Sparing all salivary glands with IMRT for head and neck cancer: Longitudinal study of patient-reported xerostomia and head-and-neck quality of life

被引：78

作者：

Hawkins, Peter G. ^{[1
]}

Lee, Jae Y. ^{[1
]}

Mao, Yanping ^{[2
]}

Li, Pin ^{[3
]}

Green, Michael ^{[1
]}

Worden, Francis P. ^{[4
]}

Swiecicki, Paul L. ^{[4
]}

Mierzwa, Michelle L. ^{[1
]}

Spector, Matthew E. ^{[5
]}

Schipper, Matthew J. ^{[1
,3
]}

Eisbruch, Avraham ^{[1
]}

机构：

[1] Univ Michigan, Dept Radiat Oncol, 1500 E Med Ctr Dr, Ann Arbor, MI 48109 USA

[2] Sun Yat Sen Univ, Dept Radiat Oncol, Canc Ctr, Guangzhou, Guangdong, Peoples R China

[3] Univ Michigan, Dept Biostat, Ann Arbor, MI 48109 USA

[4] Univ Michigan, Dept Internal Med, Div Med Oncol, Ann Arbor, MI 48109 USA

[5] Univ Michigan, Dept Otolaryngol Head & Neck Surg, Ann Arbor, MI 48109 USA

来源：

RADIOTHERAPY AND ONCOLOGY | 2018年 / 126卷 / 01期

关键词：

Xerostomia; IMRT; Patient-reported outcomes; Head-and-neck cancer; INTENSITY-MODULATED RADIOTHERAPY; 3-DIMENSIONAL CONFORMAL RADIOTHERAPY; CONTRALATERAL SUBMANDIBULAR-GLAND; NASOPHARYNGEAL CARCINOMA PATIENTS; RANDOMIZED CONTROLLED-TRIAL; SQUAMOUS-CELL CARCINOMA; RATED XEROSTOMIA; STICKY SALIVA; RADIATION-THERAPY; ORAL-CAVITY;

D O I：

10.1016/j.radonc.2017.08.002

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Background and purpose: While parotid-sparing intensity modulated radiotherapy (IMRT) has demonstrated superiority to conventional RT in terms of observer-rated xerostomia, patient-reported outcome measures (PROMS) have only marginally improved. We investigated how sparing all salivary glands affects PROMS. Materials and methods: Patients treated to the bilateral neck with all-gland-sparing IMRT answered xerostomia (XQ) and head-and-neck quality of life (HNQOL) questionnaires. Longitudinal regression was used to assess the relationship between questionnaire scores and mean bilateral parotid gland (bPG), contralateral submandibular gland (cSMG), and oral cavity (OC) doses. Marginal R-2 and Akaike information criterion (AIC) were used for model evaluation. Results: 252 patients completed approximately 600 questionnaires. On univariate analysis, bPG, cSMG, and OC doses significantly correlated with XQ-summary, XQ-eating, and HNQOL-eating scores. On multivariate analysis, bPG and OC doses significantly correlated with XQ-summary, XQ-eating, and HNQOL-eating scores; and cSMG dose with HNQOL-summary. Combining doses to all three structures yielded the highest R-2 for XQ-summary, XQ-rest, XQ-eating, and HNQOL-eating. In the 147 patients who received a mean cSMG dose <= 39 Gy, there were no failures in contralateral level IB. Conclusions: Reducing doses to all salivary glands maximizes PROMS. A cSMG dose constraint of <= 39 Gy does not increase failure risk. (C) 2017 Elsevier B.V. All rights reserved.

引用

页码：68 / 74

页数：7

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