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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.

Kouloulias V, Thalassinou S, Platoni K, Zygogianni A, Kouvaris J, Antypas C, Efstathopoulos E, Nikolaos K - Biomed Res Int (2013)

Bottom Line: The reported mean parotid-gland doses were significantly correlated with late xerostomia (spearman test, rho = 0.5013, P < 0.001).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.

View Article: PubMed Central - PubMed

Affiliation: Second Department of Radiology, Radiotherapy Unit, Attikon University Hospital, Medical School, Rimini 1, Xaidari, 12462 Athens, Greece.

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.

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Related in: MedlinePlus

Comparison of the right and left parotid-gland DVHs of the same head and neck cancer patient (tumor site: oral cavity) for IMRT versus 3DCRT (3-dimensional conformal radiotherapy) technique. The arrows show the relevant DVHs for left and right parotid glands. A and B DVHs for parotids are shifted to the left (C and D) with IMRT techniques resulting in lower doses in the parotid glands (personal archive).
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fig4: Comparison of the right and left parotid-gland DVHs of the same head and neck cancer patient (tumor site: oral cavity) for IMRT versus 3DCRT (3-dimensional conformal radiotherapy) technique. The arrows show the relevant DVHs for left and right parotid glands. A and B DVHs for parotids are shifted to the left (C and D) with IMRT techniques resulting in lower doses in the parotid glands (personal archive).

Mentions: The mean parotid-gland doses for patients treated with IMRT were significantly lower compared with the mean parotid-gland doses of patients treated with 2-3D RT (Mann Whitney, P = 0.016). Furthermore, a significant correlation of late xerostomia and the mean parotid-gland dose was found (spearman test, rho = 0.5013, P < 0.001). Numerous studies have also reported significant correlation between the mean parotid dose and salivary flow after RT and the rate of patients suffer from xerostomia [17, 60–66]. A typical IMRT plan with parotid sparing technique for oral cavity carcinoma is shown in Figure 3. Furthermore, the direct comparison of dose volume histogram (DVH) for the right and left parotid gland between IMRT and 3DCRT is presented in Figure 4. The results clearly demonstrate the superiority of IMRT technique in terms of toxicity, mainly due to parotid-gland sparing.


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.

Kouloulias V, Thalassinou S, Platoni K, Zygogianni A, Kouvaris J, Antypas C, Efstathopoulos E, Nikolaos K - Biomed Res Int (2013)

Comparison of the right and left parotid-gland DVHs of the same head and neck cancer patient (tumor site: oral cavity) for IMRT versus 3DCRT (3-dimensional conformal radiotherapy) technique. The arrows show the relevant DVHs for left and right parotid glands. A and B DVHs for parotids are shifted to the left (C and D) with IMRT techniques resulting in lower doses in the parotid glands (personal archive).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3818806&req=5

fig4: Comparison of the right and left parotid-gland DVHs of the same head and neck cancer patient (tumor site: oral cavity) for IMRT versus 3DCRT (3-dimensional conformal radiotherapy) technique. The arrows show the relevant DVHs for left and right parotid glands. A and B DVHs for parotids are shifted to the left (C and D) with IMRT techniques resulting in lower doses in the parotid glands (personal archive).
Mentions: The mean parotid-gland doses for patients treated with IMRT were significantly lower compared with the mean parotid-gland doses of patients treated with 2-3D RT (Mann Whitney, P = 0.016). Furthermore, a significant correlation of late xerostomia and the mean parotid-gland dose was found (spearman test, rho = 0.5013, P < 0.001). Numerous studies have also reported significant correlation between the mean parotid dose and salivary flow after RT and the rate of patients suffer from xerostomia [17, 60–66]. A typical IMRT plan with parotid sparing technique for oral cavity carcinoma is shown in Figure 3. Furthermore, the direct comparison of dose volume histogram (DVH) for the right and left parotid gland between IMRT and 3DCRT is presented in Figure 4. The results clearly demonstrate the superiority of IMRT technique in terms of toxicity, mainly due to parotid-gland sparing.

Bottom Line: The reported mean parotid-gland doses were significantly correlated with late xerostomia (spearman test, rho = 0.5013, P < 0.001).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.

View Article: PubMed Central - PubMed

Affiliation: Second Department of Radiology, Radiotherapy Unit, Attikon University Hospital, Medical School, Rimini 1, Xaidari, 12462 Athens, Greece.

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.

Show MeSH
Related in: MedlinePlus