1
|
Zhao D, Fan W, Jiang H, Meng L, Cai B, Zhang X, Yu W, Zhao L, Ma L. The impact of submandibular glands protection on xerostomia as monitored by diffusion-weighted imaging in nasopharyngeal carcinoma patients. Strahlenther Onkol 2024; 200:377-388. [PMID: 37955647 DOI: 10.1007/s00066-023-02167-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/01/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE To determine the impact of sparing submandibular glands (SMGs) on alleviating xerostomia and the functional dynamics of the irradiated parotid glands (PGs) and sublingual glands (SLGs) by diffusion-weighted imaging. METHODS 97 participants underwent 9 rounds of DWI scans before IC (pre-IC), pre-radiation (pre-RT), the midpoint of radiation (mid-RT), the end of radiation (post-RT), 1, 3, 6, 9, 12 (12m-RT) months following radiation. Apparent diffusion coefficient of SMGs (ADCSMG), PGs (ADCPG), and SLGs (ADCSLG), xerostomia questionnaire scores (XQ), and saliva flow rate measures under unstimulated (uSFR) and stimulated condition (sSFR) were documented. RESULTS ADCPG, ADCSMG, ADCSLG, and XQ showed a rapid increase with a top at 3m-RT followed by regression, whereas uSFR and sSFR had the reverse trend. The change rate of ADC correlated with the dose to PGs, SMGs, and SLGs, as well as uSFR, sSFR, and XQ scores (p < 0.05 for all, except for uSFR with ADCPG (p = 0.063)). Maingroup for ADCPG, uSFR, and sSFR were significant (p values were 0.028, 0.000, 0.000 respectively); ADCPG in SMG sparing group was lower while uSFR, and sSFR were higher than those in the SMG-unsparing group. Simplegroup for ADCSMG, ADCSLG (all p < 0.05 from mid-RT to 12m-RT), and XQ (all p < 0.001 at mid-, 6m-, 9m-, and 12m-RT) were significant; ADCSMG, ADCSLG, and XQ were lower in the SMG-sparing group. CONCLUSIONS SMG protection has a great impact on the functional retention of PGs and SLGs, resulting in alleviating xerostomia and improving quality of life. TRIAL REGISTRATION The clinical trial was also registered with the Chinese Clinical Study Registry (registered number: ChiCTR1900024328, Date: July 6, 2019; URL: https://www.chictr.org.cn/showproj.aspx?proj=40726 ).
Collapse
Affiliation(s)
- Dawei Zhao
- Tianjin Medical University, Tianjin, China
- Department of Radiation Oncology, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, No.1 West Huan-Hu Rd, Tianjin, China
- Department of Radiation Oncology, First Medical Center of Chinese PLA General Hospital, No.28 Fuxing Road, Beijing, China
- Department of Radiology, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, China
| | - Wenjun Fan
- Department of Radiation Oncology, First Medical Center of Chinese PLA General Hospital, No.28 Fuxing Road, Beijing, China
- Department of Radiation Oncology, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, China
| | - Huayong Jiang
- Department of Radiation Oncology, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Lingling Meng
- Department of Radiation Oncology, First Medical Center of Chinese PLA General Hospital, No.28 Fuxing Road, Beijing, China
| | - Boning Cai
- Department of Radiation Oncology, First Medical Center of Chinese PLA General Hospital, No.28 Fuxing Road, Beijing, China
| | - Xinxin Zhang
- Department of Otolaryngology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Wei Yu
- Department of Radiation Oncology, First Medical Center of Chinese PLA General Hospital, No.28 Fuxing Road, Beijing, China.
- Department of Radiation Oncology, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
| | - Lujun Zhao
- Department of Radiation Oncology, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, No.1 West Huan-Hu Rd, Tianjin, China.
| | - Lin Ma
- Department of Radiation Oncology, First Medical Center of Chinese PLA General Hospital, No.28 Fuxing Road, Beijing, China.
- Department of Radiation Oncology, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
| |
Collapse
|
2
|
Gunning JA, Gilman KE, Zúñiga TM, Simpson RJ, Limesand KH. Parotid glands have a dysregulated immune response following radiation therapy. PLoS One 2024; 19:e0297387. [PMID: 38470874 PMCID: PMC10931461 DOI: 10.1371/journal.pone.0297387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 01/04/2024] [Indexed: 03/14/2024] Open
Abstract
Head and neck cancer treatment often consists of surgical resection of the tumor followed by ionizing radiation (IR), which can damage surrounding tissues and cause adverse side effects. The underlying mechanisms of radiation-induced salivary gland dysfunction are not fully understood, and treatment options are scarce and ineffective. The wound healing process is a necessary response to tissue injury, and broadly consists of inflammatory, proliferative, and redifferentiation phases with immune cells playing key roles in all three phases. In this study, select immune cells were phenotyped and quantified, and certain cytokine and chemokine concentrations were measured in mouse parotid glands after IR. Further, we used a model where glandular function is restored to assess the immune phenotype in a regenerative response. These data suggest that irradiated parotid tissue does not progress through a typical inflammatory response observed in wounds that heal. Specifically, total immune cells (CD45+) decrease at days 2 and 5 following IR, macrophages (F4/80+CD11b+) decrease at day 2 and 5 and increase at day 30, while neutrophils (Ly6G+CD11b+) significantly increase at day 30 following IR. Additionally, radiation treatment reduces CD3- cells at all time points, significantly increases CD3+/CD4+CD8+ double positive cells, and significantly reduces CD3+/CD4-CD8- double negative cells at day 30 after IR. Previous data indicate that post-IR treatment with IGF-1 restores salivary gland function at day 30, and IGF-1 injections attenuate the increase in macrophages, neutrophils, and CD4+CD8+ T cells observed at day 30 following IR. Taken together, these data indicate that parotid salivary tissue exhibits a dysregulated immune response following radiation treatment which may contribute to chronic loss of function phenotype in head and neck cancer survivors.
Collapse
Affiliation(s)
- Jordan A. Gunning
- Department of Nutritional Sciences, The University of Arizona, Tucson, Arizona, United States of America
| | - Kristy E. Gilman
- Department of Nutritional Sciences, The University of Arizona, Tucson, Arizona, United States of America
| | - Tiffany M. Zúñiga
- Department of Nutritional Sciences, The University of Arizona, Tucson, Arizona, United States of America
- Department of Immunology and Microbiology, Aurora, Colorado, United States of America
| | - Richard J. Simpson
- Department of Nutritional Sciences, The University of Arizona, Tucson, Arizona, United States of America
| | - Kirsten H. Limesand
- Department of Nutritional Sciences, The University of Arizona, Tucson, Arizona, United States of America
| |
Collapse
|
3
|
Schepanski N, Costa FS, Machado EFM, Pacheco MN, Amaral CDB, Machado RC, Nogueira ARA, Brancher JA, Sassi LM, de Araujo MR. Evaluation of photobiomodulation therapy (PBMT) on salivary flow and composition in head and neck cancer patients undergoing radiation therapy. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:253-263. [PMID: 38218654 DOI: 10.1016/j.oooo.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/13/2023] [Accepted: 11/04/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVE Assess the impact of photobiomodulation therapy (PBMT) on xerostomia, salivary flow rate (SFR) and composition in patients undergoing radiotherapy (RT) for head and neck cancer (HNC). STUDY DESIGN Thirty patients undergoing RT (65 Gy) for HNC were enrolled. Saliva and xerostomia evaluations collected pre- and post-PBMT-RT. PBMT involved irradiation of extra and intraoral points, 15-20 sessions, 2-3 times/week. SFR, trace elements, total protein, alkaline phosphatase, xerostomia, and pH were analyzed. RESULTS The average age was 60.7 years. After treatment, there was not a significant reduction in SFR and there was no difference on xerostomia. Significant reductions in Al, Cd, Fe, Ni, P, and Sb concentrations were observed, along with a significant increase in Mg concentration. Sample data were organized into 3 groups based on a self-organizing map. Low concentrations of Al, As, Co, Cr, Cu, Fe, Mn, Mo, S, Sr, and Zn were the primary discriminatory factors for group A, while group B consisted of post-PBMT-RT samples with high concentrations of Ca, K, Mg, Na, and S. CONCLUSIONS PBMT prevented a significant reduction in SFR and xerostomia induced by radiation therapy. These findings suggest that PBMT prevents salivary gland damage minimizing the decline in salivary flow.
Collapse
Affiliation(s)
- Natalia Schepanski
- Department of Stomatology, Federal University of Paraná, Curitiba, PR, Brazil
| | | | | | | | - Clarice D B Amaral
- Department of Chemistry, Federal University of Paraná, Curitiba, PR, Brazil
| | | | | | - João Armando Brancher
- Pontifícia Universidade Católica do Paraná, Escola de Ciências da Vida, Curitiba, PR, Brazil
| | | | | |
Collapse
|
4
|
Buss LG, De Oliveira Pessoa D, Snider JM, Padi M, Martinez JA, Limesand KH. Metabolomics analysis of pathways underlying radiation-induced salivary gland dysfunction stages. PLoS One 2023; 18:e0294355. [PMID: 37983277 PMCID: PMC10659204 DOI: 10.1371/journal.pone.0294355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/30/2023] [Indexed: 11/22/2023] Open
Abstract
Salivary gland hypofunction is an adverse side effect associated with radiotherapy for head and neck cancer patients. This study delineated metabolic changes at acute, intermediate, and chronic radiation damage response stages in mouse salivary glands following a single 5 Gy dose. Ultra-high performance liquid chromatography-mass spectrometry was performed on parotid salivary gland tissue collected at 3, 14, and 30 days following radiation (IR). Pathway enrichment analysis, network analysis based on metabolite structural similarity, and network analysis based on metabolite abundance correlations were used to incorporate both metabolite levels and structural annotation. The greatest number of enriched pathways are observed at 3 days and the lowest at 30 days following radiation. Amino acid metabolism pathways, glutathione metabolism, and central carbon metabolism in cancer are enriched at all radiation time points across different analytical methods. This study suggests that glutathione and central carbon metabolism in cancer may be important pathways in the unresolved effect of radiation treatment.
Collapse
Affiliation(s)
- Lauren G Buss
- School of Nutritional Sciences and Wellness, University of Arizona, Tucson, AZ, United States of America
| | - Diogo De Oliveira Pessoa
- Biostatistics and Bioinformatics Shared Resource, Arizona Cancer Center, University of Arizona, Tucson, AZ, United States of America
| | - Justin M Snider
- School of Nutritional Sciences and Wellness, University of Arizona, Tucson, AZ, United States of America
- University of Arizona Cancer Center, Tucson, AZ, United States of America
| | - Megha Padi
- Biostatistics and Bioinformatics Shared Resource, Arizona Cancer Center, University of Arizona, Tucson, AZ, United States of America
- University of Arizona Cancer Center, Tucson, AZ, United States of America
- Department of Molecular and Cellular Biology, University of Arizona, Tucson, AZ, United States of America
| | - Jessica A Martinez
- School of Nutritional Sciences and Wellness, University of Arizona, Tucson, AZ, United States of America
- University of Arizona Cancer Center, Tucson, AZ, United States of America
| | - Kirsten H Limesand
- School of Nutritional Sciences and Wellness, University of Arizona, Tucson, AZ, United States of America
- University of Arizona Cancer Center, Tucson, AZ, United States of America
| |
Collapse
|
5
|
van Rijn-Dekker MI, van Luijk P, Schuit E, van der Schaaf A, Langendijk JA, Steenbakkers RJHM. Prediction of Radiation-Induced Parotid Gland-Related Xerostomia in Patients With Head and Neck Cancer: Regeneration-Weighted Dose. Int J Radiat Oncol Biol Phys 2023; 117:750-762. [PMID: 37150262 DOI: 10.1016/j.ijrobp.2023.04.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/26/2023] [Accepted: 04/29/2023] [Indexed: 05/09/2023]
Abstract
PURPOSE Despite improvements to treatment, patients with head and neck cancer (HNC) still experience radiation-induced xerostomia due to salivary gland damage. The stem cells of the parotid gland (PG), concentrated in the gland's main ducts (stem cell rich [SCR] region), play a critical role in the PG's response to radiation. Treatment optimization requires a dose metric that properly accounts for the relative contributions of dose to this SCR region and the PG's remainder (non-SCR region) to the risk of xerostomia in normal tissue complication probability (NTCP) models for xerostomia. MATERIALS AND METHODS Treatment and toxicity data of 1013 prospectively followed patients with HNC treated with definitive radiation therapy (RT) were used. The regeneration-weighted dose, enabling accounting for the hypothesized different effects of dose to the SCR and non-SCR region on the risk of xerostomia, was defined as Dreg PG = Dmean SCR region + r × Dmean non-SCR region, where Dreg is the regeneration-weighted dose, Dmean is the mean dose, and r is the weighting factor. Considering the different volumes of these regions, r > 3.6 in Dreg PG demonstrates an enhanced effect of the SCR region. The most predictive value of r was estimated in 102 patients of a previously published trial testing stem cell sparing RT. For each endpoint, Dreg PG, dose to other organs, and clinical factors were used to develop NTCP models using multivariable logistic regression analysis in 663 patients. The models were validated in 350 patients. RESULTS Dose to the contralateral PG was associated with daytime, eating-related, and physician-rated grade ≥2 xerostomia. Consequently, r was estimated and found to be smaller than 3.6 for most PG function-related endpoints. Therefore, the contribution of Dmean SCR region to the risk of xerostomia was larger than predicted by Dmean PG. Other frequently selected predictors were pretreatment xerostomia and Dmean oral cavity. The validation showed good discrimination and calibration. CONCLUSIONS Tools for clinical implementation of stem cell sparing RT were developed: regeneration-weighted dose to the parotid gland that accounted for regional differences in radiosensitivity within the gland and NTCP models that included this new dose metric and other prognostic factors.
Collapse
Affiliation(s)
- Maria I van Rijn-Dekker
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Peter van Luijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ewoud Schuit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Arjen van der Schaaf
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Roel J H M Steenbakkers
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| |
Collapse
|
6
|
Berger T, Noble DJ, Yang Z, Shelley LE, McMullan T, Bates A, Thomas S, Carruthers LJ, Beckett G, Duffton A, Paterson C, Jena R, McLaren DB, Burnet NG, Nailon WH. Sub-regional analysis of the parotid glands: model development for predicting late xerostomia with radiomics features in head and neck cancer patients. Acta Oncol 2023; 62:166-173. [PMID: 36802351 DOI: 10.1080/0284186x.2023.2179895] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/08/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND The irradiation of sub-regions of the parotid has been linked to xerostomia development in patients with head and neck cancer (HNC). In this study, we compared the xerostomia classification performance of radiomics features calculated on clinically relevant and de novo sub-regions of the parotid glands of HNC patients. MATERIAL AND METHODS All patients (N = 117) were treated with TomoTherapy in 30-35 fractions of 2-2.167 Gy per fraction with daily mega-voltage-CT (MVCT) acquisition for image-guidance purposes. Radiomics features (N = 123) were extracted from daily MVCTs for the whole parotid gland and nine sub-regions. The changes in feature values after each complete week of treatment were considered as predictors of xerostomia (CTCAEv4.03, grade ≥ 2) at 6 and 12 months. Combinations of predictors were generated following the removal of statistically redundant information and stepwise selection. The classification performance of the logistic regression models was evaluated on train and test sets of patients using the Area Under the Curve (AUC) associated with the different sub-regions at each week of treatment and benchmarked with the performance of models solely using dose and toxicity at baseline. RESULTS In this study, radiomics-based models predicted xerostomia better than standard clinical predictors. Models combining dose to the parotid and xerostomia scores at baseline yielded an AUCtest of 0.63 and 0.61 for xerostomia prediction at 6 and 12 months after radiotherapy while models based on radiomics features extracted from the whole parotid yielded a maximum AUCtest of 0.67 and 0.75, respectively. Overall, across sub-regions, maximum AUCtest was 0.76 and 0.80 for xerostomia prediction at 6 and 12 months. Within the first two weeks of treatment, the cranial part of the parotid systematically yielded the highest AUCtest. CONCLUSION Our results indicate that variations of radiomics features calculated on sub-regions of the parotid glands can lead to earlier and improved prediction of xerostomia in HNC patients.
Collapse
Affiliation(s)
- Thomas Berger
- Department of Oncology Physics, Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
- Edinburgh Cancer Research Centre, Institute of Genetics and Cancer, The University of Edinburgh, Edinburgh, UK
| | - David J Noble
- Edinburgh Cancer Research Centre, Institute of Genetics and Cancer, The University of Edinburgh, Edinburgh, UK
- Department of Oncology, The University of Cambridge, Cambridge, UK
- Department of Clinical Oncology, Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - Zhuolin Yang
- Department of Oncology Physics, Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
- School of Engineering, the University of Edinburgh, the King's Buildings, Edinburgh, UK
| | - Leila Ea Shelley
- Department of Oncology Physics, Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - Thomas McMullan
- Department of Oncology Physics, Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - Amy Bates
- Department of Oncology, The University of Cambridge, Cambridge, UK
| | - Simon Thomas
- Department of Medical Physics and Clinical Engineering, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Linda J Carruthers
- Department of Oncology Physics, Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - George Beckett
- Edinburgh Parallel Computing Centre, Bayes Centre, Edinburgh, UK
| | | | | | - Raj Jena
- Department of Oncology, The University of Cambridge, Cambridge, UK
| | - Duncan B McLaren
- Department of Clinical Oncology, Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | | | - William H Nailon
- Department of Oncology Physics, Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
- School of Engineering, the University of Edinburgh, the King's Buildings, Edinburgh, UK
| |
Collapse
|
7
|
Safak G, Celiker M, Tümkaya L, Mercantepe T, Rakici S, Cinar S, Yilmaz A, Terzi S, Demir E, Celebi Erdivanlı O, Ozergin Coşkun Z, Karakaş S, Birinci M, Dursun E. Comparison of effects of dexmedetomidine and amifostine against X-ray radiation-induced parotid damage. Radiat Environ Biophys 2022; 61:241-253. [PMID: 35147734 DOI: 10.1007/s00411-022-00964-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 01/21/2022] [Indexed: 06/14/2023]
Abstract
Radiotherapy can be employed as a therapeutic modality alone in the early stages of cancer and is used together with other treatments such as surgery and chemotherapy in more advanced stages. However, exposure to ionizing radiation in association with radiotherapy affects several organs in the head and neck and can give rise to early and late side effects. Exposure to ionizing radiation used in radiotherapy is known to cause cell damage by leading to oxygen stress through the production of free oxygen radicals (such as superoxide radicals, hydroxyl radical, hydrogen peroxide, and singlet oxygen), depending on the total radiation dosage, the fractionation rate, radiosensitivity, and linear energy transfer. The purpose of the present study was to determine the potential protective role of a powerful and highly selective α2-adrenoreceptor agonist with a broad pharmacological spectrum against salivary gland damage induced by ionizing radiation exposure. Forty Sprague-Dawley rats were divided into five groups-control, ionizing radiation, ionizing radiation + dexmedetomidine (100 µg/kg), ionizing radiation + dexmedetomidine (200 µg/kg), and ionizing radiation + amifostine (200 mg/kg). Following exposure to ionizing radiation, we observed necrosis, fibrosis, and vascular congestions in parotid gland epithelial cells. We also observed increases in malondialdehyde (MDA) and cleaved Caspase-3 levels and a decrease in glutathione (GSH). In groups receiving dexmedetomidine, we observed necrotic epithelial cells, fibrosis and vascular congestion in parotid gland tissue, a decrease in MDA levels, and an increase in GSH. Dexmedetomidine may be a promising antioxidant agent for the prevention of oxidative damage following radiation exposure.
Collapse
Affiliation(s)
- Gökhan Safak
- Department of Otolaryngology, Faculty of Medicine, Recep Tayyip Erdogan University, İki nolu sehitler caddesi, Rize, 53010, Turkey.
| | - Metin Celiker
- Department of Otolaryngology, Faculty of Medicine, Recep Tayyip Erdogan University, İki nolu sehitler caddesi, Rize, 53010, Turkey
| | - Levent Tümkaya
- Department of Histology and Embryology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, 53010, Turkey
| | - Tolga Mercantepe
- Department of Histology and Embryology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, 53010, Turkey
| | - Sema Rakici
- Department of Radiation Oncology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, 53010, Turkey
| | - Seda Cinar
- Department of Histology and Embryology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, 53010, Turkey
| | - Adnan Yilmaz
- Department of Biochemistry, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, 53010, Turkey
| | - Suat Terzi
- Department of Otolaryngology, Faculty of Medicine, Recep Tayyip Erdogan University, İki nolu sehitler caddesi, Rize, 53010, Turkey
| | - Emine Demir
- Department of Otolaryngology, Faculty of Medicine, Altınbas University, Rize, 34000, Turkey
| | - Ozlem Celebi Erdivanlı
- Department of Otolaryngology, Faculty of Medicine, Recep Tayyip Erdogan University, İki nolu sehitler caddesi, Rize, 53010, Turkey
| | - Zerrin Ozergin Coşkun
- Department of Otolaryngology, Faculty of Medicine, Recep Tayyip Erdogan University, İki nolu sehitler caddesi, Rize, 53010, Turkey
| | - Sibel Karakaş
- Department of Biochemistry, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, 53010, Turkey
| | - Mehmet Birinci
- Departments of Otolaryngology, Of State Hospital, Trabzon, 61000, Turkey
| | - Engin Dursun
- Department of Otolaryngology, Faculty of Medicine, Recep Tayyip Erdogan University, İki nolu sehitler caddesi, Rize, 53010, Turkey
| |
Collapse
|
8
|
Klausner G, Troussier I, Kreps S, Fabiano E, Laccourreye O, Giraud P. [Impact of neck dissection in N2-3 oropharyngeal squamous cell carcinomas treated with definitive chemoradiotherapy: An observational real-life study]. Cancer Radiother 2021; 25:771-778. [PMID: 34175226 DOI: 10.1016/j.canrad.2021.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/07/2021] [Accepted: 05/25/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE The purpose of this study was to assess the efficacy in terms of neck failure of an initial neck dissection before definitive chemoradiotherapy in N2-3 oropharyngeal squamous cell carcinomas, as well as the dosimetric impact and the acute and delayed morbidity of this approach. MATERIALS AND METHODS All patients consecutively treated between 2009 and 2018 with definitive chemoradiotherapy using intensity-modulated conformal radiotherapy (IMRT) for a histologically proven N2-3 oropharyngeal squamous cell carcinomas were retrospectively included. The therapeutic approach consisted of induction chemotherapy, followed by cisplatine-based chemoradiotherapy preceded or not by neck dissection. Neck dissection was discussed on a case-by-case basis in a dedicated multidisciplinary tumour board for patients with a dissociated response to induction chemotherapy, defined as a better response on the primary than on the node. Chemoradiotherapy without neck dissection was systematically performed in case of a major lymph node response to induction chemotherapy (decrease in size of 90% or more). Intensity-modulated radiotherapy using a simultaneous-integrated boost delivered 70Gy in 35 fractions on macroscopic tumour volumes, 63Gy on intermediate-risk levels or extra-nodal extension and 54Gy on prophylactic lymph node areas. RESULTS Two groups were constituted: 47 patients without an initial neck dissection (62.7%), and 28 patients with a neck dissection prior to definitive chemoradiotherapy (37.3%). Initial patient characteristics were not statistically different between the two groups. The median follow-up was 60.1months (range: 3.2-119months). Incidence of neck failure was higher in patients without neck dissection (P=0.015). The neck failure rate at 5years was 19.8% (95% confidence interval: 7.4-30.6%; P=0.015) without neck dissection versus 0% following neck dissection. All lymph node failures occurred in the planned target volume at 70Gy. Upfront neck dissection suggested a decrease in the mean dose received by the homolateral parotid gland (P=0.01), mandible (P=0.02), and thyroid gland (P=0.02). Acute toxicity of chemoradiotherapy after neck dissection suggested a reduction in grade≥3 adverse events (P=0.04), early discontinuation of concomitant chemotherapy (P=0.009) and feeding tube-dependence (P=0.008) in univariate analysis. During follow-up, there was no difference between the two groups in terms of xerostomia, dysgeusia, dysphagia or gastrostomy dependence in univariate analysis. CONCLUSION Neck dissection prior to definitive chemoradiotherapy in N2-3 oropharyngeal squamous cell carcinoma was associated with high neck control without additional mid and long-term morbidity.
Collapse
Affiliation(s)
- G Klausner
- Université Pierre-et-Marie-Curie, Paris Sorbonne université, 91-105, boulevard de l'Hôpital, 75013 Paris, France
| | - I Troussier
- Oncologie-radiothérapie, centre de haute énergie, 06000 Nice, France; Département de radio-oncologie, hôpitaux universitaires de Genève, 1205 Genève, Suisse
| | - S Kreps
- Service d'oncologie-radiothérapie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - E Fabiano
- Service d'oncologie-radiothérapie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - O Laccourreye
- Service d'ORL et de chirurgie cervicofaciale, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France; Université de Paris, 75015 Paris, France
| | - P Giraud
- Service d'oncologie-radiothérapie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France; Université de Paris, 75015 Paris, France.
| |
Collapse
|
9
|
Mavroidis P, Pearlstein KA, Moon DH, Xu V, Royce TJ, Weiner AA, Shen CJ, Marks LB, Chera BS, Das SK, Wang K. NTCP modeling and dose-volume correlations for acute xerostomia and dry eye after whole brain radiation. Radiat Oncol 2021; 16:56. [PMID: 33743773 PMCID: PMC7981795 DOI: 10.1186/s13014-021-01786-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 03/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Whole brain radiation (WBRT) may lead to acute xerostomia and dry eye from incidental parotid and lacrimal exposure, respectively. We performed a prospective observational study to assess the incidence/severity of this toxicity. We herein perform a secondary analysis relating parotid and lacrimal dosimetric parameters to normal tissue complication probability (NTCP) rates and associated models. METHODS Patients received WBRT to 25-40 Gy in 10-20 fractions using 3D-conformal radiation therapy without prospective delineation of the parotids or lacrimals. Patients completed questionnaires at baseline and 1 month post-WBRT. Xerostomia was assessed using the University of Michigan xerostomia score (scored 0-100, toxicity defined as ≥ 20 pt increase) and xerostomia bother score (scored from 0 to 3, toxicity defined as ≥ 2 pt increase). Dry eye was assessed using the Subjective Evaluation of Symptom of Dryness (SESoD, scored from 0 to 4, toxicity defined as ≥ 2 pt increase). The clinical data were fitted by the Lyman-Kutcher-Burman (LKB) and Relative Seriality (RS) NTCP models. RESULTS Of 55 evaluable patients, 19 (35%) had ≥ 20 point increase in xerostomia score, 11 (20%) had ≥ 2 point increase in xerostomia bother score, and 13 (24%) had ≥ 2 point increase in SESoD score. For xerostomia, parotid V10Gy-V20Gy correlated best with toxicity, with AUC 0.68 for xerostomia score and 0.69-0.71 for bother score. The values for the D50, m and n parameters of the LKB model were 22.3 Gy, 0.84 and 1.0 for xerostomia score and 28.4 Gy, 0.55 and 1.0 for bother score, respectively. The corresponding values for the D50, γ and s parameters of the RS model were 23.5 Gy, 0.28 and 0.0001 for xerostomia score and 32.0 Gy, 0.45 and 0.0001 for bother score, respectively. For dry eye, lacrimal V10Gy-V15Gy were found to correlate best with toxicity, with AUC values from 0.67 to 0.68. The parameter values of the LKB model were 53.5 Gy, 0.74 and 1.0, whereas of the RS model were 54.0 Gy, 0.37 and 0.0001, respectively. CONCLUSIONS Xerostomia was most associated with parotid V10Gy-V20Gy, and dry eye with lacrimal V10Gy-V15Gy. NTCP models were successfully created for both toxicities and may help clinicians refine dosimetric goals and assess levels of risk in patients receiving palliative WBRT.
Collapse
Affiliation(s)
- Panayiotis Mavroidis
- Department of Radiation Oncology, University of North Carolina, 101 Manning Dr., Chapel Hill, NC, 27599-7512, USA.
| | - Kevin A Pearlstein
- Department of Radiation Oncology, University of North Carolina, 101 Manning Dr., Chapel Hill, NC, 27599-7512, USA
| | - Dominic H Moon
- Department of Radiation Oncology, University of North Carolina, 101 Manning Dr., Chapel Hill, NC, 27599-7512, USA
| | - Victoria Xu
- Department of Radiation Oncology, University of North Carolina, 101 Manning Dr., Chapel Hill, NC, 27599-7512, USA
| | - Trevor J Royce
- Department of Radiation Oncology, University of North Carolina, 101 Manning Dr., Chapel Hill, NC, 27599-7512, USA
| | - Ashley A Weiner
- Department of Radiation Oncology, University of North Carolina, 101 Manning Dr., Chapel Hill, NC, 27599-7512, USA
| | - Colette J Shen
- Department of Radiation Oncology, University of North Carolina, 101 Manning Dr., Chapel Hill, NC, 27599-7512, USA
| | - Lawrence B Marks
- Department of Radiation Oncology, University of North Carolina, 101 Manning Dr., Chapel Hill, NC, 27599-7512, USA
| | - Bhishamjit S Chera
- Department of Radiation Oncology, University of North Carolina, 101 Manning Dr., Chapel Hill, NC, 27599-7512, USA
| | - Shiva K Das
- Department of Radiation Oncology, University of North Carolina, 101 Manning Dr., Chapel Hill, NC, 27599-7512, USA
| | - Kyle Wang
- Department of Radiation Oncology, University of North Carolina, 101 Manning Dr., Chapel Hill, NC, 27599-7512, USA
| |
Collapse
|
10
|
Song Y, Uchida H, Sharipol A, Piraino L, Mereness JA, Ingalls MH, Rebhahn J, Newlands SD, DeLouise LA, Ovitt CE, Benoit DSW. Development of a functional salivary gland tissue chip with potential for high-content drug screening. Commun Biol 2021; 4:361. [PMID: 33742114 PMCID: PMC7979686 DOI: 10.1038/s42003-021-01876-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 02/17/2021] [Indexed: 01/31/2023] Open
Abstract
Radiation therapy for head and neck cancers causes salivary gland dysfunction leading to permanent xerostomia. Limited progress in the discovery of new therapeutic strategies is attributed to the lack of in vitro models that mimic salivary gland function and allow high-throughput drug screening. We address this limitation by combining engineered extracellular matrices with microbubble (MB) array technology to develop functional tissue mimetics for mouse and human salivary glands. We demonstrate that mouse and human salivary tissues encapsulated within matrix metalloproteinase-degradable poly(ethylene glycol) hydrogels formed in MB arrays are viable, express key salivary gland markers, and exhibit polarized localization of functional proteins. The salivary gland mimetics (SGm) respond to calcium signaling agonists and secrete salivary proteins. SGm were then used to evaluate radiosensitivity and mitigation of radiation damage using a radioprotective compound. Altogether, SGm exhibit phenotypic and functional parameters of salivary glands, and provide an enabling technology for high-content/throughput drug testing.
Collapse
Affiliation(s)
- Yuanhui Song
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, USA
- Center for Oral Biology, University of Rochester Medical Center, Rochester, NY, USA
| | - Hitoshi Uchida
- Center for Oral Biology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Biomedical Genetics, University of Rochester Medical Center, Rochester, NY, USA
| | - Azmeer Sharipol
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, USA
- Center for Oral Biology, University of Rochester Medical Center, Rochester, NY, USA
| | - Lindsay Piraino
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, USA
- Center for Oral Biology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Dermatology, University of Rochester Medical Center, Rochester, NY, USA
| | - Jared A Mereness
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, USA
- Center for Oral Biology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Matthew H Ingalls
- Center for Oral Biology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Biomedical Genetics, University of Rochester Medical Center, Rochester, NY, USA
| | - Jonathan Rebhahn
- David H. Smith Center for Vaccine Biology and Immunology, University of Rochester Medical Center, Rochester, NY, USA
| | - Shawn D Newlands
- Department of Otolaryngology, University of Rochester Medical Center, Rochester, NY, USA
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, USA
| | - Lisa A DeLouise
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, USA
- Center for Oral Biology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Dermatology, University of Rochester Medical Center, Rochester, NY, USA
- Materials Science Program, University of Rochester, Rochester, NY, USA
| | - Catherine E Ovitt
- Center for Oral Biology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Biomedical Genetics, University of Rochester Medical Center, Rochester, NY, USA
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Danielle S W Benoit
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, USA.
- Center for Oral Biology, University of Rochester Medical Center, Rochester, NY, USA.
- Department of Biomedical Genetics, University of Rochester Medical Center, Rochester, NY, USA.
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA.
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
- Materials Science Program, University of Rochester, Rochester, NY, USA.
- Department of Chemical Engineering, University of Rochester, Rochester, NY, USA.
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, USA.
| |
Collapse
|
11
|
Wang L, Huang S, Zhang L, He X, Liu Y. Recommendation regarding the cranial upper border of level IIb in delineating clinical target volumes (CTV) for nasopharyngeal carcinoma. Radiat Oncol 2020; 15:270. [PMID: 33228742 PMCID: PMC7684755 DOI: 10.1186/s13014-020-01720-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 11/13/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To recommend a cranial border for level IIb in delineating clinical target volumes (CTV) for nasopharyngeal carcinoma (NPC) patients receiving intensity-modulated radiotherapy and to help reach a consensus on contouring level IIb in CTV. METHODS From 2012 to 2016, 331 nonmetastatic NPC patients treated with IMRT were retrospectively enrolled. Based on the AJCC 8th staging system of NPC, there were 15 stage I, 76 stage II, 103 stage III, and 137 stage IV patients. The distribution of cervical lymph nodes in NPC was assessed based on imaging. Comparisons of the safety and parotid dose parameters between patients with and without a reduction in the size of level IIb were conducted using SPSS 25.0 and R 2.14.2 software. RESULTS Metastasis rates in the most commonly involved lymph nodes, the lateral retropharyngeal and IIb nodes, were 82.8% and 64.0%, respectively. Among patients with level IIb involvement, the upper borders of the metastatic nodes were beyond the caudal edge of C1 in 13.7% of cases. The parotid gland D50 and V26 values were significantly reduced after modifying the upper bound of level IIb used to delineate the CTV (P = 0.000). CONCLUSION In principle, the upper bound of level IIb should reach the lateral skull base during delineation of the cervical CTV for NPC. To protect the parotid glands, however, individualized reduction of the upper bound of level IIb is recommended for patients who meet certain criteria.
Collapse
Affiliation(s)
- Lijun Wang
- Department of Radiation Oncology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Shengfu Huang
- Department of Radiation Oncology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China.
| | - Lanfang Zhang
- Department of Radiology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Xia He
- Department of Radiation Oncology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Yatian Liu
- Department of Radiation Oncology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| |
Collapse
|
12
|
Abstract
Radiotherapy plays a major role in the curative treatment of head and neck cancer, either as a single modality therapy, or in combination with surgery or chemotherapy, or both. Despite advances to limit radiation-induced side-effects, the major salivary glands are often affected. This frequently leads to hyposalivation which causes an increased risk for xerostomia, dental caries, mucositis, and malnutrition culminating in a significant impact on patients' quality of life. Previous research demonstrated that loss of salivary function is associated with a decrease in polarity regulators and an increase in nuclear Yap localization in a putative stem and progenitor cell (SPC) population. Yap activation has been shown to be essential for regeneration in intestinal injury models; however, the highest levels of nuclear Yap are observed in irradiated salivary SPCs that do not regenerate the gland. Thus, elucidating the inputs that regulate nuclear Yap localization and determining the role that Yap plays within the entire tissue following radiation damage and during regeneration is critical. In this study, we demonstrate that radiation treatment increases nuclear Yap localization in acinar cells and Yap-regulated genes in parotid salivary tissues. Conversely, administration of insulin-like growth factor 1 (IGF1), known to restore salivary function in mouse models, reduces nuclear Yap localization and Yap transcriptional targets to levels similar to untreated tissues. Activation of Rho-associated protein kinase (ROCK) using calpeptin results in increased Yap-regulated genes in primary acinar cells while inhibition of ROCK activity (Y-27632) leads to decreased Yap transcriptional targets. These results suggest that Yap activity is dependent on ROCK activity and provides new mechanistic insights into the regulation of radiation-induced hyposalivation.
Collapse
Affiliation(s)
- Wen Yu Wong
- Cancer Biology Graduate Interdisciplinary Program, University of Arizona, Tucson, AZ, United States of America
| | - Kristy Gilman
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ, United States of America
| | - Kirsten H. Limesand
- Cancer Biology Graduate Interdisciplinary Program, University of Arizona, Tucson, AZ, United States of America
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ, United States of America
| |
Collapse
|
13
|
Uehara T, Monzen H, Tamura M, Ishikawa K, Doi H, Nishimura Y. Dose-volume histogram analysis and clinical evaluation of knowledge-based plans with manual objective constraints for pharyngeal cancer. J Radiat Res 2020; 61:499-505. [PMID: 32329509 PMCID: PMC7299264 DOI: 10.1093/jrr/rraa021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/01/2019] [Indexed: 06/11/2023]
Abstract
The present study aimed to evaluate whether knowledge-based plans (KBP) from a single optimization could be used clinically, and to compare dose-volume histogram (DVH) parameters and plan quality between KBP with (KBPCONST) and without (KBPORIG) manual objective constraints and clinical manual optimized (CMO) plans for pharyngeal cancer. KBPs were produced from a system trained on clinical plans from 55 patients with pharyngeal cancer who had undergone intensity-modulated radiation therapy or volumetric-modulated arc therapy (VMAT). For another 15 patients, DVH parameters of KBPCONST and KBPORIG from a single optimization were compared with CMO plans with respect to the planning target volume (D98%, D50%, D2%), brainstem maximum dose (Dmax), spinal cord Dmax, parotid gland median and mean dose (Dmed and Dmean), monitor units and modulation complexity score for VMAT. The Dmax of spinal cord and brainstem and the Dmed and Dmean of ipsilateral parotid glands were unacceptably high for KBPORIG, although the KBPCONST DVH parameters met our goal for most patients. KBPCONST and CMO plans produced comparable DVH parameters. The monitor units of KBPCONST were significantly lower than those of the CMO plans (P < 0.001). Dose distribution of the KBPCONST was better than or comparable to that of the CMO plans for 13 (87%) of the 15 patients. In conclusion, KBPORIG was found to be clinically unacceptable, while KBPCONST from a single optimization was comparable or superior to CMO plans for most patients with head and neck cancer.
Collapse
Affiliation(s)
- Takuya Uehara
- Department of Radiation Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Hajime Monzen
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, Osaka-Sayama, Osaka, Japan
| | - Mikoto Tamura
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, Osaka-Sayama, Osaka, Japan
| | - Kazuki Ishikawa
- Department of Radiation Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Hiroshi Doi
- Department of Radiation Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Yasumasa Nishimura
- Department of Radiation Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| |
Collapse
|
14
|
Wong WY, Allie S, Limesand KH. PKCζ and JNK signaling regulate radiation-induced compensatory proliferation in parotid salivary glands. PLoS One 2019; 14:e0219572. [PMID: 31287841 PMCID: PMC6615637 DOI: 10.1371/journal.pone.0219572] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 06/26/2019] [Indexed: 01/05/2023] Open
Abstract
Radiotherapy is a common treatment option for head and neck cancer patients; however, the surrounding healthy salivary glands are often incidentally irradiated during the process. As a result, patients often experience persistent xerostomia and hyposalivation, which deceases their quality of life. Clinically, there is currently no standard of care available to restore salivary function. Repair of epithelial wounds involves cellular proliferation and establishment of polarity in order to regenerate the tissue. This process is partially mediated by protein kinase C zeta (PKCζ), an apical polarity regulator; however, its role following radiation damage is not completely understood. Using an in vivo radiation model, we show a significant decrease in active PKCζ in irradiated murine parotid glands, which correlates with increased proliferation that is sustained through 30 days post-irradiation. Additionally, salivary glands in PKCζ null mice show increased basal proliferation which radiation treatment did not further potentiate. Radiation damage also activates Jun N-terminal kinase (JNK), a proliferation-inducing mitogen-activated protein kinase normally inhibited by PKCζ. In both a PKCζ null mouse model and in primary salivary gland cell cultures treated with a PKCζ inhibitor, there was increased JNK activity and production of downstream proliferative transcripts. Collectively, these findings provide a potential molecular link by which PKCζ suppression following radiation damage promotes JNK activation and radiation-induced compensatory proliferation in the salivary gland.
Collapse
Affiliation(s)
- Wen Yu Wong
- Cancer Biology Graduate Interdisciplinary Program, University of Arizona, Tucson, Arizona, United States of America
| | - Sydney Allie
- Department of Nutritional Sciences, University of Arizona, Tucson, Arizona, United States of America
| | - Kirsten H. Limesand
- Cancer Biology Graduate Interdisciplinary Program, University of Arizona, Tucson, Arizona, United States of America
- Department of Nutritional Sciences, University of Arizona, Tucson, Arizona, United States of America
| |
Collapse
|
15
|
Roos DE, Dreosti MV, James CL, Hissaria P. Radiotherapy for parotid IgG4-related disease. J Med Radiat Sci 2019; 66:66-69. [PMID: 30198210 PMCID: PMC6399187 DOI: 10.1002/jmrs.304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/08/2018] [Accepted: 08/16/2018] [Indexed: 12/24/2022] Open
Abstract
We describe the use of radiotherapy for parotid IgG4-related disease (IgG4-RD), initially misdiagnosed as Kimura's disease, with sustained good partial response in a 37-year-old male. To the best of our knowledge, this is the first reported case of radiation for extra-orbital IgG4-RD, albeit inadvertently.
Collapse
Affiliation(s)
- Daniel E. Roos
- Department of Radiation OncologyRoyal Adelaide Hospital and University of Adelaide, School of MedicineAdelaideSouth AustraliaAustralia
| | | | - Craig L. James
- Adelaide Pathology PartnersAdelaideSouth AustraliaAustralia
| | - Pravin Hissaria
- Clinical Immunology and Allergy DepartmentRoyal Adelaide Hospital and SA PathologyAdelaideSouth AustraliaAustralia
| |
Collapse
|
16
|
Rahatli FK, Turnaoglu H, Iyidir OT, Kirnap NG, Haberal KM, Aydın E, Uslu N. Assessment of Parotid and Submandibular Glands With Shear Wave Elastography Following Radioactive Iodine Therapy for Papillary Thyroid Carcinoma. J Ultrasound Med 2019; 38:357-362. [PMID: 30027680 DOI: 10.1002/jum.14695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 04/18/2018] [Accepted: 04/19/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Papillary thyroid carcinoma (PTC) is the most common thyroid malignancy. Radioactive iodine (RAI) therapy is used for remnant ablation following thyroidectomy. Side effects such as dysphagia, xerostomia, and sialoadenitis may occur. We aimed to determine the differences in the parotid and submandibulary glands between healthy patients and patients with PTC who had undergone RAI therapy and have dry mouth symptoms using both shear wave elastography and ultrasonography. METHODS We enrolled 30 patients with PTC who had undergone RAI therapy following surgery and 30 healthy controls. Ultrasonography and shear wave elastography of submandibular and parotid glands were performed. The volume of the submandibular glands and the thickness of parotid glands were determined. Ten independent measurements were obtained from each gland, with the region of interest placed at different points on the glands. The mean shear wave velocities (SWVs) were calculated and compared between the patients and controls. RESULTS In the PTC group, there was a significant reduction in the volume of the submandibular glands (P < .05) and in the thickness of the parotid glands (P < .05) compared with the control group. The mean SWVs of the parotid glands and submandibular glands were significantly higher in the PTC group compared with the control group (P < .0001). The SWVs of the parotid glands were higher than the SWVs of the submandibular glands (P < .0001). CONCLUSIONS Shear wave elastography could be a noninvasive and easy assessment method of parotid and submandibular glands in patients who had undergone RAI therapy and experience dry mouth.
Collapse
Affiliation(s)
- Feride Kural Rahatli
- Department of Radiology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Hale Turnaoglu
- Department of Radiology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Ozlem Turhan Iyidir
- Department of Endocrinology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Nazli Gulsoy Kirnap
- Department of Endocrinology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Kemal Murat Haberal
- Department of Radiology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Erdinç Aydın
- Department of Ear, Nose, and Throat, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Nihal Uslu
- Department of Radiology, Faculty of Medicine, Baskent University, Ankara, Turkey
| |
Collapse
|
17
|
Wong WY, Pier M, Limesand KH. Persistent disruption of lateral junctional complexes and actin cytoskeleton in parotid salivary glands following radiation treatment. Am J Physiol Regul Integr Comp Physiol 2018; 315:R656-R667. [PMID: 29897817 PMCID: PMC6230885 DOI: 10.1152/ajpregu.00388.2017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 02/02/2023]
Abstract
Xerostomia and hyposalivation are debilitating side effects for patients treated with ionizing radiation for head and neck cancer. Despite technological advances, collateral damage to the salivary glands remains a significant problem for patients and severely diminishes their quality of life. During the wound healing process, restoration of junctional contacts is necessary to maintain polarity, structural integrity, and orientation cues for secretion. However, little is known about whether these structural molecules are impacted following radiation damage and more importantly, during tissue restoration. We evaluated changes in adherens junctions and cytoskeletal regulators in an injury model where mice were irradiated with 5 Gy and a restoration model where mice injected postradiation with insulin-like growth factor 1 (IGF1) are capable of restoring salivary function. Using coimmunoprecipitation, there is a decrease in epithelial (E)-cadherin bound to β-catenin following damage that is restored to untreated levels with IGF1. Via its adaptor proteins, β-catenin links the cadherins to the cytoskeleton and part of this regulation is mediated through Rho-associated coiled-coil containing kinase (ROCK) signaling. In our radiation model, filamentous (F)-actin organization is fragmented, and there is an induction of ROCK activity. However, a ROCK inhibitor, Y-27632, prevents E-cadherin/β-catenin dissociation following radiation treatment. These findings illustrate that radiation induces a ROCK-dependent disruption of the cadherin-catenin complex and alters F-actin organization at stages of damage when hyposalivation is observed. Understanding the regulation of these components will be critical in the discovery of therapeutics that have the potential to restore function in polarized epithelium.
Collapse
Affiliation(s)
- Wen Yu Wong
- Cancer Biology Graduate Interdisciplinary Program, University of Arizona , Tucson, Arizona
| | - Maricela Pier
- Department of Nutritional Sciences, University of Arizona , Tucson, Arizona
| | - Kirsten H Limesand
- Cancer Biology Graduate Interdisciplinary Program, University of Arizona , Tucson, Arizona
- Department of Nutritional Sciences, University of Arizona , Tucson, Arizona
| |
Collapse
|
18
|
Künzel LA, Dohm OS, Alber M, Zips D, Thorwarth D. Automatic replanning of VMAT plans for different treatment machines: A template-based approach using constrained optimization. Strahlenther Onkol 2018; 194:921-928. [PMID: 29846751 DOI: 10.1007/s00066-018-1319-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 05/12/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate a new automatic template-based replanning approach combined with constrained optimization, which may be highly useful for a rapid plan transfer for planned or unplanned machine breakdowns. This approach was tested for prostate cancer (PC) and head-and-neck cancer (HNC) cases. METHODS The constraints of a previously optimized volumetric modulated arc therapy (VMAT) plan were used as a template for automatic plan reoptimization for different accelerator head models. All plans were generated using the treatment planning system (TPS) Hyperion. Automatic replanning was performed for 16 PC cases, initially planned for MLC1 (4 mm MLC) and reoptimized for MLC2 (5 mm) and MLC3 (10 mm) and for 19 HNC cases, replanned from MLC2 to MLC3. EUD, Dmean, D2%, and D98% were evaluated for targets; for OARs EUD and D2% were analyzed. Replanning was considered successful if both plans fulfilled equal constraints. RESULTS All prostate cases were successfully replanned. The mean relative target EUD deviation was -0.15% and -0.57% for replanning to MLC2 and MLC3, respectively. OAR sparing was successful in all cases. Replanning of HNC cases from MLC2 to MLC3 was successful in 16/19 patients with a mean decrease of -0.64% in PTV60 EUD. In three cases target doses were substantially decreased by up to -2.58% (PTV60) and -3.44% (PTV54), respectively. Nevertheless, OAR sparing was always achieved as planned. CONCLUSIONS Automatic replanning of VMAT plans for a different treatment machine by using pre-existing constraints as a template for a reoptimization is feasible and successful in terms of equal constraints.
Collapse
Affiliation(s)
- Luise A Künzel
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital Tübingen, 72076, Tübingen, Germany
| | - Oliver S Dohm
- Department of Radiation Oncology, University Hospital Tübingen, 72076, Tübingen, Germany
| | - Markus Alber
- Radiation Oncology, University Hospital Heidelberg, 69120, Heidelberg, Germany
| | - Daniel Zips
- Department of Radiation Oncology, University Hospital Tübingen, 72076, Tübingen, Germany
- German Cancer Consortium (DKTK), partner site Tübingen; and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniela Thorwarth
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital Tübingen, 72076, Tübingen, Germany.
- German Cancer Consortium (DKTK), partner site Tübingen; and German Cancer Research Center (DKFZ), Heidelberg, Germany.
| |
Collapse
|
19
|
Gabriele P, Macias V, Stasi M, Chauvie S, Munoz F, Delmastro E, Scielzo G. Feasibility of Intensity-Modulated Radiation Therapy in the Treatment of Advanced Cervical Chordoma. Tumori 2018; 89:298-304. [PMID: 12908787 DOI: 10.1177/030089160308900313] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and Background Postoperative radiation is often given in cases of cervical chordoma because of the high incidence of local recurrence. The tumor mass usually surrounds the spinal cord and infiltrates vertebral bone. A combined technique using protons or electrons to boost the initial photon fields is generally applied. We evaluated the use of dynamic intensity-modulated radiation therapy as an alternative technique for treating advanced cervical chordoma. Methods and Study Design A female patient with incomplete resection of a vertebral chordoma surrounding C2-C3 was irradiated with a total dose of 58 Gy (ICRU point) in 2 Gy daily fractions for 29 days between December 2001 and January 2002. Beam arrangement consisted of seven 6 MV non-opposed coplanar fields. Pretreatment quality assurance included checking of the absolute dose at reference points and 2D dose map analysis. Treatment was delivered with a 120-leaf collimator in sliding window mode. To verify the daily setup, portal images at 0° and 90° were compared with the simulation images before treatment delivery (manual matching) and after treatment delivery (automatic anatomy matching). Results and Conclusions The mean dose to the planning target volume (PTV) was 57.6 ± 2.1 Gy covering 95% of the PTV per 95% isodose. The minimum dose to the PTV (D99) was 53.6 Gy in the overlapping area between the PTV and the spinal cord planning organ at risk volume (PRV). The maximum dose to the spinal cord was 42.2 Gy and to the spinal cord PRV (8 mm margin) 53.7 Gy. The mean dose to the parotid glands was 37.4 Gy (homolateral gland) and 19.5 Gy (contralateral gland). Average deviation in setup was -1.1 ± 2.5 mm (anterior-posterior), 2.4 ±1.3 mm (latero-lateral), 0.7 ± 0.9 mm (craniocaudal) and -0.43 ± 1° (rotation). Conclusions In the treatment of chordomas surrounding the spinal cord, intensity-modulated radiotherapy can provide high dose homogeneity and PTV coverage. Frequent digital portal image-based setup control is able to reduce random positioning errors for head and neck cancer patients immobilized with conventional thermoplastic masks.
Collapse
Affiliation(s)
- Pietro Gabriele
- Department of Radiation Oncology, Institute for Cancer Research and Treatment, Ordine Mauriziano, Turin, Italy
| | | | | | | | | | | | | |
Collapse
|
20
|
Corvò R, Foppiano F, Bacigalupo A, Berretta L, Benasso M, Vitale V. Contralateral Parotid-Sparing Radiotherapy in Patients with Unilateral Squamous Cell Carcinoma of the Head and Neck: Technical Methodology and Preliminary Results. Tumori 2018; 90:66-72. [PMID: 15143975 DOI: 10.1177/030089160409000115] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and background Radiation-induced permanent xerostomia occurs frequently in patients affected by squamous cell carcinoma of the head and neck treated by parallel opposed lateral fields. An ipsilateral technique by using co-planar multiple-field arrangement was designed to restrict treatment to the primary tumor and neck on the same side for patients with selected lateralized squamous cell carcinoma of the head and neck. Methods From November 2001 till December 2002, 30 patients affected by squamous cell carcinoma of tonsillar fossa, retro-molar trigone, alveolar ridge and oropharyngeal lateral wall were included in this investigational trial and treated with an ipsilateral multiple field technique: in detail, oblique opposed two upper half fields were planned ipsilaterally to the squamous cell carcinoma site to cover PTV1 and PTV2, whereas an anterior-lower half field was planned to encompass the lower neck node area above clavicles. On CT scans, the contralateral parotid gland was outlined as organ at risk and the contralateral upper lymph node area was contoured as volume of interest. In selected cases, convergent oblique two wedge-pair half fields were added to opposed oblique two-field technique in order to cover only PTV2: generally, in these patients, PTV1 received 1.8 Gy per fraction and PTV2 2.2 Gy per fraction up to total doses of 54 Gy and 66 Gy, respectively. Results Ten patients received radical radiotherapy, 9 patients radical alternating chemo-radiotherapy, and 11 patients adjuvant radiotherapy. At the end of treatment, unilateral confluent mucositis was recorded in 13 (43%) patients and unilateral moist skin epidermolysis in 14 (46%) patients. Six months after the end of radiotherapy, grade 0 xerostomia was recorded in 20 (67%) patients. No patient experienced grade 2+ xerostomia. At a median follow-up of 12 months, 26 (86%) patients were alive and well; 2 patients (6%) developed contralateral neck node failure, both 4 months after the end of ipsilateral radiotherapy. Conclusions These results, although preliminary, suggest that by using an ipsilateral radiotherapy technique, symptomatic xerostomia may be avoided in selected patients with lateralized squamous cell carcinoma of the head and neck without an increased short-term risk of contralateral nodal failure.
Collapse
Affiliation(s)
- Renzo Corvò
- National Cancer Research Institute, University of Genoa, Italy.
| | | | | | | | | | | |
Collapse
|
21
|
Vieira KA, Bastos CM, Vitor MGC, Deana AM, Fernandes KPS, Rodrigues MFSD, Pavesi VCS, Bussadori SK. Use of low-level laser therapy on children aged 1 to 5 years with energy-protein malnutrition: A clinical trial. Medicine (Baltimore) 2018; 97:e0538. [PMID: 29703031 PMCID: PMC5944562 DOI: 10.1097/md.0000000000010538] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Episodes of malnutrition in early childhood can produces alterations in the salivary glands. The investigation of mechanisms that can reduce the impact of malnutrition on the defenses of the organism is of the utmost important and interest to public health. The aim of this study is to evaluate the effect of low-level laser on the saliva of children aged 1 to 5 years with energy-protein malnutrition. METHODS Mandatory inclusion criteria are diagnosis of malnutrition. The sample will consist of 50 men and women malnourished children aged 12 to 71 months. Saliva will be collected and the volume of saliva will be measured and the salivary flow rate will be determined (mL/min). Concentrations of salivary IgA in all samples will be measured using a commercial Enzyme-Linked Immunosorbent Assay (ELISA) kit. Low-level laser (laser diode) will be administered in the region of the parotid glands bilaterally as well as in the regions of the submandibular and sublingual glands. DISCUSSION This study will be the first that investigate the effects of local laser therapy on the salivary glands of malnourished children. TRIAL REGISTRATION Clinical.trials.gov as NCT03355313, first received in 21 November 2017.
Collapse
|
22
|
de Castro JR, de Souza EMN, Park YJ, de Campos L, Cha S, Arana-Chavez VE, Nicolau J, Simões A. Low-power laser irradiation decreases lipid droplet accumulation in the parotid glands of diabetic rats. J Biophotonics 2018; 11:e201700179. [PMID: 29112328 DOI: 10.1002/jbio.201700179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 11/03/2017] [Indexed: 06/07/2023]
Abstract
Lipid droplet accumulation has been related to salivary gland hypofunction in diabetes. In this study, the effect of laser irradiation on the parotid glands (PGs) of diabetic rats was analyzed with regard to its effect on lipid droplet accumulation, intracellular calcium concentration and calmodulin expression. The animals were distributed into 6 groups: D0, D5, D20 and C0, C5, C20, for diabetic (D) and control animals (C), respectively. Twenty-nine days following diabetes induction, PGs of groups D5 and C5; D20 and C20 were irradiated with 5 and 20 J/cm2 of a red diode laser at 100 mW, respectively. After 24 hours, PGs were removed for histological, biochemical, and western blotting analysis. The diabetic animals showed lipid droplet accumulation, which was decreased after irradiation. Ultrastructurally, the droplets were nonmembrane bound and appeared irregularly located in the cytoplasm. Moreover, diabetic animals showed an increased intracellular calcium concentration. In contrast, after laser irradiation a progressive decrease in the concentration of this ion was observed, which would be in agreement with the results found in the increased expression of calmodulin in D20. These data are promising for using laser to decrease lipid droplet accumulation in PGs, however, more studies are necessary to better understand its mechanisms. Micrographs showing decreased lipid accumulation after laser irradiation in light micrographs (LM), and morphology of lipid droplet in transmission electron microscopic (TEM). LM: (A) PGs from nondiabetic rats that did not receive Laser irradiation (LI), (B) PGs from nondiabetic rats that received a dose of 20 J/cm2 , (C) lipid accumulation (arrows) in the secretory cells from diabetic rats that did not receive irradiation, (D) reduction of lipid accumulation in the secretory cells from diabetic rats that received a dose of 20 J/cm2 and TEM: (E) scale bar = 5 μm, (F) scale bar = 1 μm, and (G) scale bar = 0.5 μm.
Collapse
Affiliation(s)
- Juliana R de Castro
- Laboratory of Oral Biology, Department of Biomaterials and Oral Biology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Eugen M N de Souza
- Laboratory of Oral Biology, Department of Biomaterials and Oral Biology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Yun-Jong Park
- Oral Maxillofacial Diagnostic Sciences, College of Dentistry, University of Florida, Gainesville, Florida
| | - Luana de Campos
- Laboratory of Oral Biology, Department of Biomaterials and Oral Biology, School of Dentistry, University of São Paulo, São Paulo, Brazil
- Department of Oral Medicine, Brazilian Institute for Cancer Control, São Paulo, Brazil
| | - Seunghee Cha
- Oral Maxillofacial Diagnostic Sciences, College of Dentistry, University of Florida, Gainesville, Florida
| | - Victor E Arana-Chavez
- Laboratory of Oral Biology, Department of Biomaterials and Oral Biology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - José Nicolau
- Laboratory of Oral Biology, Department of Biomaterials and Oral Biology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Alyne Simões
- Laboratory of Oral Biology, Department of Biomaterials and Oral Biology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
23
|
Zhou N, Chu C, Dou X, Chen W, He J, Yan J, Zhou Z, Yang X. Early evaluation of radiation-induced parotid damage in patients with nasopharyngeal carcinoma by T2 mapping and mDIXON Quant imaging: initial findings. Radiat Oncol 2018; 13:22. [PMID: 29422068 PMCID: PMC5806279 DOI: 10.1186/s13014-018-0970-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 02/05/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Radiation-induced parotid damage is a common complication in patients with nasopharyngeal carcinoma (NPC) treated with radiotherapy to head and neck region, which severely reduce the life quality of those patients. The aim of this study was to early evaluate the changes of irradiated parotid glands with T2 mapping and mDIXON Quant imaging. METHODS Forty-one patients with NPC underwent conventional magnetic resonance imaging for nasopharynx and neck, and T2 mapping and mDIXON Quant imaging for bilateral parotid glands within 2 weeks before radiotherapy (pre-RT), 5 weeks after the beginning of radiotherapy (mid-RT), and 4 weeks after radiotherapy (post-RT). Parotid volume, T2 values, fat fraction (FF) values, and mean radiation dose were recorded and analyzed. RESULTS From pre-RT to mid-RT, parotid volume decreased (atrophy rate, 27.0 ± 11.5%), while parotid T2 and FF values increased (change rate, 6.0 ± 6.2% for T2 value and 9.1 ± 9.9% for FF value) significantly. From mid-RT to post-RT, parotid T2 value continuously increased (change rate, 4.6 ± 7.7%), but parotid FF value decreased (change rate, - 9.9 ± 18.2%) significantly. Change rate of parotid T2 value significantly correlated with parotid atrophy rate from pre-RT to post-RT (r = 0.313, P = 0.027). Multiple linear regression analysis showed that parotid T2 value (standardized coefficient [SC] = - 0.259, P = 0.001) and FF value (SC = - 0.320, P = 0.014) negatively correlated with parotid volume, while parotid T2 value positively correlated with MR scan time point (SC = 0.476, P = 0.001) significantly. Parotid T2 and FF values showed excellent reproducibility (intraclass correlation coefficient, 0.935-0.992). CONCLUSIONS T2 mapping and mDIXON Quant imaging is useful for noninvasive evaluation of radiation-induced parotid damage.
Collapse
Affiliation(s)
- Nan Zhou
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008 China
| | - Chen Chu
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008 China
| | - Xin Dou
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008 China
| | - Weibo Chen
- Philips Healthcare, Shanghai, 200233 China
| | - Jian He
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008 China
| | - Jing Yan
- The Comprehensive Cancer Centre of Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, 210008 China
| | - Zhengyang Zhou
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008 China
| | - Xiaofeng Yang
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA 30322 USA
| |
Collapse
|
24
|
Kim DW. Computed tomography features of the major salivary glands after radioactive iodine ablation in patients with papillary thyroid carcinoma. Radiol Med 2017; 123:20-27. [PMID: 28932970 DOI: 10.1007/s11547-017-0815-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 09/13/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE No previous study has investigated computed tomography (CT) features of the major salivary glands (MSGs) after postoperative radioactive iodine ablation (RIA). This study aimed to assess CT features of the MSGs after RIA in patients with papillary thyroid carcinoma (PTC). METHODS The study population comprised consecutively registered PTC patients who had undergone total thyroidectomy, RIA, follow-up neck ultrasonography (US), and neck CT. The US and CT features of the parotid and submandibular glands in each patient were retrospectively evaluated by a single radiologist. Post-RIA changes were determined by comparisons between follow-up neck US results (main reference) and between preoperative and post-RIA neck CT features. RESULTS Of the 28 patients, 13 (46.4%) showed post-RIA changes in the parotid glands (n = 8), submandibular glands (n = 0), or both (n = 5) on neck CT. Of the 56 MSGs in 28 patients, post-RIA changes were more common in the parotid glands (n = 23, 41.1%) than in the submandibular glands (n = 8, 14.3%). The common CT findings of post-RIA changes in the parotid gland included low parenchymal attenuation, decreased glandular size, a lobulated margin, decreased or increased parenchymal enhancement, and an inhomogeneous enhancement pattern, whereas common CT findings of post-RIA changes in the submandibular gland included decreased glandular size, a lobulated margin, iso-enhancement, and an inhomogeneous enhancement pattern. CONCLUSION The common CT features of post-RIA changes in MSGs include decreased glandular size, a lobulated margin, and an inhomogeneous enhancement pattern.
Collapse
Affiliation(s)
- Dong Wook Kim
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, 75, Bokji-ro, Busanjin-gu, Busan, 47392, South Korea.
| |
Collapse
|
25
|
Abstract
Noninvasive imaging has and will continue to play a pivotal role in the assessment of radiation-induced normal tissue toxicity. In this review, we will examine key literature regarding the use of anatomic and physiological imaging in relation to radiation-induced normal tissue toxicity. Additionally, this review contains a novel methodology for potentially incorporating dose-response data into treatment planning and normal tissue toxicity modeling.
Collapse
Affiliation(s)
- David V Fried
- UNC Hospitals, Department of Radiation Oncology, Chapel Hill, NC.
| | - Shiva K Das
- UNC Hospitals, Department of Radiation Oncology, Chapel Hill, NC
| | - Lawrence B Marks
- UNC Hospitals, Department of Radiation Oncology, Chapel Hill, NC
| |
Collapse
|
26
|
Huang M, Huang D, Zhang J, Chen Y, Xu B, Chen L. Preliminary study of clinical application on IMRT three-dimensional dose verification-based EPID system. J Appl Clin Med Phys 2017; 18:97-105. [PMID: 28594085 PMCID: PMC5875845 DOI: 10.1002/acm2.12098] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 02/16/2017] [Accepted: 04/02/2017] [Indexed: 12/19/2022] Open
Abstract
The three-dimensional dose (3D) distribution of intensity-modulated radiation therapy (IMRT) was verified based on electronic portal imaging devices (EPIDs), and the results were analyzed. Thirty IMRT plans of different lesions were selected for 3D EPID-based dose verification. The gamma passing rates of the 3D dose verification-based EPID system (Edose, Version 3.01, Raydose, Guangdong, China) and Delta4 measurements were then compared with treatment planning system (TPS) calculations using global gamma criteria of 5%/3 mm, 3%/3 mm, and 2%/2 mm. Furthermore, the dose-volume histograms (DVHs) for planning target volumes (PTVs) as well as organs at risk (OARs) were analyzed using Edose. For dose verification of the 30 treatment plans, the average gamma passing rates of Edose reconstructions under the gamma criteria of 5%/3 mm, 3%/3 mm, and 2%/2 mm were (98.58 ± 0.93)%, (95.67 ± 1.97)%, and (83.13 ± 4.53)%, respectively, whereas the Delta4 measurement results were (99.14% ± 1.16)%, (95.81% ± 2.88)%, and (84.74% ± 7.00)%, respectively. The dose differences between Edose reconstructions and TPS calculations were within 3% for D95% , D98% , and Dmean in each PTV, with the exception that the D98% of the PTV-clinical target volume (CTV) in esophageal carcinoma cases was (3.21 ± 2.33)%. However, the larger dose deviations in OARs (such as lens, parotid gland, optic nerve, and spinal cord) can be determined based on DVHs. The difference was particularly obvious for OARs with small volumes; for example, the maximum dose deviation for the lens reached (-6.12 ± 5.28)%. A comparison of the results obtained with Edose and Delta4 indicated that the Edose system could be applied for 3D pretreatment dose verification of IMRT. This system could also be utilized to evaluate the gamma passing rate of each treatment plan. Furthermore, the detailed dose distributions of PTVs and OARs could be indicated based on DVHs, providing additional reliable data for quality assurance in a clinic setting.
Collapse
Affiliation(s)
- Miaoyun Huang
- Department of Radiation OncologyFujian Medical University Union HospitalFuzhouChina
| | - David Huang
- Medical Physics Graduate ProgramDuke Kunshan UniversityKunshanChina
| | - Jianping Zhang
- Department of Radiation OncologyFujian Medical University Union HospitalFuzhouChina
| | - Yuangui Chen
- Department of Radiation OncologyFujian Medical University Union HospitalFuzhouChina
| | - Benhua Xu
- Department of Radiation OncologyFujian Medical University Union HospitalFuzhouChina
| | - Lixin Chen
- State Key Laboratory of Oncology in South ChinaSun Yat‐sen University Cancer CenterGuangzhouChina
| |
Collapse
|
27
|
Scalco E, Moriconi S, Rizzo G. Texture analysis to assess structural modifications induced by radiotherapy. Annu Int Conf IEEE Eng Med Biol Soc 2016; 2015:5219-22. [PMID: 26737468 DOI: 10.1109/embc.2015.7319568] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Texture analysis is an emerging tool employed in Radiotherapy (RT) to improve tumor characterization for planning and to evaluate treatment effects. In the treatment of Head and Neck Cancer, parotid glands can receive high dose that may compromise gland functionality and structure. Texture analysis was here applied on CT images of Head and Neck to evaluate changes in parotid gland structure during RT. CT images at the beginning, at the intermediate stage and at the end of RT were considered and in each time point different features (i.e. mean intensity, variance, entropy, homogeneity, local entropy, fractal dimension and volume) were extracted within parotid volume. A general decrease in tissue complexity and heterogeneity was found, with different time trend for textural features. This is explainable by different biological mechanisms associated to the variation of each index. Volume and mean intensity variation are also correlated with some pre-treatment dosimetric parameters, indicating a relationship between the dose plan and the structural variation estimated after RT.
Collapse
|
28
|
Miah AB, Gulliford SL, Morden J, Newbold KL, Bhide SA, Zaidi SH, Hall E, Harrington KJ, Nutting CM. Recovery of Salivary Function: Contralateral Parotid-sparing Intensity-modulated Radiotherapy versus Bilateral Superficial Lobe Parotid-sparing Intensity-modulated Radiotherapy. Clin Oncol (R Coll Radiol) 2016; 28:e69-e76. [PMID: 26994893 PMCID: PMC4979532 DOI: 10.1016/j.clon.2016.02.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 02/06/2016] [Accepted: 02/09/2016] [Indexed: 11/23/2022]
Abstract
AIMS To establish whether there is a difference in recovery of salivary function with bilateral superficial lobe parotid-sparing intensity-modulated radiotherapy (BSLPS-IMRT) versus contralateral parotid-sparing IMRT (CLPS-IMRT) in patients with locally advanced head and neck squamous cell cancers. MATERIALS AND METHODS A dosimetric analysis was carried out on data from two studies in which patients received BSLPS-IMRT (PARSPORT II) or CLPS-IMRT (PARSPORT). Acute (National Cancer Institute, Common Terminology Criteria for adverse events - NCI CTCAEv3.0) and late (Late Effects of Normal Tissue- subjective, objective, management analytical - LENTSOMA and Radiation Therapy Oncology Group) xerostomia scores were dichotomised: recovery (grade 0-1) versus no recovery (≥grade 2). Incidence of recovery of salivary function was compared between the two techniques and dose-response relationships were determined by fitting dose-response curves to the data using non-linear logistic regression analysis. RESULTS Seventy-one patients received BSLPS-IMRT and 35 received CLPS-IMRT. Patients received 65 Gy in 30 fractions to the primary site and involved nodal levels and 54 Gy in 30 fractions to elective nodal levels. There were significant differences in mean doses to contralateral parotid gland (29.4 Gy versus 24.9 Gy, P < 0.005) and superficial lobes (26.8 Gy versus 30.5 Gy, P = 0.02) for BSLPS and CLPS-IMRT, respectively. Lower risk of long-term ≥grade 2 subjective xerostomia (LENTSOMA) was reported with BSLPS-IMRT (odds ratio 0.50; 95% confidence interval 0.29-0.86; P = 0.012). The percentage of patients who reported recovery of parotid saliva flow at 1 year was higher with BSLPS-IMRT compared with CLPS-IMRT techniques (67.1% versus 52.8%), but the difference was not statistically significant (P = 0.12). For the whole parotid gland, the tolerance doses, D50, were 25.6 Gy (95% confidence interval 20.6-30.5), k = 2.7 (0.9-4.5) (CLPS-IMRT) and 28.9 Gy (26.1-31.9), k = 2.4 (1.4-3.4) (BSLPS-IMRT). For the superficial lobe, D50 were similar: BSLPS-IMRT 23.5 Gy (19.3-27.6), k = 1.9 (0.5-3.8); CLPS-IMRT 24.0 Gy (17.7-30.1), k = 2.1 (0.1-4.1). CONCLUSION BSLPS-IMRT reduces the risk of developing high-grade subjective xerostomia compared with CLPS-IMRT. The D50 of the superficial lobe may be a more reliable predictor of recovery of parotid function than the whole gland mean dose.
Collapse
Affiliation(s)
- A B Miah
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - S L Gulliford
- Joint Department of Physics, The Institute of Cancer Research, Surrey, UK
| | - J Morden
- The Institute of Cancer Research, Clinical Trials and Statistic Unit, London, UK
| | - K L Newbold
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - S A Bhide
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - S H Zaidi
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - E Hall
- The Institute of Cancer Research, Clinical Trials and Statistic Unit, London, UK
| | - K J Harrington
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - C M Nutting
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK.
| |
Collapse
|
29
|
Zhu Z, Pang B, Iglesias-Bartolome R, Wu X, Hu L, Zhang C, Wang J, Silvio Gutkind J, Wang S. Prevention of irradiation-induced salivary hypofunction by rapamycin in swine parotid glands. Oncotarget 2016; 7:20271-81. [PMID: 26958808 PMCID: PMC4991453 DOI: 10.18632/oncotarget.7941] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 02/09/2016] [Indexed: 12/21/2022] Open
Abstract
Radiotherapy is commonly used in patients with oral cavity and pharyngeal cancers, usually resulting in irreversible salivary hypofunction. Currently management of radiation damage to salivary glands still remains a great challenge. Recent studies show that activation of mammalian target of rapamycin (mTOR) occurs in salivary gland lesions, making it possible to apply mTOR inhibitor for treatment. Our results indicate inhibition of mTOR by rapamycin significantly alleviated irradiation-induced salivary hypofunction by restoring 46% salivary flow rate and protecting histological structures in swine. Furthermore, rapamycin protected human submandibular gland cell line (HSG) from irradiation-induced cell depletion and loss of cell proliferation capacity. These findings lay the foundation for a new clinical application of rapamycin to prevent irradiation-induced salivary hypofunction.
Collapse
Affiliation(s)
- Zhao Zhu
- Molecular Laboratory for Gene Therapy and Tooth Regeneration, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Beijing 100050, China
| | - Baoxing Pang
- Molecular Laboratory for Gene Therapy and Tooth Regeneration, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Beijing 100050, China
| | - Ramiro Iglesias-Bartolome
- Oral and Pharyngeal Cancer Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD 20852, USA
| | - Xiaoshan Wu
- Molecular Laboratory for Gene Therapy and Tooth Regeneration, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Beijing 100050, China
| | - Lei Hu
- Molecular Laboratory for Gene Therapy and Tooth Regeneration, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Beijing 100050, China
| | - Chunmei Zhang
- Molecular Laboratory for Gene Therapy and Tooth Regeneration, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Beijing 100050, China
| | - Jinsong Wang
- Molecular Laboratory for Gene Therapy and Tooth Regeneration, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Beijing 100050, China
| | - J Silvio Gutkind
- UC San Diego, Department of Pharmacology and Moores Cancer Center, La Jolla, CA 92093, USA
| | - Songlin Wang
- Molecular Laboratory for Gene Therapy and Tooth Regeneration, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Beijing 100050, China
| |
Collapse
|
30
|
Belli ML, Broggi S, Scalco E, Cattaneo GM, Dell'Oca I, Logghe G, Moriconi S, Sanguineti G, Valentini V, Di Muzio N, Fiorino C, Calandrino R. Analysis of serial CT images for studying the RT effects in head-neck cancer patients. Annu Int Conf IEEE Eng Med Biol Soc 2016; 2015:5235-8. [PMID: 26737472 DOI: 10.1109/embc.2015.7319572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Images taken during and after RT for head and neck cancer have the potential to quantitatively assess xerostomia. Image information may be used as biomarkers of RT effects on parotid glands with significant potential to support adaptive treatment strategies. We investigated the possibility to extract information based on in-room CT images (kVCT, MVCT), acquired for daily image-guided radiotherapy treatment of head-and-neck cancer patients, in order to predict individual response in terms of toxicity. Follow-up MRI images were also used in order to investigate long term parotid gland deformation.
Collapse
|
31
|
Xiao W, Lin Z, Zhang W, Li M, Wu VWC. A split-parotid delineation approach for dose optimization in volumetric modulated arc therapy for nasopharyngeal carcinoma patients with parapharyngeal space invasion and level IIa cervical lymph node involvements. Br J Radiol 2016; 89:20150635. [PMID: 26838951 PMCID: PMC4846197 DOI: 10.1259/bjr.20150635] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 01/21/2016] [Accepted: 02/01/2016] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE This study evaluated the potential benefit of a split-parotid delineation approach on the parotid gland in the treatment planning of patients with nasopharyngeal carcinoma (NPC). METHODS 50 patients with NPC with parapharyngeal space (PPS) and/or level IIa cervical node involvements were divided into three groups: PPS only, level IIa cervical node only and both. Two volumetric-modulated arc therapy plans were computed. The first plan (control) was generated based on the routine treatment-planning protocol, while the second plan (test) was computed with the split-parotid delineation approach, in which a line through the anterolateral margin of the retromandibular vein was created that divided the parotid gland into anterolateral and posteromedial subsegments. For the test plan, the anterolateral subsegment was prescribed, with a dose constraint of 25 Gy in the plan optimization. Dosimetric data of the parotid gland, target volumes and selected organs at risk (OARs) were compared between the control and test plans. RESULTS The mean dose to the anterolateral subsegment of the parotid gland in all three groups was kept below 25 Gy. The test plan demonstrated significantly lower mean parotid dose than the control plan in the entire gland and the anterolateral subsegment in all three groups. The difference was the greatest in Group 3. CONCLUSION The split-parotid delineation approach significantly lowered the mean dose to the anterolateral subsegment and overall gland without greatly compromising the doses to target volumes and other OARs. The effect was more obvious for both PPS and level IIa cervical node involvements than for either of them alone. ADVANCES IN KNOWLEDGE It is the first article based on the assumption that parotid gland stem cells are situated at the anterolateral segment of the gland, and applied the split-parotid delineation approach to the parotid gland in the treatment planning of patients with NPC with PPS and level IIa cervical node involvements, so that the function of the post-radiotherapy parotid gland might be better preserved.
Collapse
Affiliation(s)
- Wei Xiao
- Cancer Hospital, Shantou University Medical College, Shantou, Guangdong, China
| | - Zhixiong Lin
- Cancer Hospital, Shantou University Medical College, Shantou, Guangdong, China
| | - Wuzhe Zhang
- Cancer Hospital, Shantou University Medical College, Shantou, Guangdong, China
| | - Mei Li
- Cancer Hospital, Shantou University Medical College, Shantou, Guangdong, China
| | - Vincent WC Wu
- Cancer Hospital, Shantou University Medical College, Shantou, Guangdong, China
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR
| |
Collapse
|
32
|
Acauan MD, Gomes APN, Braga-Filho A, de Figueiredo MAZ, Cherubini K, Salum FG. Effect of low-level laser therapy on irradiated parotid glands--study in mice. J Biomed Opt 2015; 20:108002. [PMID: 26502234 DOI: 10.1117/1.jbo.20.10.108002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 09/23/2015] [Indexed: 06/05/2023]
Abstract
The objective of this study was to evaluate the effect of low-level laser therapy (LLLT) on radiotherapy-induced morphological changes and caspase-3 immunodetection in parotids of mice. Forty-one Swiss mice were divided into control, radiotherapy, 2- and 4-J laser groups. The experimental groups were exposed to ionizing radiation in a single session of 10 Gy. In the laser groups, a GaAlAs laser (830 nm, 100 mW, 0.028 cm2, 3.57 W/cm2) was used on the region corresponding to the parotid glands, with 2-J energy (20 s, 71 J/cm2) or 4 J (40 s, 135 J/cm2) per point. LLLT was performed immediately before and 24 h after radiotherapy. One point was applied in each parotid gland. The animals were euthanized 48 h or 7 days after radiotherapy and parotid glands were dissected for morphological analysis and immunodetection of caspase-3. There was no significant difference between groups in the immunodetection of caspase-3, but the laser groups had a lower percentage compared to the radiotherapy group. LLLT promoted the preservation of acinar structure, reduced the occurrence of vacuolation, and stimulated parotid gland vascularization. Of the two LLLT protocols, the one using 4 J of energy showed better results.
Collapse
Affiliation(s)
- Monique Dossena Acauan
- Pontifical Catholic University of Rio Grande do Sul-PUCRS, Oral Medicine Division, São Lucas Hospital, Avenue Ipiranga, 6690, Room 231, CEP: 90610-000, Porto Alegre, RS, Brazil
| | - Ana Paula Neutziling Gomes
- Federal University of Pelotas-UFPEL, Oral Pathology Division, Rua Gonçalves Chaves 457, CEP: 96015-560, Pelotas, RS, Brazil
| | - Aroldo Braga-Filho
- Pontifical Catholic University of Rio Grande do Sul-PUCRS, Radiotherapy Division, São Lucas Hospital, Brazil
| | - Maria Antonia Zancanaro de Figueiredo
- Pontifical Catholic University of Rio Grande do Sul-PUCRS, Oral Medicine Division, São Lucas Hospital, Avenue Ipiranga, 6690, Room 231, CEP: 90610-000, Porto Alegre, RS, Brazil
| | - Karen Cherubini
- Pontifical Catholic University of Rio Grande do Sul-PUCRS, Oral Medicine Division, São Lucas Hospital, Avenue Ipiranga, 6690, Room 231, CEP: 90610-000, Porto Alegre, RS, Brazil
| | - Fernanda Gonçalves Salum
- Pontifical Catholic University of Rio Grande do Sul-PUCRS, Oral Medicine Division, São Lucas Hospital, Avenue Ipiranga, 6690, Room 231, CEP: 90610-000, Porto Alegre, RS, Brazil
| |
Collapse
|
33
|
Badea I, Tamas-Szora A, Chiorean I, Crisan M, Ciuleanu E, Baciut G, Badea M. Acoustic Radiation Force Impulse quantitative elastography: a new noninvasive technique for the evaluation of parotid glands. A preliminary study in controls and in patients with irradiated nasopharyngeal carcinoma. Med Ultrason 2015; 17:308-314. [PMID: 26343078 DOI: 10.11152/mu.2013.2066.173.iub] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM We aim to define the values of the shear wave velocity (SWV) in the normal parotid glands (PG) and to identify the modifications of tissue stiffness in patients with irradiated nasopharyngeal carcinoma. MATERIAL AND METHODS Sixty normal parotid glands pertaining to 30 healthy volunteers and 40 pathological parotid glands pertaining to 20 patients who had had underwent radiation therapy for nasopharyngeal carcinoma were included in this study. The patients underwent a B mode ultrasonography examination and the volume of the parotid gland was determined. A subsequent Acoustic Radiation Forde Impulse Imaging (ARFI) examination was performed and the SWV were determined for the central and the periphery of the glandular parenchyma. RESULTS The mean volume of the gland in the volunteers' group (12.02+/-0.6 ml) was significantly higher than in the group of patients who underwent radiation therapy (10.3+/-0.74 ml) (p<0.0001). The SWV values in the normal group were lower compared to the patients group (1.54+/-0.6 m/s vs. 1.76+/-0.73 m/s, p<0.0001). CONCLUSION Elastography using the ARFI technique constitutes an objective method used for the evaluation of glandular stiffness in both normal and post radiotherapy glands. The SWV values determined in patients who underwent head and neck radiotherapy are increased, indicating a greater tissue stiffness thereby implying a structural transformation of the glandular parenchyma.
Collapse
Affiliation(s)
- Iulia Badea
- Department of Preventive Dentistry, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Attila Tamas-Szora
- Imaging Department, "O. Fodor" Institute of Gastroenterology and Hepatology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj Napoca, Romania.
| | - Ioana Chiorean
- Department of Mathematics, Faculty of Mathematics and Informatics, Babas-Bolyai University, Cluj Napoca, Romania
| | - Maria Crisan
- Department of Histology, "Iuliu Hatiegenu" University of Medicine and Pharmacy,Cluj Napoca, Romania
| | - Elisabeta Ciuleanu
- Department of Radiotherapy, Oncologic Institute "Prof. Dr. Ion Chiricuta", Cluj Napoca, Romania
| | - Grigore Baciut
- Departemnt of Maxillofacial Surgery, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Mindra Badea
- Department of Preventive Dentistry, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj Napoca, Romania
| |
Collapse
|
34
|
Li Y, Zhao C. [Study on DWMRI in evaluating the influence of intensity modulated radiotherapy on salivary gland function of nasopharyngeal carcinoma patients]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2015; 50:754-759. [PMID: 26696349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To evaluate the dynamic change of salivary gland function in patients with nasopharyngeal carcinoma (NPC) before and after intensity modulated radiotherapy (IMRT) by DWMRI. METHODS Twenty-three NPC patients confirmed by pathology were enrolled. Male/Female: 19/4. The age was from 37 to 69 years. All cases underwent salivary glands examination by DWMRI before IMRT, at the end of IMRT, 6 months and 12 months after IMRT, at the same time the ADC value of salivary glands were calculated. The patients were divided into two groups: G1, Dmean < 26 Gy, G2, Dmean ≥ 26 Gy. SPSS 13.0 and SAS 8.2 software was used to analyze the date. RESULTS The ADC values of parotid in two group patients at rest were not significantly different between 6 months after and at the end of IMRT (t value was 0.732, 1.405, all P > 0.05). The ADC values of parotid in two group patients at rest were significantly lower in the 12 months after IMRT than at the end of IMRT (t value 2.621, 3.417, all P < 0.05). During the period of acid stimulation, A significant change of ADC in parotid was found in G1 (all P < 0.05) and no significant change of ADC in parotid was found in G2 at the various follow-up time after IMRT (all P > 0.05). At the various follow-up time after IMRT, the average ADC values of parotid were significantly higher in G2 than G1 in the same time points of acid stimulation (all P < 0.05). The ADC values of submandibular glands at rest were significantly higher at the various follow-up time after IMRT than before IMRT (t value was -9.782, -8.963, -7.722, all P < 0.05). During the period of acid stimulation no significant change of ADC in submandibular glands was found after IMRT (F = 1.124, P = -0.348). CONCLUSIONS The changes of salivary function can be well reflected by ADC values. There is a good clinical application value of DWMRI for evaluating radiation-induced salivary glands functional changes and observing salivary function recovery during the follow-up period after IMRT.
Collapse
Affiliation(s)
- Yanjie Li
- Department of Ophthalmology, First Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Changqing Zhao
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Hospital of Shanxi Medical University, Taiyuan 030001, China;
| |
Collapse
|
35
|
Najim M, Perera L, Bendall L, Sykes JR, Gebski V, Cross S, Veness M. Volumetric and dosimetric changes to salivary glands during radiotherapy for head and neck cancer. Acta Oncol 2015. [PMID: 26219957 DOI: 10.3109/0284186x.2015.1068951] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Maria Najim
- a Department of Radiation Oncology , Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, University of Sydney , Sydney , NSW , Australia
| | - Lakmalie Perera
- a Department of Radiation Oncology , Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, University of Sydney , Sydney , NSW , Australia
| | - Louise Bendall
- b Department of Medical Physics , Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, University of Sydney , Sydney , NSW , Australia
| | - Jonathan R Sykes
- b Department of Medical Physics , Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, University of Sydney , Sydney , NSW , Australia
- d Department of Medical Physics , Blacktown Cancer Centre, Blacktown Hospital, Sydney , NSW , Australia
| | - Val Gebski
- c NHMRC Clinical Trials Centre, University of Sydney , Sydney , NSW , Australia
| | - Shamira Cross
- a Department of Radiation Oncology , Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, University of Sydney , Sydney , NSW , Australia
| | - Michael Veness
- a Department of Radiation Oncology , Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, University of Sydney , Sydney , NSW , Australia
| |
Collapse
|
36
|
Qi XS, Santhanam A, Neylon J, Min Y, Armstrong T, Sheng K, Staton RJ, Pukala J, Pham A, Low DA, Lee SP, Steinberg M, Manon R, Chen AM, Kupelian P. Near Real-Time Assessment of Anatomic and Dosimetric Variations for Head and Neck Radiation Therapy via Graphics Processing Unit-based Dose Deformation Framework. Int J Radiat Oncol Biol Phys 2015; 92:415-22. [PMID: 25847607 DOI: 10.1016/j.ijrobp.2015.01.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 01/16/2015] [Accepted: 01/27/2015] [Indexed: 12/25/2022]
Abstract
PURPOSE The purpose of this study was to systematically monitor anatomic variations and their dosimetric consequences during intensity modulated radiation therapy (IMRT) for head and neck (H&N) cancer by using a graphics processing unit (GPU)-based deformable image registration (DIR) framework. METHODS AND MATERIALS Eleven IMRT H&N patients undergoing IMRT with daily megavoltage computed tomography (CT) and weekly kilovoltage CT (kVCT) scans were included in this analysis. Pretreatment kVCTs were automatically registered with their corresponding planning CTs through a GPU-based DIR framework. The deformation of each contoured structure in the H&N region was computed to account for nonrigid change in the patient setup. The Jacobian determinant of the planning target volumes and the surrounding critical structures were used to quantify anatomical volume changes. The actual delivered dose was calculated accounting for the organ deformation. The dose distribution uncertainties due to registration errors were estimated using a landmark-based gamma evaluation. RESULTS Dramatic interfractional anatomic changes were observed. During the treatment course of 6 to 7 weeks, the parotid gland volumes changed up to 34.7%, and the center-of-mass displacement of the 2 parotid glands varied in the range of 0.9 to 8.8 mm. For the primary treatment volume, the cumulative minimum and mean and equivalent uniform doses assessed by the weekly kVCTs were lower than the planned doses by up to 14.9% (P=.14), 2% (P=.39), and 7.3% (P=.05), respectively. The cumulative mean doses were significantly higher than the planned dose for the left parotid (P=.03) and right parotid glands (P=.006). The computation including DIR and dose accumulation was ultrafast (∼45 seconds) with registration accuracy at the subvoxel level. CONCLUSIONS A systematic analysis of anatomic variations in the H&N region and their dosimetric consequences is critical in improving treatment efficacy. Nearly real-time assessment of anatomic and dosimetric variations is feasible using the GPU-based DIR framework. Clinical implementation of this technology may enable timely plan adaptation and improved outcome.
Collapse
Affiliation(s)
- X Sharon Qi
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California.
| | - Anand Santhanam
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California
| | - John Neylon
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California
| | - Yugang Min
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California
| | - Tess Armstrong
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California
| | - Ke Sheng
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California
| | - Robert J Staton
- Department of Radiation Oncology, UF Health Cancer Center - Orlando Health, Orlando, Florida
| | - Jason Pukala
- Department of Radiation Oncology, UF Health Cancer Center - Orlando Health, Orlando, Florida
| | - Andrew Pham
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California
| | - Daniel A Low
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California
| | - Steve P Lee
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California
| | - Michael Steinberg
- Department of Radiation Oncology, UF Health Cancer Center - Orlando Health, Orlando, Florida
| | - Rafael Manon
- Department of Radiation Oncology, UF Health Cancer Center - Orlando Health, Orlando, Florida
| | - Allen M Chen
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California
| | - Patrick Kupelian
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California
| |
Collapse
|
37
|
Hoogeveen RC, Rottke D, van der Stelt PF, Berkhout WER. Dose reduction in orthodontic lateral cephalography: dosimetric evaluation of a novel cephalographic thyroid protector (CTP) and anatomical cranial collimation (ACC). Dentomaxillofac Radiol 2015; 44:20140260. [PMID: 25564885 PMCID: PMC4628428 DOI: 10.1259/dmfr.20140260] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 12/19/2014] [Accepted: 01/06/2015] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES To test the dose-reducing capabilities of a novel thyroid protection device and a recently introduced cranial collimator to be used in orthodontic lateral cephalography. METHODS Cephalographic thyroid protector (CTP) was designed to shield the thyroid while leaving the cervical vertebrae depicted. Using a RANDO(®) head phantom (The Phantom Laboratory, Salem, NY) equipped with dosemeters and a Proline XC (Planmeca, Helsinki, Finland) cephalograph, lateral cephalograms were taken, and the effective dose (ED) was calculated for four protocols: (1) without shielding; (2) with CTP; (3) with CTP and anatomical cranial collimator (ACC); and (4) with a thyroid collar (TC). RESULTS The ED for the respective protocols was (1) 8.51; (2) 5.39; (3) 3.50; and (4) 4.97 µSv. The organ dose for the thyroid was reduced from 30.17 to 4.50 µSv in Protocols 2 and 3 and to 3.33 µSv in Protocol 4. CONCLUSIONS The use of just the CTP (Protocol 2) resulted in a 36.8% reduction of the ED of a lateral cephalogram. This was comparable to the classical TC (Protocol 4). A 58.8% reduction of the ED was obtained when combining CTP and ACC (Protocol 3). The dose to the radiosensitive thyroid gland was reduced by 85% in Protocols 2 and 3 and by 89% in Protocol 4.
Collapse
Affiliation(s)
- R C Hoogeveen
- Section of Oral and Maxillofacial Radiology, Academic Center for Dentistry Amsterdam ACTA, Amsterdam, Netherlands
| | | | | | | |
Collapse
|
38
|
Morgan-Bathke M, Harris ZI, Arnett DG, Klein RR, Burd R, Ann DK, Limesand KH. The Rapalogue, CCI-779, improves salivary gland function following radiation. PLoS One 2014; 9:e113183. [PMID: 25437438 PMCID: PMC4249875 DOI: 10.1371/journal.pone.0113183] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 10/21/2014] [Indexed: 01/14/2023] Open
Abstract
The standard of care for head and neck cancer typically includes surgical resection of the tumor followed by targeted head and neck radiation. However depending on tumor location and stage, some cases may not require surgical resection while others may be treated with chemoradiation. Unfortunately, these radiation treatments cause chronic negative side effects for patients. These side effects are associated with damage to surrounding normal salivary gland tissue and include xerostomia, changes in taste and malnutrition. The underlying mechanisms of chronic radiation-induced salivary gland dysfunction are unknown, however, in rodent models persistently elevated proliferation is correlated with reduced stimulated salivary flow. The rapalogue, CCI-779, has been used in other cell systems to induce autophagy and reduce proliferation, therefore the aim of this study was to determine if CCI-779 could be utilized to ameliorate chronic radiation-induced salivary gland dysfunction. Four to six week old Atg5f/f; Aqp5-Cre, Atg5+/+; Aqp5-Cre and FVB mice were treated with targeted head and neck radiation. FVB mice were treated with CCI-779, chloroquine, or DMSO post-radiation. Stimulated salivary flow rates were determined and parotid and submandibular salivary gland tissues were collected for analyses. Mice with a defect in autophagy, via a conditional knockout of Atg5 in the salivary glands, display increased compensatory proliferation in the acinar cell compartment and hypertrophy at 24-72 hours following radiation. FVB mice treated with post-therapy CCI-779 have significant improvements in salivary gland physiology as determined by stimulated salivary flow rates, proliferation indices and amylase production and secretion. Consequently, post-radiation use of CCI-779 allows for improvement of salivary gland function and reestablishment of glandular homeostasis. As CCI-779 is already FDA approved for other uses, it could have a secondary use to alleviate the chronic side effects in head and neck cancer patients who have completed anti-tumor therapy.
Collapse
Affiliation(s)
- Maria Morgan-Bathke
- Department of Nutritional Sciences, University of Arizona, Tucson, Arizona, United States of America
| | - Zoey I. Harris
- Department of Nutritional Sciences, University of Arizona, Tucson, Arizona, United States of America
| | - Deborah G. Arnett
- Department of Nutritional Sciences, University of Arizona, Tucson, Arizona, United States of America
| | - Rob R. Klein
- Department of Pathology, University of Arizona, Tucson, Arizona, United States of America
| | - Randy Burd
- Department of Nutritional Sciences, University of Arizona, Tucson, Arizona, United States of America
| | - David K. Ann
- Department of Molecular Pharmacology, Beckman Research Institute, City of Hope, Duarte, California, United States of America
| | - Kirsten H. Limesand
- Department of Nutritional Sciences, University of Arizona, Tucson, Arizona, United States of America
| |
Collapse
|
39
|
Yang X, Tridandapani S, Beitler JJ, Yu DS, Chen Z, Kim S, Bruner DW, Curran WJ, Liu T. Diagnostic accuracy of ultrasonic histogram features to evaluate radiation toxicity of the parotid glands: a clinical study of xerostomia following head-and-neck cancer radiotherapy. Acad Radiol 2014; 21:1304-13. [PMID: 25088832 DOI: 10.1016/j.acra.2014.05.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 05/13/2014] [Accepted: 05/13/2014] [Indexed: 12/29/2022]
Abstract
RATIONALE AND OBJECTIVES To investigate the diagnostic accuracy of ultrasound histogram features in the quantitative assessment of radiation-induced parotid gland injury and to identify potential imaging biomarkers for radiation-induced xerostomia (dry mouth)-the most common and debilitating side effect after head-and-neck radiotherapy (RT). MATERIALS AND METHODS Thirty-four patients, who have developed xerostomia after RT for head-and-neck cancer, were enrolled. Radiation-induced xerostomia was defined by the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer morbidity scale. Ultrasound scans were performed on each patient's parotids bilaterally. The 34 patients were stratified into the acute-toxicity groups (16 patients, ≤ 3 months after treatment) and the late-toxicity group (18 patients, > 3 months after treatment). A separate control group of 13 healthy volunteers underwent similar ultrasound scans of their parotid glands. Six sonographic features were derived from the echo-intensity histograms to assess acute and late toxicity of the parotid glands. The quantitative assessments were compared to a radiologist's clinical evaluations. The diagnostic accuracy of these ultrasonic histogram features was evaluated with the receiver operating characteristic (ROC) curve. RESULTS With an area under the ROC curve greater than 0.90, several histogram features demonstrated excellent diagnostic accuracy for evaluation of acute and late toxicity of parotid glands. Significant differences (P < .05) in all six sonographic features were demonstrated between the control, acute-toxicity, and late-toxicity groups. However, subjective radiologic evaluation cannot distinguish between acute and late toxicity of parotid glands. CONCLUSIONS We demonstrated that ultrasound histogram features could be used to measure acute and late toxicity of the parotid glands after head-and-neck cancer RT, which may be developed into a low-cost imaging method for xerostomia monitoring and assessment.
Collapse
Affiliation(s)
- Xiaofeng Yang
- Department of Radiation Oncology, Emory University, 1365 Clifton Rd NE, Atlanta, GA 30322
| | - Srini Tridandapani
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Jonathan J Beitler
- Department of Radiation Oncology, Emory University, 1365 Clifton Rd NE, Atlanta, GA 30322; Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - David S Yu
- Department of Radiation Oncology, Emory University, 1365 Clifton Rd NE, Atlanta, GA 30322; Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Zhengjia Chen
- Winship Cancer Institute, Emory University, Atlanta, Georgia; Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Sungjin Kim
- Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Deborah W Bruner
- Winship Cancer Institute, Emory University, Atlanta, Georgia; School of Nursing, Emory University, Atlanta, Georgia
| | - Walter J Curran
- Department of Radiation Oncology, Emory University, 1365 Clifton Rd NE, Atlanta, GA 30322; Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Tian Liu
- Department of Radiation Oncology, Emory University, 1365 Clifton Rd NE, Atlanta, GA 30322; Winship Cancer Institute, Emory University, Atlanta, Georgia.
| |
Collapse
|
40
|
Abstract
BACKGROUND Intensity-modulated radiation therapy (IMRT) has been increasingly employed for treating head and neck (H&N) tumours due to its ability to produce isodoses suitable for the complex anatomy of the region. The aim of this study was to assess possible differences between IMRT and conformal radiation therapy (CRT) with regard to risk of radiation-induced secondary malignancies for H&N tumours. MATERIAL AND METHODS IMRT and CRT plans were made for 10 H&N adult patients and the resulting treatment planning data were used to calculate the risk of radiation-induced malignancies in four different tissues. Three risk models with biologically relevant parameters were used for calculations. The influence of scatter radiation and repeated imaging sessions has also been investigated. RESULTS The results showed that the total lifetime risks of developing radiation-induced secondary malignancies from the two treatment techniques, CRT and IMRT, were comparable and in the interval 0.9-2.5%. The risk contributions from the primary beam and scatter radiation were comparable, whereas the contribution from repeated diagnostic imaging was considerably smaller. CONCLUSION The results indicated that the redistribution of the dose characteristic to IMRT leads to a redistribution of the risks in individual tissues. However, the total levels of risk were similar between the two irradiation techniques considered.
Collapse
MESH Headings
- Adult
- Algorithms
- Diagnostic Imaging/adverse effects
- Esophagus/radiation effects
- Female
- Head and Neck Neoplasms/radiotherapy
- Humans
- Hypopharyngeal Neoplasms/radiotherapy
- Lung/radiation effects
- Male
- Neoplasms, Radiation-Induced/etiology
- Neoplasms, Second Primary/etiology
- Organs at Risk/radiation effects
- Parotid Gland/radiation effects
- Phantoms, Imaging
- Photons/therapeutic use
- Radiotherapy Planning, Computer-Assisted/methods
- Radiotherapy, Conformal/adverse effects
- Radiotherapy, Conformal/methods
- Radiotherapy, Image-Guided/adverse effects
- Radiotherapy, Image-Guided/methods
- Radiotherapy, Intensity-Modulated/adverse effects
- Radiotherapy, Intensity-Modulated/methods
- Risk
- Scattering, Radiation
- Sex Factors
- Tongue Neoplasms/radiotherapy
- Tonsillar Neoplasms/radiotherapy
Collapse
Affiliation(s)
- Oscar Ardenfors
- Medical Radiation Physics, Department of Physics, Stockholm University , Stockholm , Sweden
| | | | | |
Collapse
|
41
|
Beetz I, Steenbakkers RJHM, Chouvalova O, Leemans CR, Doornaert P, van der Laan BFAM, Christianen MEMC, Vissink A, Bijl HP, van Luijk P, Langendijk JA. The QUANTEC criteria for parotid gland dose and their efficacy to prevent moderate to severe patient-rated xerostomia. Acta Oncol 2014; 53:597-604. [PMID: 23998646 DOI: 10.3109/0284186x.2013.831186] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Recently, the Quantitative Analysis of Normal Tissue Effect in the Clinic (QUANTEC) Group defined dose-volume constraints for the parotid glands to avoid severe xerostomia. The aim of this study was to determine if application of these QUANTEC criteria also protected against moderate-to-severe patient-rated xerostomia. MATERIAL AND METHODS The study population consisted of 307 head and neck cancer patients treated with primary (chemo)radiotherapy, either with 3D-CRT (56%) or with IMRT (44%). All patients participated in a standard follow-up program in which radiation-induced toxicity and quality of life were prospectively assessed. Patients who met the QUANTEC criteria were classified as low risk and otherwise as high risk. RESULTS In total, 41% of the patients (treated with 3D-CRT and IMRT) were classified as low risk patients. In the group treated with 3D-CRT and IMRT, it was possible to meet the QUANTEC criteria in 47% and 32% of the patients, respectively. Sparing the parotid glands with IMRT was considerably more difficult in patients with lymph node metastases and in patients with nasopharyngeal and oropharyngeal tumours. Low risk patients reported significantly less moderate-to-severe xerostomia than high risk patients. However, the predicted risk of elderly patients and patients with pre-existing minor patient-rated xerostomia at baseline was > 20%, even when the QUANTEC criteria were met. CONCLUSIONS Significantly lower rates of radiation-induced patient-rated xerostomia were found among low risk patients treated according to the QUANTEC criteria, but these criteria do not completely protect against xerostomia. Particularly in elderly patients and patients already suffering from minor xerostomia at baseline, the QUANTEC criteria do not sufficiently protect against persistent, moderate-to-severe patient-rated xerostomia.
Collapse
Affiliation(s)
- Ivo Beetz
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen , Groningen , the Netherlands
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Lin H, Huang S, Deng X, Zhu J, Chen L. Comparison of 3D anatomical dose verification and 2D phantom dose verification of IMRT/VMAT treatments for nasopharyngeal carcinoma. Radiat Oncol 2014; 9:71. [PMID: 24606879 PMCID: PMC4014203 DOI: 10.1186/1748-717x-9-71] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 03/02/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The two-dimensional phantom dose verification (2D-PDV) using hybrid plan and planar dose measurement has been widely used for IMRT treatment QA. Due to the lack of information about the correlations between the verification results and the anatomical structure of patients, it is inadequate in clinical evaluation. A three-dimensional anatomical dose verification (3D-ADV) method was used in this study to evaluate the IMRT/VMAT treatment delivery for nasopharyngeal carcinoma and comparison with 2D-PDV was analyzed. METHODS Twenty nasopharyngeal carcinoma (NPC) patients treated with IMRT/VMAT were recruited in the study. A 2D ion-chamber array was used for the 2D-PDV in both single-gantry-angle composite (SGAC) and multi-gantry-angle composite (MGAC) verifications. Differences in the gamma pass rate between the 2 verification methods were assessed. Based on measurement of irradiation dose fluence, the 3D dose distribution was reconstructed for 3D-ADV in the above cases. The reconstructed dose homogeneity index (HI), conformity index (CI) of the planning target volume (PTV) were calculated. Gamma pass rate and deviations in the dose-volume histogram (DVH) of each PTV and organ at risk (OAR) were analyzed. RESULTS In 2D-PDV, the gamma pass rate (3%, 3 mm) of SGAC (99.55% ± 0.83%) was significantly higher than that of MGAC (92.41% ± 7.19%). In 3D-ADV, the gamma pass rates (3%, 3 mm) were 99.75% ± 0.21% in global, 83.82% ± 16.98% to 93.71% ± 6.22% in the PTVs and 45.12% ± 32.78% to 98.08% ± 2.29% in the OARs. The maximum HI increment in PTVnx was 19.34%, while the maximum CI decrement in PTV1 and PTV2 were -32.45% and -6.93%, respectively. Deviations in dose volume of PTVs were all within ±5%. D2% of the brainstem, spinal cord, left/right optic nerves, and the mean doses to the left/right parotid glands maximally increased by 3.5%, 6.03%, 31.13%/26.90% and 4.78%/4.54%, respectively. CONCLUSION The 2D-PDV and global gamma pass rate might be insufficient to provide an accurate assessment for the complex NPC IMRT operation. In contrast, the 3D-ADV is superior in clinic-related quality assurance offering evaluation of organ specific pass rate and dose-volume deviations.
Collapse
Affiliation(s)
- Hailei Lin
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
- Department of Radiation Oncology, Beijing Hospital of the Ministry of Health, Beijing 100730, China
| | - Shaomin Huang
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Xiaowu Deng
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Jinhan Zhu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
- School of Physics and Engineering, Sun Yat-sen University, Guangzhou 510275, China
| | - Lixin Chen
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| |
Collapse
|
43
|
Yuan L, Wu QJ, Yin FF, Jiang Y, Yoo D, Ge Y. Incorporating single-side sparing in models for predicting parotid dose sparing in head and neck IMRT. Med Phys 2014; 41:021728. [PMID: 24506619 PMCID: PMC3977781 DOI: 10.1118/1.4862075] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Revised: 12/12/2013] [Accepted: 12/30/2013] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Sparing of single-side parotid gland is a common practice in head-and-neck (HN) intensity modulated radiation therapy (IMRT) planning. It is a special case of dose sparing tradeoff between different organs-at-risk. The authors describe an improved mathematical model for predicting achievable dose sparing in parotid glands in HN IMRT planning that incorporates single-side sparing considerations based on patient anatomy and learning from prior plan data. METHODS Among 68 HN cases analyzed retrospectively, 35 cases had physician prescribed single-side parotid sparing preferences. The single-side sparing model was trained with cases which had single-side sparing preferences, while the standard model was trained with the remainder of cases. A receiver operating characteristics (ROC) analysis was performed to determine the best criterion that separates the two case groups using the physician's single-side sparing prescription as ground truth. The final predictive model (combined model) takes into account the single-side sparing by switching between the standard and single-side sparing models according to the single-side sparing criterion. The models were tested with 20 additional cases. The significance of the improvement of prediction accuracy by the combined model over the standard model was evaluated using the Wilcoxon rank-sum test. RESULTS Using the ROC analysis, the best single-side sparing criterion is (1) the predicted median dose of one parotid is higher than 24 Gy; and (2) that of the other is higher than 7 Gy. This criterion gives a true positive rate of 0.82 and a false positive rate of 0.19, respectively. For the bilateral sparing cases, the combined and the standard models performed equally well, with the median of the prediction errors for parotid median dose being 0.34 Gy by both models (p = 0.81). For the single-side sparing cases, the standard model overestimates the median dose by 7.8 Gy on average, while the predictions by the combined model differ from actual values by only 2.2 Gy (p = 0.005). Similarly, the sum of residues between the modeled and the actual plan DVHs is the same for the bilateral sparing cases by both models (p = 0.67), while the standard model predicts significantly higher DVHs than the combined model for the single-side sparing cases (p = 0.01). CONCLUSIONS The combined model for predicting parotid sparing that takes into account single-side sparing improves the prediction accuracy over the previous model.
Collapse
Affiliation(s)
- Lulin Yuan
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina 27710
| | - Q Jackie Wu
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina 27710
| | - Fang-Fang Yin
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina 27710
| | - Yuliang Jiang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China, 100191
| | - David Yoo
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina 27710
| | - Yaorong Ge
- Department of Software and Information Systems, University of North Carolina at Charlotte, Charlotte, North Carolina 28223
| |
Collapse
|
44
|
Pota M, Scalco E, Sanguineti G, Belli ML, Cattaneo GM, Esposito M, Rizzo G. Likelihood-fuzzy analysis of parotid gland shrinkage in radiotherapy patients. Stud Health Technol Inform 2014; 207:360-369. [PMID: 25488242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In head-and-neck radiotherapy, an early detection of patients who will undergo parotid glands shrinkage during the treatment is of primary importance, since this condition has been found to be associated with acute toxicity. In this work, a recently proposed approach, here named Likelihood-Fuzzy Analysis, based on both statistical learning and Fuzzy Logic, is proposed to support the identification of early predictors of parotid shrinkage from Computed Tomography images acquired during radiotherapy. For this purpose, a set of textural image parameters was extracted and considered as candidate of parotid shrinkage prediction; for all these parameters and combinations of maximum three of them, a fuzzy rule base was extracted, gaining very good results in terms of accuracy, sensitivity and specificity. The performance of classification was also compared to a classical Fisher's Linear Discriminant Analysis and found to provide better results. Moreover, the use of Fuzzy Logic allowed obtaining an interpretable description of the relations between textural features and the shrinkage process.
Collapse
Affiliation(s)
- Marco Pota
- Institute for High Performance Computing and Networking (ICAR-CNR), Napoli, Italy
| | - Elisa Scalco
- Institute of Molecular Bioimaging and Physiology (IBFM-CNR), Segrate MI, Italy
| | | | - Maria Luisa Belli
- Medical Physics Department, San Raffaele Scientific Institute, Milano, Italy
| | | | - Massimo Esposito
- Institute for High Performance Computing and Networking (ICAR-CNR), Napoli, Italy
| | - Giovanna Rizzo
- Institute of Molecular Bioimaging and Physiology (IBFM-CNR), Segrate MI, Italy
| |
Collapse
|
45
|
Kouloulias V, Thalassinou S, Platoni K, Zygogianni A, Kouvaris J, Antypas C, Efstathopoulos E, Nikolaos K. The treatment outcome and radiation-induced toxicity for patients with head and neck carcinoma in the IMRT era: a systematic review with dosimetric and clinical parameters. Biomed Res Int 2013; 2013:401261. [PMID: 24228247 PMCID: PMC3818806 DOI: 10.1155/2013/401261] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 08/08/2013] [Accepted: 08/22/2013] [Indexed: 12/16/2022]
Abstract
A descriptive analysis was made in terms of the related radiation induced acute and late mucositis and xerostomia along with survival and tumor control rates (significance level at 0.016, bonferroni correction), for irradiation in head and neck carcinomas with either 2D Radiation Therapy (2DRT) and 3D conformal (3DCRT) or Intensity Modulated Radiation Therapy (IMRT). The mean score of grade > II xerostomia for IMRT versus 2-3D RT was 0.31 ± 0.23 and 0.56 ± 0.23, respectively (Mann Whitney, P < 0.001). The parotid-dose for IMRT versus 2-3D RT was 29.56 ± 5.45 and 50.73 ± 6.79, respectively (Mann Whitney, P = 0.016). The reported mean parotid-gland doses were significantly correlated with late xerostomia (spearman test, rho = 0.5013, P < 0.001). A trend was noted for the superiority of IMRT concerning the acute oral mucositis. The 3-year overall survival for either IMRT or 2-3DRT was 89.5% and 82.7%, respectively (P = 0.026, Kruskal-Wallis test). The mean 3-year locoregional control rate was 83.6% (range: 70-97%) and 74.4 (range: 61-82%), respectively (P = 0.025, Kruskal-Wallis). In conclusion, no significant differences in terms of locoregional control, overall survival and acute mucositis could be noted, while late xerostomia is definitely higher in 2-3D RT versus IMRT. Patients with head and neck carcinoma should be referred preferably to IMRT techniques.
Collapse
Affiliation(s)
- Vassilis Kouloulias
- Second Department of Radiology, Radiotherapy Unit, Attikon University Hospital, Medical School, Rimini 1, Xaidari, 12462 Athens, Greece
| | - Stella Thalassinou
- Second Department of Radiology, Radiotherapy Unit, Attikon University Hospital, Medical School, Rimini 1, Xaidari, 12462 Athens, Greece
| | - Kalliopi Platoni
- Second Department of Radiology, Radiotherapy Unit, Attikon University Hospital, Medical School, Rimini 1, Xaidari, 12462 Athens, Greece
| | - Anna Zygogianni
- First Department of Radiology, Radiotherapy Unit, Aretaieion University Hospital, Medical School, Vas. Sofias 76, 11528 Athens, Greece
| | - John Kouvaris
- First Department of Radiology, Radiotherapy Unit, Aretaieion University Hospital, Medical School, Vas. Sofias 76, 11528 Athens, Greece
| | - Christos Antypas
- First Department of Radiology, Radiotherapy Unit, Aretaieion University Hospital, Medical School, Vas. Sofias 76, 11528 Athens, Greece
| | - Efstathios Efstathopoulos
- Second Department of Radiology, Radiotherapy Unit, Attikon University Hospital, Medical School, Rimini 1, Xaidari, 12462 Athens, Greece
| | - Kelekis Nikolaos
- Second Department of Radiology, Radiotherapy Unit, Attikon University Hospital, Medical School, Rimini 1, Xaidari, 12462 Athens, Greece
| |
Collapse
|
46
|
Cheng CC, Chiu SC, Jen YM, Chang HC, Chung HW, Liu YJ, Chiu HC, Chen CY, Huang GS, Juan CJ. Parotid perfusion in nasopharyngeal carcinoma patients in early-to-intermediate stage after low-dose intensity-modulated radiotherapy: evaluated by fat-saturated dynamic contrast-enhanced magnetic resonance imaging. Magn Reson Imaging 2013; 31:1278-84. [PMID: 23664679 DOI: 10.1016/j.mri.2013.03.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Revised: 12/13/2012] [Accepted: 03/14/2013] [Indexed: 11/19/2022]
Abstract
PURPOSE To investigate parotid perfusion in early-to-intermediate stage after parotid-sparing radiation dose using fat-saturated DCE-MRI, and to verify whether the perfusion alteration was related to radiation dose and the PSV. METHODS AND MATERIALS Thirty-two parotid glands from 16 consecutive patients with pathologically proven nasopharyngeal carcinoma treated by IMRT were examined. The parotid glands received a radiation dose of 28.9±3.9Gy with a PSV of 43.1%±13.9%. Perfusion parameters were calculated using time-shifted Brix model from fat-saturated DCE-MRI data before (pre-RT) and in early-to-intermediate stage after (post-RT) IMRT. Paired t-test was used to evaluate perfusion changes, while Pearson's correlation test was used to examine perfusion dependency on radiation dose and PSV. For multiple comparisons Bonferroni correction was applied. RESULTS Successful fat saturation was achieved in 29 of 32 parotid glands. Compared with pre-RT, the post-RT parotid glands showed significantly higher A, peak enhancement, and wash-in slope, plus a lower Kel, suggesting a mixed effect of increased vascular permeability and acinar loss. Linear regression showed that peak enhancement was positively associated with radiation dose in post-RT parotid glands. Kel and slope were negatively associated with PSV, while time-to-peak was positively associated with PSV significantly. CONCLUSIONS Our results suggest that time-shifted Brix model is feasible for quantifying parotid perfusion using DCE-MRI. The perfusion alterations in early-to-intermediate stage after IMRT might be related to a mixed effect of increased vascular permeability and acinar loss with dose and PSV dependencies.
Collapse
Affiliation(s)
- Cheng-Chieh Cheng
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan, Republic of China; Department of Radiology, Tri-Service General Hospital, Taipei, Taiwan, Republic of China
| | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Al-Okshi A, Nilsson M, Petersson A, Wiese M, Lindh C. Using GafChromic film to estimate the effective dose from dental cone beam CT and panoramic radiography. Dentomaxillofac Radiol 2013; 42:20120343. [PMID: 23610090 PMCID: PMC3699970 DOI: 10.1259/dmfr.20120343] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 04/10/2013] [Accepted: 04/11/2013] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To demonstrate the feasibility of GafChromic(®) XR-QA2 (ISP Corp., Wayne, NJ) as a dosemeter when performing measurements of the effective dose from three cone beam CT (CBCT) units and to compare the doses from examinations of three common dental clinical situations. A second aim was to compare the radiation doses for three digital panoramic units with the doses for the CBCT units. METHODS The CBCT units used were Veraviewepocs 3De(®) (J Morita MFG Corp., Kyoto, Japan), ProMax(®) 3D (Planmeca, Helsinki, Finland) and NewTom VGi(®) (Quantitative Radiology, Verona, Italy). GafChromic XR-QA2 films were placed between the selected layers of the head and neck of a tissue-equivalent human skull (RANDO(®) phantom; The Phantom Laboratory, Salem, NY). The exposure parameters were set using the automatic exposure control function of the units. Depending on the availability, medium and smaller field of view (FOV) scanning modes were used. The effective dose was estimated using the 2007 International Commission on Radiological Protection formalism. RESULTS The lowest effective dose of a CBCT unit was observed for ProMax 3D, FOV 4 × 5 cm (10 μSv), the highest for NewTom VGi, FOV 8 × 8 cm-high resolution (129 μSv). The range of effective doses for digital panoramic machines measured was 8-14 μSv. CONCLUSIONS This study demonstrates the feasibility of using radiochromic films for dental CBCT and panoramic dosimetry.
Collapse
Affiliation(s)
- A Al-Okshi
- Department of Oral and Maxillofacial Radiology, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - M Nilsson
- Department of Oral and Maxillofacial Radiology, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - A Petersson
- Department of Oral and Maxillofacial Radiology, Faculty of Odontology, Malmö University, Malmö, Sweden
- Department of Radiology, University of Copenhagen, Copenhagen, Denmark
| | - M Wiese
- Department of Radiology, University of Copenhagen, Copenhagen, Denmark
| | - C Lindh
- Department of Oral and Maxillofacial Radiology, Faculty of Odontology, Malmö University, Malmö, Sweden
| |
Collapse
|
48
|
Su YX, Benedek GA, Sieg P, Liao GQ, Dendorfer A, Meller B, Rades D, Klinger M, Hakim SG. Radioprotective effect of lidocaine on neurotransmitter agonist-induced secretion in irradiated salivary glands. PLoS One 2013; 8:e60256. [PMID: 23555936 PMCID: PMC3612107 DOI: 10.1371/journal.pone.0060256] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Accepted: 02/24/2013] [Indexed: 02/04/2023] Open
Abstract
Background Previously we verified the radioprotective effect of lidocaine on the function and ultrastructure of salivary glands in rabbits. However, the underlying mechanism of lidocaine's radioprotective effect is unknown. We hypothesized that lidocaine, as a membrane stabilization agent, has a protective effect on intracellular neuroreceptor-mediated signaling and hence can help preserve the secretory function of salivary glands during radiotherapy. Methods and Materials Rabbits were irradiated with or without pretreatment with lidocaine before receiving fractionated radiation to a total dose of 35 Gy. Sialoscintigraphy and saliva total protein assay were performed before radiation and 1 week after the last radiation fraction. Isolated salivary gland acini were stimulated with either carbachol or adrenaline. Ca2+ influx in response to the stimulation with these agonists was measured using laser scanning confocal microscopy. Results The uptake of activity and the excretion fraction of the parotid glands were significantly reduced after radiation, but lidocaine had a protective effect. Saliva total protein concentration was not altered after radiation. For isolated acini, Ca2+ influx in response to stimulation with carbachol, but not adrenaline, was impaired after irradiation; lidocaine pretreatment attenuated this effect. Conclusions Lidocaine has a radioprotective effect on the capacity of muscarinic agonist-induced water secretion in irradiated salivary glands.
Collapse
Affiliation(s)
- Yu-xiong Su
- Department of Oral and Maxillofacial Surgery, University of Luebeck, Luebeck, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Ramaekers BLT, Grutters JPC, Pijls-Johannesma M, Lambin P, Joore MA, Langendijk JA. Protons in head-and-neck cancer: bridging the gap of evidence. Int J Radiat Oncol Biol Phys 2012; 85:1282-8. [PMID: 23273998 DOI: 10.1016/j.ijrobp.2012.11.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 10/29/2012] [Accepted: 11/01/2012] [Indexed: 11/18/2022]
Abstract
PURPOSE To use Normal Tissue Complication Probability (NTCP) models and comparative planning studies to explore the (cost-)effectiveness of swallowing sparing intensity modulated proton radiotherapy (IMPT) compared with swallowing sparing intensity modulated radiotherapy with photons (IMRT) in head and neck cancer (HNC). METHODS AND MATERIALS A Markov model was constructed to examine and compare the costs and quality-adjusted life years (QALYs) of the following strategies: (1) IMPT for all patients; (2) IMRT for all patients; and (3) IMPT if efficient. The assumption of equal survival for IMPT and IMRT in the base case analysis was relaxed in a sensitivity analysis. RESULTS Intensity modulated proton radiation therapy and IMRT for all patients yielded 6.620 and 6.520 QALYs and cost €50,989 and €41,038, respectively. Intensity modulated proton radiation therapy if efficient yielded 6.563 QALYs and cost €43,650. The incremental cost-effectiveness ratio of IMPT if efficient versus IMRT for all patients was €60,278 per QALY gained. In the sensitivity analysis, IMRT was more effective (0.967 QALYs) and less expensive (€8218) and thus dominated IMPT for all patients. CONCLUSIONS Cost-effectiveness analysis based on normal tissue complication probability models and planning studies proved feasible and informative and enables the analysis of individualized strategies. The increased effectiveness of IMPT does not seem to outweigh the higher costs for all head-and-neck cancer patients. However, when assuming equal survival among both modalities, there seems to be value in identifying those patients for whom IMPT is cost-effective.
Collapse
Affiliation(s)
- Bram L T Ramaekers
- Department of Health Services Research, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
| | | | | | | | | | | |
Collapse
|
50
|
Xu CJ, van der Schaaf A, Van't Veld AA, Langendijk JA, Schilstra C. Statistical Validation of Normal Tissue Complication Probability Models. Int J Radiat Oncol Biol Phys 2012; 84:e123-9. [PMID: 22541961 DOI: 10.1016/j.ijrobp.2012.02.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 01/13/2012] [Accepted: 02/09/2012] [Indexed: 12/25/2022]
Affiliation(s)
- Cheng-Jian Xu
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | | | | | | | | |
Collapse
|