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Xerostomia after radiotherapy

What matters—mean total dose or dose to each parotid gland?

Xerostomie nach Strahlentherapie

Was ist klinisch relevant – die durchschnittliche Gesamtdosis oder die Dosis in jeder Parotis?

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Abstract

Purpose

Xerostomia is a debilitating side effect of radiotherapy in patients with head and neck cancer. We undertook a prospective study of the effect on xerostomia and outcomes of sparing one or both parotid glands during radiotherapy for patients with squamous cell carcinoma of the head and neck.

Methods and materials

Patients with locally advanced squamous cell carcinoma of the head and neck received definitive (70 Gy in 2 Gy fractions) or adjuvant (60–66 Gy in 2 Gy fractions) curative-intent radiotherapy using helical tomotherapy with concurrent chemotherapy if appropriate. Group A received < 26 Gy to the left and right parotids and group B received < 26 Gy to either parotid.

Results

The study included 126 patients; 114 (55 in group A and 59 in group B) had follow-up data. There were no statistically significant differences between groups in disease stage. Xerostomia was significantly reduced in group A vs. group B (p = 0.0381). Patients in group A also had significantly less dysphagia. Relapse-free and overall survival were not compromised in group A: 2-year relapse-free survival was 86% vs. 72% in group B (p = 0.361); 2-year overall survival was 88% and 76%, respectively (p = 0.251).

Conclusion

This analysis suggests that reducing radiotherapy doses to both parotid glands to < 26 Gy can reduce xerostomia and dysphagia significantly without compromising survival. Sparing both parotids while maintaining target volume coverage and clinical outcome should be the treatment goal and reporting radiotherapy doses delivered to the individual parotids should be standard practice.

Zusammenfassung

Ziel

Für Patienten mit Kopf-Hals-Tumoren ist die Xerostomie nach Strahlentherapie ein häufiges Problem. Im Rahmen einer prospektiven Studie haben wir untersucht, inwieweit die Schonung nur einer oder beider Parotiden das Ausmaß der Xerostomie und das Therapieergebnis beeinflusst.

Patienten und Methoden

Patienten mit lokal fortgeschrittenem Plattenepithelkarzinom im Kopf-Hals-Bereich wurden primär (70 Gy, 2 Gy pro Fraktion) oder adjuvant (60–66 Gy, 2 Gy pro Fraktion) mit kurativer Intention mit der helikalen Tomotherapie bestrahlt. Bei entsprechender Indikation wurde simultan eine platinbasierte Chemotherapie appliziert. Die Parotiden der Patienten der Gruppe A erhielten beide jeweils < 26 Gy, während in Gruppe B nur eine der beiden Parotiden mit < 26 Gy bestrahlt wurde.

Ergebnisse

126 Patienten wurden eingeschlossen, von denen 114 systematisch nachgesorgt werden konnten, 55 in Gruppe A und 59 in Gruppe B. Bezüglich der Tumorstadien bestand statistisch zwischen den Gruppen kein Unterschied. Die Xerostomierate war in Gruppe A signifikant geringer als in Gruppe B (p = 0,0381). Bei signifikant weniger Patienten der Gruppe A kam es zu einer Dysphagie (p = 0,0032). Das rezidivfreie Überleben und das Gesamtüberleben waren nicht beeinträchtigt; das rezidivfreie Überleben nach 2 Jahren betrug 86% in Gruppe A versus 72% in Gruppe B (p = 0,361); das Gesamtüberleben nach 2 Jahren lag bei 88% in Gruppe A versus 76% in Gruppe B (p = 0,251).

Schlussfolgerung

Bei der Diskussion um Parotisschonung/Dosisbelastung ist es entscheidend, dass jede Parotis individuell zu betrachten ist und nicht der Mittelwert über beide. Diese Ergebnisse zeigen, dass siginifikant weniger Patienten eine Xerostomie und Dysphagie entwickeln, wenn beide Parotiden mit < 26 Gy belastet werden, ohne dass das Gesamtüberleben oder das rezidivfreie Überleben negativ beeinträchtigt werden.

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Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Radiation Oncology, University Medical Center Hamburg–Eppendorf, Martinistr. 52, 20246, Hamburg, Germany

    S. Tribius M.D., J. Sommer, C. Prosch, A. Bajrovic, A. Kruell & C. Petersen

  2. Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Hamburg–Eppendorf, Hamburg, Germany

    A. Muenscher

  3. Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg–Eppendorf, Hamburg, Germany

    M. Blessmann

  4. Department of Medical Physics, University Medical Center Hamburg–Eppendorf, Hamburg, Germany

    M. Todorovic

  5. Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg–Eppendorf, Hamburg, Germany

    P. Tennstedt

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  1. S. Tribius M.D.
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  2. J. Sommer
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  3. C. Prosch
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  9. M. Todorovic
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Correspondence to S. Tribius M.D..

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The first two authors contributed equally to the authorship of the manuscript.

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Tribius, S., Sommer, J., Prosch, C. et al. Xerostomia after radiotherapy. Strahlenther Onkol 189, 216–222 (2013). https://doi.org/10.1007/s00066-012-0257-2

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