World Journal of Surgery

, Volume 27, Issue 7, pp 832–837 | Cite as

Salivary Gland Sparing and Improved Target Irradiation by Conformal and Intensity Modulated Irradiation of Head and Neck Cancer

  • Avraham Eisbruch
  • Jonathan A. Ship
  • Laura A. Dawson
  • Hyungjin M. Kim
  • Carol R. Bradford
  • Jeffrey E. Terrell
  • Douglas B. Chepeha
  • Theodore N. Teknos
  • Norman D. Hogikyan
  • Yoshimi Anzai
  • Lon H. Marsh
  • Randall K. Ten Haken
  • Gregory T. Wolf
World Progress in Surgery


The goals of this study were to facilitate sparing of the major salivary glands while adequately treating tumor targets in patients requiring comprehensive bilateral neck irradiation (RT), and to assess the potential for improved xerostomia. Since 1994 techniques of target irradiation and locoregional tumor control with conformal and intensity modulated radiation therapy (IMRT) have been developed. In patients treated with these modalities, the salivary flow rates before and periodically after RT have been measured selectively from each major salivary gland and the residual flows correlated with glands’ dose volume histograms (DVHs). In addition, subjective xerostomia questionnaires have been developed and validated. The pattern of locoregional recurrence has been examined from computed tomography (CT) scans at the time of recurrence, transferring the recurrence volumes to the planning CT scans, and regenerating the dose distributions at the recurrence sites. Treatment plans for target coverage and dose homogeneity using static, multisegmental IMRT were found to be significantly better than standard RT plans. In addition, significant parotid gland sparing was achieved in the conformal plans. The relationships among dose, irradiated volume, and the residual saliva flow rates from the parotid glands were characterized by dose and volume thresholds. A mean radiation dose of 26 Gy was found to be the threshold for preserved stimulated saliva flow. Xerostomia questionnaire scores suggested that xerostomia was significantly reduced in patients irradiated with bilateral neck, parotid-sparing RT, compared to patients with similar tumors treated with standard RT. Examination of locoregional tumor recurrence patterns revealed that the large majority of recurrences occurred inside targets, in areas that had been judged to be at high risk and that had received RT doses according to the perceived risk. Tangible gains in salivary gland sparing and target coverage are being achieved, and an improvement in some measures of quality of life is suggested by our findings. Additional reduction of xerostomia may be achieved by further sparing of the salivary glands and the non-involved oral cavity. A mean parotid gland dose of ≤ 26 Gy should be a planning objective if significant parotid function preservation is desired. The pattern of recurrence suggests that careful escalation of the dose to areas judged to be at highest risk may improve tumor control.


Intensity Modulate Radiation Therapy Amifostine Salivary Flow Rate Major Salivary Gland Saliva Flow Rate 



This work was supported in part by National Institutes of Health grant CA78165.


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Copyright information

© Société Internationale de Chirurgie 2003

Authors and Affiliations

  • Avraham Eisbruch
    • 1
  • Jonathan A. Ship
    • 2
  • Laura A. Dawson
    • 1
  • Hyungjin M. Kim
    • 3
  • Carol R. Bradford
    • 4
  • Jeffrey E. Terrell
    • 4
  • Douglas B. Chepeha
    • 4
  • Theodore N. Teknos
    • 4
  • Norman D. Hogikyan
    • 4
  • Yoshimi Anzai
    • 5
  • Lon H. Marsh
    • 1
  • Randall K. Ten Haken
    • 1
  • Gregory T. Wolf
    • 4
  1. 1.Department of Radiation OncologyUniversity of MichiganAnn Arbor
  2. 2.New York University College of DentistryNew York
  3. 3.Department of Biostatistics, University of MichiganAnn Arbor
  4. 4.Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of MichiganAnn Arbor
  5. 5.Department of RadiologyUniversity of MichiganAnn Arbor

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