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Early changes of parotid density and volume predict modifications at the end of therapy and intensity of acute xerostomia

Die Nutzung frühe Veränderungen in Dichte und Volumens der Ohrspeicheldrüse als Prädicator für Modifikationen am Ende der Therapie und der Intensität akuter Xerostomie

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Abstract

Purpose

To quantitatively assess the predictive power of early variations of parotid gland volume and density on final changes at the end of therapy and, possibly, on acute xerostomia during IMRT for head-neck cancer.

Materials and methods

Data of 92 parotids (46 patients) were available. Kinetics of the changes during treatment were described by the daily rate of density (rΔρ) and volume (rΔvol) variation based on weekly diagnostic kVCT images. Correlation between early and final changes was investigated as well as the correlation with prospective toxicity data (CTCAEv3.0) collected weekly during treatment for 24/46 patients.

Results

A higher rΔρ was observed during the first compared to last week of treatment (−0,50 vs −0,05HU, p-value = 0.0001). Based on early variations, a good estimation of the final changes may be obtained (Δρ: AUC = 0.82, p = 0.0001; Δvol: AUC = 0.77, p = 0.0001).

Both early rΔρ and rΔvol predict a higher “mean” acute xerostomia score (≥ median value, 1.57; p-value = 0.01). Median early density rate changes for patients with mean xerostomia score ≥ / < 1.57 were −0.98 vs −0.22 HU/day respectively (p = 0.05).

Conclusions

Early density and volume variations accurately predict final changes of parotid glands. A higher longitudinally assessed score of acute xerostomia is well predicted by higher rΔρ and rΔvol in the first two weeks of treatment: best cut-off values were −0.50 HU/day and −380 mm3/day for rΔρ and rΔvol respectively. Further studies are necessary to definitively assess the potential of early density/volume changes in identifying more sensitive patients at higher risk of experiencing xerostomia.

Zusammenfassung

Ziel

Ziel der Studie ist die Untersuchung der prädiktiven Aussagekraft von frühen Veränderungen in Volumen und Dichte der Ohrspeicheldrüse in Bezug auf die finale Verformung zum Ende der Therapie sowie das Risiko von Xerostomie während der intesitätsmodulierten Strahlentherapie (IMRT) bei Kopf und Hals Tumoren.

Materialien und Methoden

Die Studie umfasst 46 Patienten (92 Speicheldrüsen). Für 24 Patienten wurden prospektiv gesammelte Toxizitätsdaten (CTCAEv3.0) während der Therapie ausgewertet. Die Reaktion auf die Behandlung wurde beobachtet anhand der tägliche Veränderung der Dichte (rΔρ) sowie des Volumens (rΔvol) der Ohrspeicheldrüsen. Die Beziehung zwischen frühen und späten Veränderungen, sowie der Zusammenhang mit den wöchentlich dokumentieren Toxitätsdaten wurde für 24 der 46 Fälle untersucht.

Ergebnisse

Am Anfang der Therapie wurde ein höheres rΔρ beobachtet (−0,50 vs −0,05HU, p-Wert = 0,0001) als gegen Therapieende. Basierend auf frühen Veränderungen kann die finale Verformung der Speicheldrüsen gut abgeschätzt werden (Δρ: AUC = 0.82, p = 0.0001; Δvol: AUC = 0.77, p = 0.0001). Sowohl der frühe rΔρ- als auch der rΔvol-Wert sagen eine höheres „mittlere“ Auftreten von Xerostomie für den Durchschnitt der untersuchten Population vorher (1.57; p-Wert = 0.01, log. Regression). Die mittlere frühe Veränderung der Dichte für Patienten mit mittlerem Xerostomie-Wert ≥ / < 1.57 waren −0.98 bzw. −0.22 HU (p = 0.05, Mann–Whitney-Test).

Schlussfolgerung

Frühe Dichte- und Volumenvariationen können präzise letztendliche Änderungen der Ohrspeicheldrüse vorhersagen. Eine akuten Xerostomie kann gut durch größere rΔρ- und rΔvol-Werte in den ersten zwei Behandlungswochen vorhergesagt werden: die beste Cut-off-Werte für rΔρ und rΔvol waren jeweils −0.50 HU/ Tag und −380 mm3/day. Weitere Studien sind notwendig, um das ganze Potenzial der frühen Dichte/ Volumen Änderungen für die Identifizierung sensibler Patienten mit einemerhöhten Mundtrockenheitsrisiko zu beurteilen.

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Compliance with ethical guidelines

Acknowledgments

The study was funded by an AIRC grant (IG10521). Thanks to Deli A.M., Longoni L., Todica A., Vai A., Knopf A. for the German translation and Bagg F for the English review.

Conflict of interest

M. L. Belli, E. Scalco, G. Sanguineti, C. Fiorino, S. Broggi, N. Dinapoli, F. Ricchetti, V. Valentini, G. Rizzo, and G. M. Cattaneo state that there are no conflict of interest.

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Authors and Affiliations

  1. Medical Physics, Ospedale San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milano, Italy

    Maria Luisa Belli, Claudio Fiorino PhD, Sara Broggi & Giovanni Mauro Cattaneo

  2. Istituto di Bioimmagini e Fisiologia Molecolare, CNR, Milano, Italy

    Elisa Scalco, Claudio Fiorino PhD, Giovanna Rizzo & Giovanni Mauro Cattaneo

  3. Department of Radiation Oncology, Regina Elena National Cancer Institute, Rome, Italy

    Giuseppe Sanguineti

  4. Radiotherapy, Università Cattolica del Sacro Cuore, Rome, Italy

    Nicola Dinapoli & Vincenzo Valentini

  5. Radiotherapy, Ospedale Sacro Cuore, Negrar, Italy

    Francesco Ricchetti

Authors
  1. Maria Luisa Belli
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  2. Elisa Scalco
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  3. Giuseppe Sanguineti
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  4. Claudio Fiorino PhD
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Corresponding author

Correspondence to Claudio Fiorino PhD.

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Belli, M., Scalco, E., Sanguineti, G. et al. Early changes of parotid density and volume predict modifications at the end of therapy and intensity of acute xerostomia. Strahlenther Onkol 190, 1001–1007 (2014). https://doi.org/10.1007/s00066-014-0669-2

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  • DOI: https://doi.org/10.1007/s00066-014-0669-2

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