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Golestannejad Z, Khozeimeh F, Najafizade N, Tabesh A, Faghihian E, Maheronnaghsh M, Kheirkhah M, Hosseini SM, Sadeghalbanaei L, Jamshidi M, Chermahini AA, Saberi Z, Pakravan F, Dehghan P, Emamibafrani M, Amini N, Tadayon F. Comparison of oral candidiasis characteristics in head-and-neck cancer patients before and during radiotherapy. Dent Res J (Isfahan) 2023; 20:63. [PMID: 37388299 PMCID: PMC10300268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/16/2022] [Accepted: 03/05/2023] [Indexed: 07/01/2023] Open
Abstract
Background Patients undergoing head-and-neck radiotherapy are susceptible to Candida colonization and infection. This study aimed to identify oral Candida species type (ST), colony count (CC), and oropharyngeal candidiasis (OPC) in head-and-neck cancer patients, undergoing radiotherapy, before and 2 weeks after radiation. Materials and Methods In this quasi-experimental study, head-and-neck cancer patients undergoing radiotherapy (up to 6000 cGy) were recruited. Samples were taken before and 2 weeks after radiation therapy (RT). CC was assigned using Sabouraud dextrose agar culture medium and morphological studies were performed to confirm OPC. For identification, polymerase chain reaction-restriction fragment length polymorphism was performed. Data were analyzed using Chi-square-test and kappa coefficient. P < 0.05 was considered statistically significant. Results Twenty-one of 33 patients were Candida positive. The detected fungal species included Candida albicans (60%), Candida tropicalis (22%), Candida glabrata (9%), and other species (9%). Following RT, OPC and CC changed significantly (P = 0.003 and P = 0.001, respectively), whereas ST did not significantly change (P = 0.081). Two new species (Candida krusei and Candida parapsilosis) were detected after the intervention. The OPC, CC, and ST changes after RT were not significantly related to malignancy site or radiation dose (P > 0.05). Conclusion The present study showed that OPC, CC, and ST were not related to the malignancy site. Following RT, OPC and CC changed significantly, while ST showed no significant change. The radiation dose and malignancy site had no effects on the OPC, CC, or ST alterations following RT.
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Affiliation(s)
- Zahra Golestannejad
- Department of Oral and Maxillofacial Medicine, Dental Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Faezeh Khozeimeh
- Department of Oral and Maxillofacial Medicine, Dental Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nadia Najafizade
- Department of Radiation Oncology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Adel Tabesh
- Department of Oral and Maxillofacial Medicine, Dental Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elham Faghihian
- Department of Oral and Maxillofacial Medicine, Dental Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehrnoush Maheronnaghsh
- Department of Mycology and Parasitology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahnaz Kheirkhah
- Department of Mycology and Parasitology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sayed Mohsen Hosseini
- Department of Biostatistics and Epidemiology, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Leila Sadeghalbanaei
- Department of Orthodontics, Dental Students Research Committee, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mina Jamshidi
- Department of Periodontics, Dental Students Research Committee, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmad Amiri Chermahini
- Department of Endodontics, Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Zahra Saberi
- Department of Oral and Maxillofacial Medicine, Dental Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fahimeh Pakravan
- Department of Oral and Maxillofacial Medicine, Dental Implants Research Center, School of Dentistry, Dental Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parvin Dehghan
- Department of Mycology and Parasitology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Emamibafrani
- Department of Dentist, Dental Students Research Committee, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nima Amini
- Department of Pediatric Dentistry, School of Dentistry, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
| | - Faezeh Tadayon
- Department of Dentist, Dental Students Research Committee, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
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Nash D, Juneja S, Palmer AL, van Herk M, McWilliam A, Osorio EV. The geometric and dosimetric effect of algorithm choice on propagated contours from CT to cone beam CTs. Phys Med 2022; 100:112-119. [DOI: 10.1016/j.ejmp.2022.06.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 05/17/2022] [Accepted: 06/28/2022] [Indexed: 11/17/2022] Open
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Parotid Gland Stem Cell Preservation during Intensity-Modulated Radiotherapy for Nasopharyngeal Carcinoma: Dosimetric Analysis and Feasibility. JOURNAL OF ONCOLOGY 2022; 2022:4922409. [PMID: 35865088 PMCID: PMC9296294 DOI: 10.1155/2022/4922409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 11/18/2022]
Abstract
Objective. Parotid gland (PG) is a radiosensitive organ, and xerostomia (XS) is a key factor affecting patients’ life quality after conventional radiotherapy for head and neck tumors. In this study, dosimetry analysis was performed on PG stem cell preservation in intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC). Methods. All clinical data of 80 NPC patients diagnosed pathologically in the Radiotherapy Department of Taizhou Hospital of Zhejiang Province Affiliated with Wenzhou Medical University from August 2017 to September 2019 were retrospectively analyzed. Patients were assigned to a regular group and a restricted group according to different IMRT plans, in which a dose limitation for the parotid duct was added in the restricted group in addition to the conventional plan used in the regular group to minimize the parotid duct radiation dose. The differences in planning target volume (PTV) dose distribution, organ at risk (OAR) dose, and dose to the PG and its ducts were compared between the two groups. Results. Significantly higher mean irradiation doses of the brainstem, mandible, and oral cavity were determined in the restricted group compared with the regular group (
), but there was no significant difference in the mean dose of other OARs irradiated (
). As compared to the irradiation of bilateral PGs, no statistical differences were found in the mean irradiation dose and V30 between regular and restricted groups (
), but lower V20 and higher V45 were determined in the restricted group (
). The mean irradiation dose, V15, V20, and V26 of bilateral parotid ducts were lower in the restricted group as compared to the regular group (
). Conclusion. IMRT for NPC can effectively reduce the mean irradiation dose and play a PG stem cell preservation role by giving specific dose limitation conditions to the parotid duct area without affecting PTV dose distribution and OAR irradiation dose, which has certain feasibility.
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Liu WS, Chien JC, Huang YH, Chen PC, Huang WL, Chiang SW, Lee CC, Kang BH, Hu YC. High Superior-Middle Pharyngeal Constrictor Muscle Mean Dose Correlates with Severe Late Lung Infection and Survival in Nasopharyngeal Cancer Patients. Cancer Manag Res 2022; 14:1063-1073. [PMID: 35300065 PMCID: PMC8923639 DOI: 10.2147/cmar.s350714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/28/2022] [Indexed: 01/23/2023] Open
Abstract
Purpose The study aimed to evaluate 1) the correlation of doses of swallowing-related organs at risk (OAR) with severe swallowing-related late adverse effects (AE) in nasopharyngeal carcinoma (NPC) patients and 2) the effect of high mean doses of OARs on overall survival (OS). Patients and Methods This retrospective cohort study enrolled non-metastatic Stage I–IV NPC patients from January 2012 to June 2017. OAR mean doses and severe (≥G3) swallowing-related late AE (xerostomia, dysphagia, and lung infection) were evaluated by t-test and validated using receiver operating characteristic curves. The risk factors of OS were calculated by Cox regression methods. Results This study enrolled 185 (43 female, 142 male) NPC patients, mean age 52.4 years, primarily with Stage III (93, 50.3%) or Stage IV (67, 36.2%) disease. The mean doses of pharyngeal constrictor muscle (PCM), superior-middle PCM (SMPCM), and superior PCM (SPCM) were significantly higher in those with severe (≥G3) lung infection than in those without (65.7 vs 62.2 Gy, p = 0.036; 68.1 vs 64.2 Gy, p = 0.015; and 70.0 vs 65.9 Gy, p = 0.012, respectively). Patients with severe (≥G3) dysphagia had significant higher mean doses of base of tongue (56.2 vs 50.2 Gy, p = 0.008), laryngeal box (50.6 vs 46.4 Gy, p = 0.036), PCM (65.4 vs 62.1 Gy, p = 0.008), SMPCM (67.1 vs 64.2 Gy, p = 0.014), and SPCM (69.3 vs 65.8 Gy, p = 0.004). Mean SMPCM dose >64.9 Gy (adjusted hazard ratio [aHR] = 3.2, 95% confidence interval [CI] 1.2–8.8, p = 0.021), age >62 years (aHR = 2.7, 95% CI 1.1–6.9, p = 0.032), N3 status (aHR = 4.0, 95% CI 1.8–9.0, p = 001), and severe late AE of lung infection (aHR = 4.6, 95% CI 1.5–14.0, p = 0.007) significantly affected OS. Conclusion Severe lung infection and dysphagia were associated with significantly higher mean doses of PCM, SMPCM, and SPCM. Among these OARs, only a high SMPCM mean dose was a risk factor for OS in NPC patients.
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Affiliation(s)
- Wen-Shan Liu
- Department of Radiation Oncology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Nursing, Meiho University, Pingtung, Taiwan
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Correspondence: Wen-Shan Liu, Department of Radiation Oncology, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Road, Zuoying Dist., Kaohsiung City, 813414, Taiwan, Tel +886934075313, Email
| | - Ju-Chun Chien
- Department of Radiation Oncology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yu-Hsien Huang
- Department of Radiation Oncology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Po-Chun Chen
- Department of Radiation Oncology, Pingtung Christian Hospital, Pingtung, Taiwan
- Graduate Institute of Bioresources, National Pingtung University of Science and Technology, Pingtung, Taiwan
| | - Wei-Lun Huang
- Department of Radiation Oncology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Shao-Wei Chiang
- Department of Radiation Oncology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ching-Chih Lee
- Department of Otorhinolaryngology - Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Bor-Hwang Kang
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Department of Otorhinolaryngology - Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yu-Chang Hu
- Department of Radiation Oncology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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Kanehira T, van Kranen S, Jansen T, Hamming-Vrieze O, Al-Mamgani A, Sonke JJ. Comparisons of normal tissue complication probability models derived from planned and delivered dose for head and neck cancer patients. Radiother Oncol 2021; 164:209-215. [PMID: 34619234 DOI: 10.1016/j.radonc.2021.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/24/2021] [Accepted: 09/18/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND PURPOSE Normal tissue complication probability (NTCP) models are typically derived from the planned dose distribution, which can deviate from the delivered dose due to anatomical day-to-day variations. The aim of this study was to compare NTCP models derived from the planned and the delivered dose for head and neck cancer (HNC) patients. MATERIAL AND METHOD 322 HNC patients who received radiotherapy with daily CBCT guidance were included in this retrospective study. The delivered dose was estimated by deformably accumulating dose from daily CBCT to planning anatomy. We used a Lyman-Kutcher-Burman NTCP model, to relate the equivalent uniform dose (EUD) of organs at risk (OAR) with oral mucositis, xerostomia and dysphagia respectively. We compared the model parameters and performances. RESULTS The median differences between planned and delivered EUD to the OARs were significantly larger for patients with toxicity than without for acute dysphagia (≥G2 and ≥G3) and late dysphagia (≥G3) (p < 0.05). Those differences resulted in small differences in steepness and agreement to the data between delivered- and planned-fitted NTCP curves, and the differences were not significant. The differences in AUC were less than 0.01. CONCLUSION Differences between delivered and planned dose did not lead to significant differences in NTCP curves. The additional clinical relevance of NTCP models using accumulated dose for oral mucositis, xerostomia and dysphagia in HNC radiotherapy is likely to be limited.
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Affiliation(s)
- Takahiro Kanehira
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Simon van Kranen
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Tomas Jansen
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Olga Hamming-Vrieze
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Abrahim Al-Mamgani
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jan-Jakob Sonke
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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Yang K, Xie W, Zhang X, Wang Y, Shou A, Wang Q, Tian J, Yang J, Li G. A nomogram for predicting late radiation-induced xerostomia among locoregionally advanced nasopharyngeal carcinoma in intensity modulated radiation therapy era. Aging (Albany NY) 2021; 13:18645-18657. [PMID: 34282056 PMCID: PMC8351700 DOI: 10.18632/aging.203308] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 06/29/2021] [Indexed: 02/05/2023]
Abstract
Background: Dry mouth sensation cannot be improved completely even though parotids are spared correctly. Our purpose is to develop a nomogram to predict the moderate-to-severe late radiation xerostomia for patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC) in intensity modulated radiation therapy (IMRT) / volumetric modulated arc radiotherapy (VMAT) era. Methods: A dataset of 311 patients was retrospectively collected between January 2010 and February 2013. The binary logistic regression was to estimate each factor’s prognostic value for development of moderate-to-severe patient-reported xerostomia at least 2 years (Xer2y) after completion of radiotherapy. Therefore, we can develop a nomogram according to binary logistic regression coefficients. This novel model was validated by bootstrapping analyses. Results: Contralateral Parotid mean dose (coMD<24.4Gy), VMAT (yes), and platinum-based concurrent chemoradiotherapy (no) were significantly related to patient-reported xerostomia at least 2 years (Xer2y) (all p < 0.001), and were included in the nomogram. Receiver operating characteristic (ROC) analysis revealed AUC (area under the ROC curve) with the value of 0.811 (0.710-0.912) of the nomogram, which was significantly higher than coMD 0.698 (0.560-0.840) from QUANTEC2010 (p<0.001). Calibration plots illustrated that the predicted Xer2y was close to the actual observation, and decision curve analyses (DCA) indicated valid positive net benefits. Conclusion: We developed a feasible nomogram to predict patient-rated Xer2y based on comprehensive individual data in patients with LA-NPC in the real world. The proposed model is able to facilitate the development of treatment plan and quality of life improvement.
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Affiliation(s)
- Kaixuan Yang
- Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China.,Department of Radiation Oncology, West China Second University Hospital and Key Laboratory of Obstetrics and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Wenji Xie
- Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Xiangbin Zhang
- Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Yu Wang
- West China School of Medicine, Sichuan University, Chengdu 610041, Sichuan, China
| | - Arthur Shou
- School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu 610041, Sichuan, China
| | - Qiang Wang
- Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Jiangfang Tian
- Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Jiangping Yang
- Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Guangjun Li
- Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
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Buranaporn P, Dankulchai P, Jaikuna T, Prasartseree T. Relation between DIR recalculated dose based CBCT and GI and GU toxicity in postoperative prostate cancer patients treated with VMAT. Radiother Oncol 2021; 157:8-14. [PMID: 33418004 DOI: 10.1016/j.radonc.2020.12.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND PURPOSE To investigate the relationship between deformable image registration (DIR) recalculated dose on cone beam computed tomography (CBCT) and gastrointestinal and genitourinary toxicity in postoperative prostate cancer patients treated with volumetric modulated arc therapy and its actual delivered dose. MATERIAL AND METHODS A total of 114 patients were retrospectively studied. Delineation of rectum and bladder was performed on each CBCT image. Actual delivered dose on CBCT available fraction was recalculated using DIR. Dosimetric parameters of rectum and bladder were then evaluated by Quantitative Analyses of Normal Tissue Effects in the Clinic study. Differences in mean volume between patients with grade 0-1 and grade 2-5 CTCAEv5.0 toxicities were compared. Relationship between toxicity and radiation volume was analyzed using logit analysis. RESULTS Significant differences between the actual and planned dose-volume were observed in nearly all doses of rectum. High-grade acute rectal toxicity was significantly associated with planned dose-volume in V50 and V75, and actual dose in all doses. High-grade chronic rectal toxicity was significantly associated with all planned and actual rectal dose-volume parameters. There was no significant association between all dose-volume parameters and acute or chronic bladder toxicity. CONCLUSION Significant differences between actual and planned dose-volume, and significant association between actual dose-volume and acute rectal toxicity, but not planned dose-volume suggests that actual dose-volume may more precisely reflect toxicity due to daily variation in the rectum during the treatment course. Adaptive planning should be considered as a novel approach for reducing toxicity.
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Affiliation(s)
- Panyapat Buranaporn
- Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pittaya Dankulchai
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Tanwiwat Jaikuna
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tissana Prasartseree
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Ribeiro LN, Lima MH, Carvalho AT, Albuquerque RF, Leão JC, Silva IH. Evaluation of the salivary function of patients in treatment with radiotherapy for head and neck cancer submitted to photobiomodulation. Med Oral Patol Oral Cir Bucal 2021; 26:e14-e20. [PMID: 33247577 PMCID: PMC7806351 DOI: 10.4317/medoral.23912] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 11/02/2020] [Indexed: 11/05/2022] Open
Abstract
Background Head and neck radiotherapy is typically associated with toxicities that can have profound effects on the patient's quality of life. Xerostomia, which may or may not be related to hypofunction of the salivary gland, leading to negative consequences, mainly in quality of life, leaving patients more susceptible to the development of oral mucositis, dental caries, oral infection and difficulties in speech is one of the most common side effects of such treatment. The aim of the present study was to evaluate salivary function of patients in treatment with radiotherapy for head and neck cancer submitted to photobiomodulation.
Material and Methods A cross-sectional study with a quantitative approach was carried out in the Dentistry Department of the Hospital de Câncer de Pernambuco between February and September 2019.
Results The study sample comprised 23 patients of both genders, treated with radiotherapy for cancer in the head and neck region. The patients were submitted to photobiomodulation with infrared laser, as intraoral applications in order to prevent mucositis and extraoral applications to stimulate salivary glands. The applications were undertaken three times a week on alternate days throughout the radiotherapy period. The following parameters were used: Intraoral 15mW, 12J / cm2, 10s / point, 2.4 J / point, and extraoral 30mW, 7.5J / cm2, 10s / point, 0.3J / point, both with a wavelength of 830nm and area of 0.028cm². Subjective and objective symptoms were evaluated by measuring the unstimulated salivary flow (USF) using the spitting technique before, during and after radiotherapy treatment. For statistical analysis, a significance level of 5% was adopted. Most patients were male (70%) with 60 years of age on average. At the beginning of treatment, 22 patients had USF> 0.2 ml / min (grade 1), at the end of which 15 patients remained unchanged and only 3 patients progressed to grade 3. As for the subjective classification, most (52%) remained in grade 1 (absence of disability) throughout the treatment.
Conclusions Based upon the results of this study it was possible to conclude that the use of photobiomodulation did not significantly interfere with the xerostomia complaint of patients in treatment with radiotherapy, however, it does seem to prevent patients from reaching higher degrees of xerostomia taking into account salivary flow measures. Key words:Photobiomodulation, head and neck neoplasms, radiotherapy, xerostomia, saliva.
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Affiliation(s)
- L-N Ribeiro
- Hospital of Cancer of Pernambuco Avenida Cruz Cabugá 1597 - Santo Amaro 50040-000, Recife - PE. Brazil
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Wu VWC, Ying MT, Kwong DL, Khong PL, Wong GK, Tam SY. A longitudinal study on parotid and submandibular gland changes assessed by magnetic resonance imaging and ultrasonography in post-radiotherapy nasopharyngeal cancer patients. BJR Open 2020; 2:20200003. [PMID: 33178971 PMCID: PMC7583169 DOI: 10.1259/bjro.20200003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 12/24/2022] Open
Abstract
Objectives With regard to the intensity modulated radiotherapy (IMRT) of nasopharyngeal carcinoma (NPC) patients, this longitudinal study evaluated the radiation-induced changes in the parotid and submandibular glands in terms of gland size, echogenicity and haemodynamic parameters. Methods 21 NPC patients treated by IMRT underwent MRI and ultrasound scans before radiotherapy, and at 6, 12, 18 and 24 months after treatment. Parotid and submandibular gland volumes were measured from the MRI images, whereas the parotid echogenicity and haemodynamic parameters including the resistive index, pulsatility index, peak systolic velocity and end diastolic velocity were evaluated by ultrasonography. Trend lines were plotted to show the pattern of changes. The correlations of gland doses and the post-RT changes were also studied. Results The volume of the parotid and submandibular glands demonstrated a significant drop from pre-RT to 6 months post-RT. The parotid gland changed from hyperechoic before RT to either isoechoic or hypoechoic after treatment. The resistive index and pulsatility index decreased from pre-RT to 6 month post-RT, then started to increase at 12 month time interval. Both peak systolic velocity and end diastolic velocity increased after 6 months post-RT then followed a decreasing trend up to 24 months post-RT. There was mild correlation between post-RT gland dose and gland volume, but not with haemodynamic changes. Conclusions Radiation from IMRT caused shrinkage of parotid and submandibular glands in NPC patients. It also changed the echogenicity and vascular condition of the parotid gland. The most significant changes were observed at 6 months after radiotherapy. Advances in knowledge It is the first paper that reports on the longitudinal changes of salivary gland volume, echogenicity and haemodynamic parameters altogether in NPC patients after radiotherapy. The results are useful for the prediction of glandular changes that is associated with xerostomia, which help to provide timely management of the complication when the patients attend follow-up visits.
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Affiliation(s)
- Vincent W C Wu
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Michael Tc Ying
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Dora Lw Kwong
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Pek-Lan Khong
- Department of Radiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Gary Kw Wong
- Department of Clinical Oncology, Queen Mary Hospital, Sha Tin, Hong Kong
| | - Shing-Yau Tam
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
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McCulloch MM, Cazoulat G, Ford AC, Elgohari B, Bahig H, Kim AD, Elhalawani H, He R, Wang J, Ding Y, Mohamed AS, Polan DF, King JB, Peterson CB, Ohrt AN, Fuller CD, Lai SY, Brock KK. Biomechanical modeling of radiation dose-induced volumetric changes of the parotid glands for deformable image registration. Phys Med Biol 2020; 65:165017. [PMID: 32320955 DOI: 10.1088/1361-6560/ab8bf1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE Early animal studies suggest that parotid gland (PG) toxicity prediction could be improved by an accurate estimation of the radiation dose to sub-regions of the PG. Translation to clinical investigation requires voxel-level dose accumulation in this organ that responds volumetrically throughout treatment. To date, deformable image registration (DIR) has been evaluated for the PG using only surface alignment. We sought to develop and evaluate an advanced DIR technique capable of modeling these complex PG volume changes over the course of radiation therapy. MATERIALS AND METHODS Planning and mid-treatment magnetic resonance images from 19 patients and computed tomography images from nine patients who underwent radiation therapy for head and neck cancer were retrospectively evaluated. A finite element model (FEM)-based DIR algorithm was applied between the corresponding pairs of images, based on boundary conditions on the PG surfaces only (Morfeus-spatial). To investigate an anticipated improvement in accuracy, we added a population model-based thermal expansion coefficient to simulate the dose distribution effect on the volume change inside the glands (Morfeus-spatialDose). The model accuracy was quantified using target registration error for magnetic resonance images, where corresponding anatomical landmarks could be identified. The potential clinical impact was evaluated using differences in mean dose, median dose, D98, and D50 of the PGs. RESULTS In the magnetic resonance images, the mean (±standard deviation) target registration error significantly reduced by 0.25 ± 0.38 mm (p = 0.01) when using Morfeus-spatialDose instead of Morfeus-spatial. In the computed tomography images, differences in the mean dose, median dose, D98, and D50 of the PGs reached 2.9 ± 0.8, 3.8, 4.1, and 3.8 Gy, respectively, between Morfeus-spatial and Morfeus-spatialDose. CONCLUSION Differences between Morfeus-spatial and Morfeus-spatialDose may be impactful when considering high-dose gradients of radiation in the PGs. The proposed DIR model can allow more accurate PG alignment than the standard model and improve dose estimation and toxicity prediction modeling.
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Affiliation(s)
- Molly M McCulloch
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States of America. Department of Radiation Medicine, School of Medicine, Oregon Health and Science University, Portland, OR 97239, United States of America
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Coutinho JVDS, Ferreira PS, Soares J, Passamai JL, D'Azeredo Orlando MT, Gouvea SA. Evaluation of induced biological effects in rats by continuous and natural gamma radiation using a physical simulator. Int J Radiat Biol 2020; 96:1473-1485. [PMID: 32845812 DOI: 10.1080/09553002.2020.1812760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE The effects of radioactivity on human health have been debated for many years but there are still important gaps that need to be addressed especially related to the effects of high natural background radiation on the local population. The beach of Meaípe, in the city of Guarapari (Brazil), emits natural gamma radiation due to the presence of monazite sands. We aimed to investigate the effects of gamma radiation doses on the biological system of wistar rats using a physical simulator of gamma radiation designed using Meaípe monazite sands. METHODS Female Wistar rats were divided into three groups, submitted to no radiation (control group) and to continuous radiation levels, one of very high level (20 μSv h-1) and another of high level (3.6 μSv h-1). The three group of animals were monitored weekly for 3 months and at the end of the study the animals were sacrificed, and the organs were extracted and weighed for anthropometric, oxidative stress and histological evaluations. RESULTS Exposure to radiation released by the monazite sands did not cause anthropometric alterations or blood pressure change in the animals. Similarly, there was no change in the quantification of ovarian follicles between the radiation groups and the control group. There was no difference in the oxidative stress quantification by the thiobarbituric acid reactive substance and advanced oxidation protein product methods in the ovaries. There were no evidenced damages in the structure of the renal tissue. It was observed the presence of granulomas in the hepatic tissue and alterations in the nuclei of the hepatocytes. CONCLUSIONS Our results suggest that the continuous exposure of females rats to 3.6 and 20 μSv h-1 doses of gamma radiation slightly affected the hepatic tissue, but did not alter the histological parameters in the kidneys and ovaries and oxidative stress.
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Affiliation(s)
| | - Priscila Santos Ferreira
- Postgraduate Program in Physiological Sciences, Federal University of Espirito Santo, Vitoria, Brazil
| | - Jacyra Soares
- Department of Atmospheric Science, IAG, University of Sao Paulo, Sao Paulo, Brazil
| | - José Luis Passamai
- Department of Physics, Federal University of Espirito Santo, Vitoria, Brazil
| | | | - Sonia Alves Gouvea
- Department of Physiological Sciences, Federal University of Espirito Santo, Vitoria, Brazil
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Kanehira T, Svensson S, van Kranen S, Sonke JJ. Accurate estimation of daily delivered radiotherapy dose with an external treatment planning system. Phys Imaging Radiat Oncol 2020; 14:39-42. [PMID: 33458312 PMCID: PMC7807587 DOI: 10.1016/j.phro.2020.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 05/16/2020] [Accepted: 05/18/2020] [Indexed: 11/28/2022] Open
Abstract
Accurate estimation of the daily radiotherapy dose is challenging in a multi-institutional collaboration when the institution specific treatment planning system (TPS) is not available. We developed and evaluated a method to tackle this problem. Residual errors in daily estimations were minimized with single correction based on the planned dose. For nine patients, medians of the absolute estimation errors for targets and OARs were less than 0.2 Gy (Dmean), 0.3 Gy (D1), and 0.1 Gy (D99). In general, mimicking errors were significantly smaller than dose differences caused by anatomical changes. The demonstrated accuracy may facilitate dose accumulation in a multi-institutional/multi-vendor setting.
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Affiliation(s)
- Takahiro Kanehira
- Department of Radiation Oncology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | | | - Simon van Kranen
- Department of Radiation Oncology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Jan-Jakob Sonke
- Department of Radiation Oncology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
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Radaideh KM. Dosimetric impact of weight loss and anatomical changes at organs at risk during intensity-modulated radiotherapy for head-and-neck cancer. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2020. [DOI: 10.1080/16878507.2020.1731125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Wu VWC, Leung KY. A Review on the Assessment of Radiation Induced Salivary Gland Damage After Radiotherapy. Front Oncol 2019; 9:1090. [PMID: 31750235 PMCID: PMC6843028 DOI: 10.3389/fonc.2019.01090] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 10/02/2019] [Indexed: 12/30/2022] Open
Abstract
Head and neck cancers are common in Southern China including Hong Kong. Intensity modulated radiotherapy has been the treatment of choice for these patients. Although radiotherapy provides good local control, radiotherapy treatment side-effects are still inevitable due to close proximity of the organs at risk from the target volume. Xerostomia, which is caused due to the damage of salivary glands, is one of the main radiation induced toxicities in post-radiotherapy head and neck patients. This review article discusses the methods for the assessing of radiation induced salivary gland changes including the gland morphology and saliva flow rate. The discussion also includes the recovery of the salivary gland after radiotherapy and how it is affected by the dose. It is expected that the future direction in monitoring the recovery of salivary glands will focus in cellular or molecular levels, and the development of imaging biomarker.
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Affiliation(s)
- Vincent W C Wu
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Kit Yee Leung
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Kowloon, Hong Kong
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Rigaud B, Simon A, Castelli J, Lafond C, Acosta O, Haigron P, Cazoulat G, de Crevoisier R. Deformable image registration for radiation therapy: principle, methods, applications and evaluation. Acta Oncol 2019; 58:1225-1237. [PMID: 31155990 DOI: 10.1080/0284186x.2019.1620331] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background: Deformable image registration (DIR) is increasingly used in the field of radiation therapy (RT) to account for anatomical deformations. The aims of this paper are to describe the main applications of DIR in RT and discuss current DIR evaluation methods. Methods: Articles on DIR published from January 2000 to October 2018 were extracted from PubMed and Science Direct. Our search was restricted to articles that report data obtained from humans, were written in English, and address DIR methods for RT. A total of 207 articles were selected from among 2506 identified in the search process. Results: At planning, DIR is used for organ delineation using atlas-based segmentation, deformation-based planning target volume definition, functional planning and magnetic resonance imaging-based dose calculation. In image-guided RT, DIR is used for contour propagation and dose calculation on per-treatment imaging. DIR is also used to determine the accumulated dose from fraction to fraction in external beam RT and brachytherapy, both for dose reporting and adaptive RT. In the case of re-irradiation, DIR can be used to estimate the cumulated dose of the two irradiations. Finally, DIR can be used to predict toxicity in voxel-wise population analysis. However, the evaluation of DIR remains an open issue, especially when dealing with complex cases such as the disappearance of matter. To quantify DIR uncertainties, most evaluation methods are limited to geometry-based metrics. Software companies have now integrated DIR tools into treatment planning systems for clinical use, such as contour propagation and fraction dose accumulation. Conclusions: DIR is increasingly important in RT applications, from planning to toxicity prediction. DIR is routinely used to reduce the workload of contour propagation. However, its use for complex dosimetric applications must be carefully evaluated by combining quantitative and qualitative analyses.
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Affiliation(s)
- Bastien Rigaud
- CLCC Eugène Marquis, University of Rennes, Inserm , Rennes , France
| | - Antoine Simon
- CLCC Eugène Marquis, University of Rennes, Inserm , Rennes , France
| | - Joël Castelli
- CLCC Eugène Marquis, University of Rennes, Inserm , Rennes , France
| | - Caroline Lafond
- CLCC Eugène Marquis, University of Rennes, Inserm , Rennes , France
| | - Oscar Acosta
- CLCC Eugène Marquis, University of Rennes, Inserm , Rennes , France
| | - Pascal Haigron
- CLCC Eugène Marquis, University of Rennes, Inserm , Rennes , France
| | - Guillaume Cazoulat
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center , Houston , TX , USA
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