Identifying dose constraints for the parotid ducts to minimize patient-reported xerostomia: Is conventional mean dose sparing of the parotid glands sufficient?

IF 2 4区医学 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of Applied Clinical Medical Physics Pub Date : 2024-09-17 DOI:10.1002/acm2.14515

Manal Ahmidouch, Shiva K. Das, Tong Zhu, Colette Shen, Lawrence B. Marks, Bhishamjit S. Chera, David V. Fried

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Abstract

Background and purpose

The aim of this study was to identify dose constraints for the parotid ducts that limit patient-reported xerostomia and estimate whether these constraints are achieved during conventional parotid gland sparing radiation therapy (PGS-RT).

Methods and materials

Thirty-eight oropharyngeal squamous cell carcinoma patients were treated prospectively on trial with MRI sialography-guided parotid duct sparing radiation therapy (PDS-RT). PDS-RT explicitly minimizes dose to the parotid ducts in addition to PGS-RT. Parotid duct dose constraints were identified that distinguished patients reporting high and low rates of xerostomia. Atlas-based parotid duct contours were generated on a retrospective cohort of similar patients where the parotid ducts were not contoured nor explicitly spared to estimate the dose received by the parotid ducts during PGS-RT.

Results

Patients whose intraglandular parotid ducts or total parotid ducts were planned for a mean dose < 14 Gy and < 12 Gy, respectively, reported significantly (p < 0.01) lower rates of xerostomia at 6 and 12 months post-RT. Patients receiving PDS-RT had average total and intraglandular duct doses of 11.6 and 13.6 Gy, respectively, compared to an estimated 23.8 and 22.1 Gy, for those receiving PGS-RT (p < 0.01). Only 6% (6/108) and 20% (22/108) of patients receiving PGS-RT were estimated to meet the dose constraints for the total ducts and intraglandular ducts, respectively.

Conclusion

Parotid duct dose thresholds exist that appear to distinguish patients with and without xerostomia. The identified dose thresholds are frequently not met in PGS-RT plans. In addition to reducing the dose to the parotid gland(s), parotid duct sparing may also further reduce xerostomia.

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确定腮腺导管的剂量限制，最大限度地减少患者报告的口腔干燥症：传统的腮腺平均剂量疏导是否足够？

背景和目的本研究旨在确定限制患者报告的口腔异物感的腮腺导管剂量约束，并估计在常规腮腺疏导放射治疗（PGS-RT）中是否能实现这些约束。方法和材料38例口咽鳞状细胞癌患者接受了磁共振腮腺造影引导的腮腺导管疏导放射治疗（PDS-RT）的前瞻性试验治疗。PDS-RT在PGS-RT的基础上明确将腮腺导管的剂量降至最低。研究发现，腮腺导管剂量限制可区分口干症发生率高和低的患者。结果腺内腮腺导管或总腮腺导管的计划平均剂量分别为14 Gy和12 Gy的患者，在PGS-RT术后6个月和12个月时的口干症发生率显著降低（P为0.01）。接受PDS-RT治疗的患者的平均总剂量和腺管内剂量分别为11.6 Gy和13.6 Gy，而接受PGS-RT治疗的患者的平均总剂量和腺管内剂量分别为23.8 Gy和22.1 Gy (p <0.01)。在接受 PGS-RT 的患者中，估计分别只有 6% （6/108）和 20% （22/108）的患者符合总导管和腺内导管的剂量限制。在 PGS-RT 计划中，已确定的剂量阈值经常无法达到。除了减少腮腺的剂量外，疏通腮腺导管还可以进一步减少口腔异味。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Applied Clinical Medical Physics 医学-核医学

CiteScore

3.60

自引率

19.00%

发文量

331

审稿时长

3 months

期刊介绍： Journal of Applied Clinical Medical Physics is an international Open Access publication dedicated to clinical medical physics. JACMP welcomes original contributions dealing with all aspects of medical physics from scientists working in the clinical medical physics around the world. JACMP accepts only online submission. JACMP will publish: -Original Contributions: Peer-reviewed, investigations that represent new and significant contributions to the field. Recommended word count: up to 7500. -Review Articles: Reviews of major areas or sub-areas in the field of clinical medical physics. These articles may be of any length and are peer reviewed. -Technical Notes: These should be no longer than 3000 words, including key references. -Letters to the Editor: Comments on papers published in JACMP or on any other matters of interest to clinical medical physics. These should not be more than 1250 (including the literature) and their publication is only based on the decision of the editor, who occasionally asks experts on the merit of the contents. -Book Reviews: The editorial office solicits Book Reviews. -Announcements of Forthcoming Meetings: The Editor may provide notice of forthcoming meetings, course offerings, and other events relevant to clinical medical physics. -Parallel Opposed Editorial: We welcome topics relevant to clinical practice and medical physics profession. The contents can be controversial debate or opposed aspects of an issue. One author argues for the position and the other against. Each side of the debate contains an opening statement up to 800 words, followed by a rebuttal up to 500 words. Readers interested in participating in this series should contact the moderator with a proposed title and a short description of the topic