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Investigations on Parotid Gland Recovery after IMRT in Head and Neck Tumor Patients

Untersuchungen zum Erholungsverhalten der Parotis nach IMRT-Bestrahlung von Kopf-Hals Tumoren

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In recent years, the role of intensity-modulated radiotherapy (IMRT) for head and neck irradiation has increased. The main motivation is sparing the parotid gland and reduction of xerostomia. Generally, relative parotid volumes have been evaluated for treatment outcome and planning constraints, neglecting that absolute parotid volumes can vary significantly. The aim of the present study was to investigate changes in parotid gland function and set this in relation to absolute volumes.

Material and Methods:

: 46 head and neck patients were treated by sparing at least the contralateral parotid gland. The mean dose to the contralateral gland was limited to 26 Gy. Parotid function was measured with scintigraphy before and at 3, 6, 9, and 12 months after radiotherapy. Gland recovery was correlated with absolute parotid gland volumes and mean dose. Finally the dose–effect relationship was investigated.


The dose–volume histograms (DVHs) for the ipsi- and contralateral glands were significantly different. A correlation between absolute volumes receiving certain doses and the function loss after 3, 6, 9, and 12 months was found. The most significant correlation was found for the absolute volume that received at least 40 Gy (aV40). ED50 values of 23–38 Gy were observed for more than 50% function loss and and 52–68 Gy afor more than 75% function loss.


The mean dose, aV40 or aV26, revealed similar correlations with the excretion rate and with recovery. Hence, also absolute volumes can be used for treatment planning. Longer recovery times show higher ED50 values indicating partial regeneration of gland functions.


In den letzten Jahren gewann die Intensitätsmodulierte Strahlentherapie (IMRT) bei der Behandlung von Kopf-Hals Tumoren immer mehr an Bedeutung. Hauptbeweggrund dafür ist die mögliche Schonung der Ohrspeicheldrüse und somit eine Reduktion von Xerostomie. Bisher wurden hauptsächlich relative Parotisvolumina für die Korrelation mit dem Behandlungserfolg und zur Schwellwertvorgabe in der Bestrahlungsplanung verwendet. Vernachlässigt wurde jedoch dabei eine signifikante Variabilität der absoluten Parotisvolumina. Ziel dieser Studie war es deshalb, Funktionsveränderungen zu quantifizieren und mit absoluten Volumina zu korrelieren.

Material und Methoden:

46 Kopf-Hals Patienten wurden mit IMRT behandelt und dabei wurde die kontralaterale Parotis geschont. Deren mittlere Dosis wurde dabei auf 26 Gy limitiert. Die Speicheldrüsenfunktion wurde mittels Szintigraphie vor sowie 3, 6, 9 und 12 Monate nach der Therapie erfasst. Das Erholungsverhalten wurde zu den absoluten Volumina und mittleren Dosen in Korrelation gesetzt. Abschließend wurde die Dosis-Wirkungs Beziehung untersucht.


DVHs für ipsi- and contralaterale Parotis unterschieden sich signifikant. Korrelationen zeigten sich zwischen absoluten Volumina und Funktionsveränderungen nach 3, 6, 9 und 12 Monaten. Korrelation mit der höchsten Signifikanz erwies sich beim Volumen welches mehr als 40 Gy erhalten hatte (aV40). ED50 Werte von 23–38 Gy und 52–68 Gy wurden für mehr als 50 bzw. 75% Funktionsverlust beobachtet.


Die mittlere Dosis wie auch aV40 oder aV26 führen zu denselben Korrelationen mit der Funktionsveränderung der Parotis. Somit können auch absolute Volumina bei der Planungsvorgabe verwendet werden. Längere Zeitabstände zur Therapie ergaben auch höhere ED50 Werte, was auf eine partielle Regeneration der Speicheldrüse schließen lässt.

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Correspondence to Markus Stock PhD.

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Stock, M., Dörr, W., Stromberger, C. et al. Investigations on Parotid Gland Recovery after IMRT in Head and Neck Tumor Patients. Strahlenther Onkol 186, 665–671 (2010).

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