’t been summarized by an evidence-based method. Objectives This review aims to evaluate the efficacy of positioning stents in preventing oral complications after radiotherapy. Methods We conducted an electronic search in MEDLINE, EMBASE, Cochrane CDSR, and Cochrane CENTRAL database for randomized-controlled clinical trials, controlled clinical trials and cohort studies that assessed oral complications after head and neck radiotherapy with positioning stents. Two reviewers extracted information on radiotherapy, follow-up period, oral complications and assessments independently. Results Three RCTs and two cohort studies were included in this review. Oral complications such as mucositis, xerostomia, taste alteration, trismus, salivary changes, dysphagia and pain on swallowing were assessed by different methods in these studies. Conclusions Oral complications were common in patients after head and neck radiotherapy. There is insufficient evidence that positioning stents have a preventive effect against xerostomia, and it needs more high-quality and prospective trials with long-term follow-up to support it.
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Affiliation(s)
- Dong Chen
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, NO.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, Sichuan, China.,Department of Endodontic Dentistry, Sichuan University West China Hospital of Stomatology, NO.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, Sichuan, China
| | - Xiaoju Chen
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, NO.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, Sichuan, China.,Department of Endodontic Dentistry, Sichuan University West China Hospital of Stomatology, NO.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, Sichuan, China
| | - Xinmei Chen
- Department of Endodontic Dentistry, Sichuan University West China Hospital of Stomatology, NO.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, Sichuan, China
| | - Nanchuan Jiang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei, China.
| | - Li Jiang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, NO.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, Sichuan, China. .,Department of Endodontic Dentistry, Sichuan University West China Hospital of Stomatology, NO.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, Sichuan, China.
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Bruno JS, Miranda‐Silva W, Guedes VDS, Parahyba CJ, Moraes FYD, Fregnani ER. Digital Workflow for Producing Oral Positioning Radiotherapy Stents for Head and Neck Cancer. J Prosthodont 2020; 29:448-452. [DOI: 10.1111/jopr.13155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Julia Stephanie Bruno
- Oral Medicine ServiceHospital Sírio‐Libanês Rua Adma Jafet, 91 São Paulo SP 01308‐050 Brazil
| | - Wanessa Miranda‐Silva
- Oral Medicine ServiceHospital Sírio‐Libanês Rua Adma Jafet, 91 São Paulo SP 01308‐050 Brazil
| | | | | | - Fabio Ynoe de Moraes
- Division of Radiation Oncology, Department of OncologyQueen's University, Kingston Health Science Centre 15 Arch Street Kingston, ON Kingston Canada, K7L 3N6 Canada
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A prospective parallel design study testing non-inferiority of customized oral stents made using 3D printing or manually fabricated methods. Oral Oncol 2020; 106:104665. [PMID: 32298994 DOI: 10.1016/j.oraloncology.2020.104665] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 03/25/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE Customized mouth-opening-tongue-depressing-stents (MOTDs) may reduce toxicity in patients with head and neck cancers (HNC) receiving radiotherapy (RT). However, making MOTDs requires substantial resources, which limits their utilization. Previously, we described a workflow for fabricating customized 3D-printed MOTDs. This study reports the results of a prospective trial testing the non-inferiority of 3D-printed to standard and commercially-available (TruGuard) MOTDs as measured by patient reported outcomes (PROs). MATERIALS AND METHODS PROs were collected at 3 time points: (t1) simulation, (t2) prior to RT, (t3) between fractions 15-25 of RT. Study participants received a 3D-printed MOTDs (t1, t2, t3), a wax-pattern (t1), an acrylic-MOTDs (t2, t3) and an optional TruGuard (t1, t2, t3). Patients inserted the stents for 5-10 min and completed a PRO-questionnaire covering ease-of-insertion and removal, gagging, jaw-pain, roughness and stability. Inter-incisal opening and tongue-displacement were recorded. With 39 patients, we estimated 90% power to detect a non-inferiority margin of 2 at a significance level of 0.025. Matched pairs and t-test were used for statistics. RESULTS 41 patients were evaluable. The 3D-printed MOTDs achieved a significantly better overall PRO score compared to the wax-stent (p = 0.0007) and standard-stent (p = 0.0002), but was not significantly different from the TruGuard (p = 0.41). There was no difference between 3D-printed and standard MOTDs in terms of inter-incisal opening (p = 0.4) and position reproducibility (p = 0.98). The average 3D-printed MOTDs turn-around time was 8 vs 48 h for the standard-stent. CONCLUSIONS 3D-printed stents demonstrated non-inferior PROs compared to TruGuard and standard-stents. Our 3D-printing process may expand utilization of MOTDs.
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Inoue Y, Yamagata K, Nakamura M, Ohnishi K, Tabuchi K, Bukawa H. Are Intraoral Stents Effective for Reducing the Severity of Oral Mucositis During Radiotherapy for Maxillary and Nasal Cavity Cancer? J Oral Maxillofac Surg 2020; 78:1214.e1-1214.e8. [PMID: 32165135 DOI: 10.1016/j.joms.2020.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 12/02/2019] [Accepted: 02/03/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE The intraoral stent (IOS) is an individualized mouth opening device that can be used during radiotherapy (RT) for head and neck cancer to prevent unnecessary irradiation to normal tissues. The purpose of the present study was to compare the severity of oral mucositis (OM) between patients using and not using an IOS during RT for maxillary and nasal cavity cancer. PATIENTS AND METHODS We designed and implemented a retrospective cohort study. The study sample included patients with maxillary and nasal cavity cancer who had undergone RT. The primary predictor variable was IOS application, and the outcome variable was the grade of OM. RESULTS The IOS group included 18 patients with an IOS and the control group, 16 patients without an IOS. The parameters of the dose-volume histogram included the median dosage covering 1 mL (D1mL) for the tongue and the mean dosage. The D1mL (36.2 vs 65.4 Gy) and mean dosage (4.9 Gy vs 25.9 Gy) were both significantly lower in the IOS group than in the control group (P < .005). The incidence of OM using the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0, were significantly different between the oral stomatitis grade and the use of an IOS (P = .028). A significant difference was found in opioid use between the IOS and control groups (P = .009). CONCLUSIONS The use of an IOS decreased the radiation dosage to the tongue, the grade of OM, and opioid usage during RT.
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Affiliation(s)
- Yutaka Inoue
- Resident, Department of Oral and Maxillofacial Surgery, Institute of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kenji Yamagata
- Associate Professor, Department of Oral and Maxillofacial Surgery, Institute of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Masatoshi Nakamura
- Resident, Department of Radiation Oncology, Institute of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kayoko Ohnishi
- Assistant Professor, Department of Radiation Oncology, Institute of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Keiji Tabuchi
- Professor, Department of Otorhinolaryngology, Institute of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroki Bukawa
- Professor, Department of Oral and Maxillofacial Surgery, Institute of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Appendino P, Della Ferrera F, Nassisi D, Blandino G, Gino E, Solla SD, Ruo Redda MG. Are intraoral customized stents still necessary in the era of Highly Conformal Radiotherapy for Head & Neck cancer? Case series and literature review. Rep Pract Oncol Radiother 2019; 24:491-498. [PMID: 31467490 DOI: 10.1016/j.rpor.2019.07.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 05/19/2019] [Accepted: 07/30/2019] [Indexed: 01/04/2023] Open
Abstract
Aim To evaluate the dose sparing efficacy of intraoral customized stents in combination with IGRT/VMAT in Head & Neck cancer patients. Background Despite advances in high-dose conformal radiotherapy (RT) techniques, adverse effects (such as oral mucositis) during and after RT often require temporary suspension of treatment and affect the quality of life in survivors. Intraoral customized stents can decrease radiation doses in healthy tissues and minimize damage from radiations. At the best of our knowledge the clinical impact of such devices in combination with VMAT (volumetric modulated arc therapy) is not reported in the literature. Cases description Three Head & Neck cancer patients were submitted to image guided (IG) RT/VMAT in their treatment protocol. Dose distribution with and without the use of an intraoral stent was compared in each patient. Mean radiation doses proved to be lower in all patients, especially in the subsite: oral cavity. Conclusions There are several reports on the efficacy of IS during RT for Head & Neck cancer. Despite technological advances, the combination between high conformal RT and intraoral stents could still play a role in the management of this kind of patients. This strengthens the usefulness of the individualization of treatments and multidisciplinary approach.
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Affiliation(s)
- P Appendino
- Department of Dentistry and Oral Surgery, Mauriziano Umberto I Hospital, Corso Turati 62, 10128 Turin, Italy
| | - F Della Ferrera
- Department of Dentistry and Oral Surgery, Mauriziano Umberto I Hospital, Corso Turati 62, 10128 Turin, Italy
| | - D Nassisi
- Department of Radiation Oncology, University of Turin School of Medicine, Mauriziano Umberto I Hospital, Corso Turati 62, 10128 Turin, Italy
| | - G Blandino
- Department of Radiation Oncology, University of Turin School of Medicine, Mauriziano Umberto I Hospital, Corso Turati 62, 10128 Turin, Italy
| | - E Gino
- Department of Medical Physics, Mauriziano Umberto I Hospital, Corso Turati 62, 10128 Turin, Italy
| | - S D Solla
- Department of Radiation Oncology, University of Turin School of Medicine, Mauriziano Umberto I Hospital, Corso Turati 62, 10128 Turin, Italy
| | - M G Ruo Redda
- Department of Radiation Oncology, University of Turin School of Medicine, Mauriziano Umberto I Hospital, Corso Turati 62, 10128 Turin, Italy
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Construction and clinical evaluation of a new customized bite block used in radiotherapy of head and neck cancer. Cancer Radiother 2019; 23:125-131. [DOI: 10.1016/j.canrad.2018.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 05/17/2018] [Accepted: 05/30/2018] [Indexed: 12/12/2022]
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21
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Kitamori H, Sumida I, Tsujimoto T, Shimamoto H, Murakami S, Ohki M. Evaluation of mouthpiece fixation devices for head and neck radiotherapy patients fabricated in PolyJet photopolymer by a 3D printer. Phys Med 2019; 58:90-98. [DOI: 10.1016/j.ejmp.2019.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/04/2019] [Accepted: 02/06/2019] [Indexed: 11/30/2022] Open
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