Prospective study of sequential volumetric changes of parotid gland in early oropharyngeal carcinoma patients treated by intensity-modulated radiation therapy: An institutional experience

Aims and Objectives: During course of radiation therapy, anatomical variations occur risking overdose of parotid gland. We tried to quantify volume of parotid gland and mean dose to parotid gland after every 10 fractions (#). Materials and Methods: We conducted the prospective study from July 2016 to May 2017 in 25 patients of early-stage oropharyngeal carcinoma. Patients had Karnofsy Performance Score of 80-100, median age was 54 years, and 18 patients were males. Patients were planned with intensity-modulated radiation therapy planning with dose as 66 Gy/30# to planning target volume (PTV) including primary and 54 Gy/30# to PTV-nodal including elective neck irradiation. After each 10#, replanning was done, and variations in parotid volume were studied including D-mean (mean dose to parotids) and D-50 (the dose delivered to 50% of volume). Other tumor characteristic like PTV of primary was also assessed and minimum PTV volume covered by 95% isodose line was kept as 95%. Results: Average parotid volumes decreased by the mean value of 10% and 6% for the left and right parotids, respectively, and PTV of primary target decreased by mean of 13%. The difference in D-mean doses to parotid glands was 32% and 42% and difference in D-50 dose was 30% and 35% on the left and right side, respectively. Conclusions: The parotid volumes differ considerably during adaptive planning done after every ten fractions. These differences in parotid volumes and doses received to parotid glands play a significant role in the risk of xerostomia observed during later follow-up.