1. Volumetric changes of the parotid gland during IMRT based on mid-treatment imaging: implications for parotid stem cell sparing strategies in head and neck cancer.
- Author
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Gjini, Megi, Ahmed, Sadia, Kalnicki, Shalom, Tomé, Wolfgang A., Garg, Madhur K., Kabarriti, Rafi, and Brodin, N. Patrik
- Subjects
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STATISTICS , *HEAD & neck cancer , *REGRESSION analysis , *TREATMENT effectiveness , *DOSE-response relationship (Radiation) , *RADIATION doses , *STEM cells , *XEROSTOMIA , *DESCRIPTIVE statistics , *PAROTID glands , *RADIOTHERAPY , *COMPUTED tomography , *LOGISTIC regression analysis , *RECEIVER operating characteristic curves , *DISEASE risk factors - Abstract
To evaluate the change in parotid glands at mid-treatment during IMRT and the association between radiation dose to the parotid gland stem cell (PGSC) region and patient-reported xerostomia for patients with head and neck cancer (HNC). Patients who were treated from 2006–2012 at our institution with patient-reported xerostomia outcomes available at least 9 months following RT were included. PG and PGSC regions were delineated and the dose was estimated from the treatment plan dose distribution, using contours from pre- and mid-treatment CT scans. The association between radiation dose and volumetric changes was assessed using linear regression. Univariable logistic regression, logistic dose-response curves, and receiver operating characteristics (ROC) were used to examine the relationship between radiation dose and patient-reported xerostomia. Sixty-three patients were included, most treated with 70 Gy in 33 fractions; 34 patients had mid-treatment CT scans. Both contralateral and ipsilateral PGs had considerable volume reduction from baseline to mid-treatment (25% and 27%, respectively, both p <.001), significantly associated with mean PG dose (−0.44%/Gy, p =.008 and −0.54%/Gy, p <.001, respectively). There was a > 5 Gy difference in mean PG and PGSC dose for 8/34 patients at mid-treatment, with 6/8 (75%) reporting severe xerostomia. Xerostomia prediction based on whole PG or PGSC region dose showed similar performance (ROC AUC 0.754 and 0.749, respectively). The corresponding dose-response models also predicted similar risk of patient-reported xerostomia with mean dose to the contralateral PG (32.5%) or PGSC region (31.4%) at the 20 Gy QUANTEC-recommended sparing level. The radiation dose to the PGSC region did not show stronger association with patient-reported xerostomia compared to that of whole PG, possibly due to considerable anatomical changes identified at mid-treatment. This shift in the size and position of the PG warrants adaptive planning strategies to evaluate the true benefit of parotid stem cell sparing. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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