Skip to main content

Advertisement

SpringerLink
Log in

Intensity-modulated radiotherapy does not induce volumetric changes of the Bichat fat pad in nasopharyngeal cancer

  • Original Article
  • Published:
Strahlentherapie und Onkologie Aims and scope Submit manuscript

Abstract

Purpose

To evaluate morphological and functional changes in the Bichat fat pad (BFP) after curative concurrent chemoradiotherapy in nasopharyngeal cancer (NPC) patients.

Methods

We retrospectively analyzed the volumetric, metabolic, and dosimetry parameters of BFPs in 7 NPC patients who underwent intensity-modulated radiotherapy (IMRT) between 2015 and 2020. Inclusion criteria were i) histologically confirmed diagnosis of NPC, ii) follow-up period of at least 12 months, iii) no history of previous irradiation or surgery in the maxillofacial area, and ìv) availability of pre- and posttreatment MRI and 18F‑FDG PET-CT performed in our Institution. All patients had stage III–IVA disease (n = 7) and received platinum-based chemotherapy. Planned doses in 30 daily fractions/5 days per week were 66 Gy (2.2 Gy/die 5 days/week) to the gross tumor volume, 66 Gy (2.1–2.2 Gy/die 5 days/week) to the gross nodal volume, 60 Gy (2 Gy/die 5 days week) to clinical target volume (CTV)1, and 54 Gy (1.8 Gy/die 5 days/week) to CTV2. All patients completed the planned radiotherapy course in a median time of 42 days (range 42–43). Relationships between BFP volumes and the following DVH parameters were evaluated: mean dose, maximum dose (Dmax), and percentage of BFP volume receiving more than 5 to 65 Gy (V5 to V65).

Results

The pre-RT volumes of the left and right BFPs were 12.24 cc (range 6.51–20.01 cc) and 11.55 cc (range 5.78–17.53 cc), respectively. The mean volumes of left BFPPRE and BFPPOST were 12.24 cc (range 6.51–20.01cc) and 13.85 cc (range 7.54–20.21 cc), respectively, with no significant statistical differences (P > 0.05). No statistically significant correlations were found between dosimetry features and BFP volumetric changes (all P > 0.05).

Conclusion

Our original results showed that chemoradiotherapy does not induce significant volumetric changes of the BFP. Further investigations are needed to evaluate the effects of higher radiation doses on BFP. This is the first real-world study on this issue.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Tostevin PMJ, Ellis H (1995) The buccal pad of fat: a review. Clin Anat 8:403–406. https://doi.org/10.1002/CA.980080606

    Article  CAS  PubMed  Google Scholar 

  2. Bradley P (2011) Buccal pad of fat and its applications in oral and maxillofacial surgery: a review of published literature (February) 2004 to (July) 2009. Oral Surg 112:146. https://doi.org/10.1016/j.tripleo.2011.01.045

    Article  Google Scholar 

  3. Peñarrocha-Diago M, Alonso-González R, Aloy-Prósper A, Peñarrocha-Oltra D, Camacho F, Peñarrocha-Diago M (2015) Use of buccal fat pad to repair post-extraction peri-implant bone defects in the posterior maxilla. A preliminary prospective study. Med Oral Patol Oral Cir Bucal 20:e699–706. https://doi.org/10.4317/medoral.20212

    Article  PubMed  PubMed Central  Google Scholar 

  4. Mannelli G, Arcuri F, Comini LV, Valente D, Spinelli G (2019) Buccal fat pad: report of 24 cases and literature review of 1,635 cases of oral defect reconstruction. ORL 81:24–35. https://doi.org/10.1159/000494027

    Article  PubMed  Google Scholar 

  5. Dai T, Tian Z, Wang Z, Qiu W, Zhang Z, He Y (2015) Surgical management of osteoradionecrosis of the jaws. J Craniofac Surg 26:e175–179. https://doi.org/10.1097/SCS.0000000000001445

    Article  PubMed  Google Scholar 

  6. Nabil S, Ramli R (2012) The use of buccal fat pad flap in the treatment of osteoradionecrosis. Int J Oral Maxillofac Surg 41:1422–1426. https://doi.org/10.1016/J.IJOM.2012.04.001

    Article  CAS  PubMed  Google Scholar 

  7. Porcaro G, Amosso E, Mirabelli L, Busa A, Carini F, Maddalone M (2015) Osteoradionecrosis of the posterior maxilla: a new approach combining erbium: yttrium aluminium garnet laser and bichat bulla flap. J Craniofac Surg 26:e627–629. https://doi.org/10.1097/SCS.0000000000002136

    Article  PubMed  Google Scholar 

  8. Marx RE (1983) Osteoradionecrosis: a new concept of its pathophysiology. J Oral Maxillofac Surg 41:283–288. https://doi.org/10.1016/0278-2391(83)90294-X

    Article  CAS  PubMed  Google Scholar 

  9. Lyons A, Ghazali N (2008) Osteoradionecrosis of the jaws: current understanding of its pathophysiology and treatment. Br J Oral Maxillofac Surg 46:653–660. https://doi.org/10.1016/j.bjoms.2008.04.006

    Article  PubMed  Google Scholar 

  10. Chouikh F, Dierks EJ (2021) The buccal fat pad flap. Oral Maxillofac Surg Clin North Am. https://doi.org/10.1016/j.coms.2020.12.005

    Article  PubMed  Google Scholar 

  11. Tideman H, Bosanquet A, Scott J (1986) Use of the buccal fat pad as a pedicled graft. J Oral Maxillofac Surg 44:435–440. https://doi.org/10.1016/S0278-2391(86)80007-6

    Article  CAS  PubMed  Google Scholar 

  12. Merlotti A, Alterio D, Vigna-Taglianti R, Muraglia A, Lastrucci L, Manzo R et al (2014) Technical guidelines for head and neck cancer IMRT on behalf of the Italian association of radiation oncology—head and neck working group. Radiat Oncol 9:1–32. https://doi.org/10.1186/s13014-014-0264-9

    Article  Google Scholar 

  13. Iatì G, Parisi S, Santacaterina A, Pontoriero A, Cacciola A, Brogna A et al (2020) Simultaneous integrated boost radiotherapy in unresectable stage IV (M0) head and neck squamous cell cancer patients: daily clinical practice. Rep Pract Oncol Radiother 25:399–404. https://doi.org/10.1016/j.rpor.2020.04.006

    Article  PubMed  PubMed Central  Google Scholar 

  14. Cacciola A, Conti A, Tomasello F (2020) Big data analysis: the leap into a new science methodology. World Neurosurg 133:97–98. https://doi.org/10.1016/j.wneu.2019.04.268

    Article  PubMed  Google Scholar 

  15. Parisi S, Lillo S, Cacciola A, Santacaterina A, Palazzolo C, Platania A et al (2020) Vaginal mucosal melanoma: a complete remission after immunotherapy radiotherapy regimen (24 Gy/3 fractions/21 days). Folia Med 62:605–609. https://doi.org/10.3897/folmed.62.e49926

    Article  Google Scholar 

  16. Nutting CM, Morden JP, Harrington KJ, Urbano TG, Bhide SA, Clark C et al (2011) Parotid-sparing intensity modulated versus conventional radiotherapy in head and neck cancer (PARSPORT): a phase 3 multicentre randomised controlled trial. Lancet Oncol 12:127–136. https://doi.org/10.1016/S1470-2045(10)70290-4

    Article  PubMed  PubMed Central  Google Scholar 

  17. Gupta T, Sinha S, Ghosh-Laskar S, Budrukkar A, Mummudi N, Swain M et al (2020) Intensity-modulated radiation therapy versus three-dimensional conformal radiotherapy in head and neck squamous cell carcinoma: long-term and mature outcomes of a prospective randomized trial. Radiat Oncol 15:1–9. https://doi.org/10.1186/s13014-020-01666-5

    Article  CAS  Google Scholar 

  18. Brouwer CL, Steenbakkers RJHM, Bourhis J, Budach W, Grau C, Grégoire V et al (2015) CT-based delineation of organs at risk in the head and neck region: DAHANCA, EORTC, GORTEC, HKNPCSG, NCIC CTG, NCRI, NRG Oncology and TROG consensus guidelines. Radiother Oncol 117:83–90. https://doi.org/10.1016/J.RADONC.2015.07.041

    Article  PubMed  Google Scholar 

  19. Gierloff M, Stöhring C, Buder T, Gassling V, Açil Y, Wiltfang J (2012) Aging changes of the midfacial fat compartments: a computed tomographic study. Plast Reconstr Surg 129:263–273. https://doi.org/10.1097/PRS.0B013E3182362B96

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy

    Alberto Cacciola MD, Sara Lillo MD, Silvana Parisi MD, Consuelo Tamburella MD & Stefano Pergolizzi MD

  2. Unit of Medical Physics, Azienda Ospedaliera Universitaria, University Hospital Policlinico “G. Martino”, Messina, Italy

    Anna Brogna MSc

  3. REM Radioterapia srl, Istituto Oncologico del Mediterraneo, Viagrande, Italy

    Gianluca Ferini MD

  4. Radiology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy

    Alfredo Blandino MD

  5. Nuclear Medicine Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy

    Fabio Minutoli MD

Authors
  1. Alberto Cacciola MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sara Lillo MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Silvana Parisi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Consuelo Tamburella MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anna Brogna MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gianluca Ferini MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Alfredo Blandino MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Fabio Minutoli MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Stefano Pergolizzi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Silvana Parisi MD.

Ethics declarations

Conflict of interest

A. Cacciola, S. Lillo, S. Parisi, C. Tamburella, A. Brogna, G. Ferini, A. Blandino, F. Minutoli, and S. Pergolizzi declare that they have no competing interests.

Additional information

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cacciola, A., Lillo, S., Parisi, S. et al. Intensity-modulated radiotherapy does not induce volumetric changes of the Bichat fat pad in nasopharyngeal cancer. Strahlenther Onkol 198, 1002–1007 (2022). https://doi.org/10.1007/s00066-022-01974-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00066-022-01974-7

Keywords

Search

Navigation