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Zhang X, Zheng W, Huang S, Li H, Bi Z, Yang X. Xerostomia prediction in patients with nasopharyngeal carcinoma during radiotherapy using segmental dose distribution in dosiomics and radiomics models. Oral Oncol 2024; 158:107000. [PMID: 39226775 DOI: 10.1016/j.oraloncology.2024.107000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 07/31/2024] [Accepted: 08/14/2024] [Indexed: 09/05/2024]
Abstract
OBJECTIVES This study aimed to integrate radiomics and dosiomics features to develop a predictive model for xerostomia (XM) in nasopharyngeal carcinoma after radiotherapy. It explores the influence of distinct feature extraction methods and dose ranges on the performance. MATERIALS AND METHODS Data from 363 patients with nasopharyngeal carcinoma were retrospectively analyzed. We pioneered a dose-segmentation strategy, where the overall dose distribution (OD) was divided into four segmental dose distributions (SDs) at intervals of 15 Gy. Features were extracted using manual definition and deep learning, applying OD or SD and integrating radiomics and dosiomics, yielding corresponding feature scores (manually defined radiomics, MDR; manually defined dosiomics, MDD; deep learning-based radiomics, DLR; deep learning-based dosiomics, DLD). Subsequently, 18 models were developed by combining features and model types (random forest and support vector machine). RESULTS AND CONCLUSION Under OD, O(DLR_DLD) demonstrated exceptional performance, with an optimal area under the curve (AUC) of 0.81 and an average AUC of 0.71. Within SD, S(DLR_DLD) surpassed the other models, achieving an optimal AUC of 0.90 and an average AUC of 0.85. Therefore, the integration of dosiomics into radiomics can augment predictive efficacy. The dose-segmentation strategy can facilitate the extraction of more profound information. This indicates that ScoreDLR and ScoreMDR were negatively associated with XM, whereas ScoreDLD, derived from SD exceeding 15 Gy, displayed a positive association with XM. For feature extraction, deep learning was superior to manual definition.
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Affiliation(s)
- Xushi Zhang
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong Province, China; School of Biomedical Engineering, Guangzhou Medical University, Guangzhou 511400, Guangdong Province, China.
| | - Wanjia Zheng
- Department of Radiation Oncology, Southern Theater Air Force Hospital of the People's Liberation Army, Guangzhou 510050, Guangdong Province, China.
| | - Sijuan Huang
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong Province, China.
| | - Haojiang Li
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong Province, China.
| | - Zhisheng Bi
- School of Biomedical Engineering, Guangzhou Medical University, Guangzhou 511400, Guangdong Province, China; Department of Emergency Medicine, the Second Affiliated Hospital, Guangzhou Medical University, Guangzhou 510260, Guangdong Province, China.
| | - Xin Yang
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong Province, China.
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Kim YJ. Xerostomia and Its Cellular Targets. Int J Mol Sci 2023; 24:ijms24065358. [PMID: 36982432 PMCID: PMC10049126 DOI: 10.3390/ijms24065358] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/26/2023] [Accepted: 03/02/2023] [Indexed: 03/14/2023] Open
Abstract
Xerostomia, the subjective feeling of a dry mouth associated with dysfunction of the salivary glands, is mainly caused by radiation and chemotherapy, various systemic and autoimmune diseases, and drugs. As saliva plays numerous essential roles in oral and systemic health, xerostomia significantly reduces quality of life, but its prevalence is increasing. Salivation mainly depends on parasympathetic and sympathetic nerves, and the salivary glands responsible for this secretion move fluid unidirectionally through structural features such as the polarity of acinar cells. Saliva secretion is initiated by the binding of released neurotransmitters from nerves to specific G-protein-coupled receptors (GPCRs) on acinar cells. This signal induces two intracellular calcium (Ca2+) pathways (Ca2+ release from the endoplasmic reticulum and Ca2+ influx across the plasma membrane), and this increased intracellular Ca2+ concentration ([Ca2+]i) causes the translocation of the water channel aquaporin 5 (AQP5) to the apical membrane. Consequently, the GPCR-mediated increased [Ca2+]i in acinar cells promotes saliva secretion, and this saliva moves into the oral cavity through the ducts. In this review, we seek to elucidate the potential of GPCRs, the inositol 1,4,5-trisphosphate receptor (IP3R), store-operated Ca2+ entry (SOCE), and AQP5, which are essential for salivation, as cellular targets in the etiology of xerostomia.
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Affiliation(s)
- Yoon-Jung Kim
- Department of Physiology and Neuroscience, Dental Research Institute, Seoul National University School of Dentistry, Seoul 03080, Republic of Korea
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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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Desideri I, Loi M, Francolini G, Becherini C, Livi L, Bonomo P. Application of Radiomics for the Prediction of Radiation-Induced Toxicity in the IMRT Era: Current State-of-the-Art. Front Oncol 2020; 10:1708. [PMID: 33117669 PMCID: PMC7574641 DOI: 10.3389/fonc.2020.01708] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 07/30/2020] [Indexed: 12/14/2022] Open
Abstract
Normal tissue complication probability (NTCP) models that were formulated in the Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC) are one of the pillars in support of everyday’s clinical radiation oncology. Because of steady therapeutic refinements and the availability of cutting-edge technical solutions, the ceiling of organs-at-risk-sparing has been reached for photon-based intensity modulated radiotherapy (IMRT). The possibility to capture heterogeneity of patients and tissues in the prediction of toxicity is still an unmet need in modern radiation therapy. Potentially, a major step towards a wider therapeutic index could be obtained from refined assessment of radiation-induced morbidity at an individual level. The rising integration of quantitative imaging and machine learning applications into radiation oncology workflow offers an unprecedented opportunity to further explore the biologic interplay underlying the normal tissue response to radiation. Based on these premises, in this review we focused on the current-state-of-the-art on the use of radiomics for the prediction of toxicity in the field of head and neck, lung, breast and prostate radiotherapy.
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Affiliation(s)
- Isacco Desideri
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Mauro Loi
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Giulio Francolini
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Carlotta Becherini
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Lorenzo Livi
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Pierluigi Bonomo
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
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Rocchi C, Emmerson E. Mouth-Watering Results: Clinical Need, Current Approaches, and Future Directions for Salivary Gland Regeneration. Trends Mol Med 2020; 26:649-669. [PMID: 32371171 DOI: 10.1016/j.molmed.2020.03.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 03/03/2020] [Accepted: 03/27/2020] [Indexed: 12/31/2022]
Abstract
Permanent damage to the salivary glands and resulting hyposalivation and xerostomia have a substantial impact on patient health, quality of life, and healthcare costs. Currently, patients rely on lifelong treatments that alleviate the symptoms, but no long-term restorative solutions exist. Recent advances in adult stem cell enrichment and transplantation, bioengineering, and gene transfer have proved successful in rescuing salivary gland function in a number of animal models that reflect human diseases and that result in hyposalivation and xerostomia. By overcoming the limitations of stem cell transplants and better understanding the mechanisms of cellular plasticity in the adult salivary gland, such studies provide encouraging evidence that a regenerative strategy for patients will be available in the near future.
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Affiliation(s)
- Cecilia Rocchi
- The MRC Centre for Regenerative Medicine, The University of Edinburgh, Edinburgh BioQuarter, 5 Little France Drive, Edinburgh, EH16 4UU, UK
| | - Elaine Emmerson
- The MRC Centre for Regenerative Medicine, The University of Edinburgh, Edinburgh BioQuarter, 5 Little France Drive, Edinburgh, EH16 4UU, UK.
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Mnejja W, Daoud H, Fourati N, Sahnoun T, Siala W, Farhat L, Daoud J. Quel impact de la RCMI des carcinomes nasopharyngés sur les structures glandulaires ? Cancer Radiother 2020; 24:38-43. [DOI: 10.1016/j.canrad.2019.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/14/2019] [Accepted: 06/19/2019] [Indexed: 12/09/2022]
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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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Leung WS, Wu VWC, Liu CYW, Cheng ACK. A dosimetric comparison of the use of equally spaced beam (ESB), beam angle optimization (BAO), and volumetric modulated arc therapy (VMAT) in head and neck cancers treated by intensity modulated radiotherapy. J Appl Clin Med Phys 2019; 20:121-130. [PMID: 31593367 PMCID: PMC6839392 DOI: 10.1002/acm2.12748] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/02/2019] [Accepted: 09/13/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Previous studies have shown that the beam arrangement had significant influence on plan quality in intensity modulated radiotherapy (IMRT). This study aimed to evaluate the dosimetric performance of beam arrangement methods by employing equally spaced beams (ESB), beam angle optimization (BAO), and volumetric modulated arc therapy (VMAT) in the planning of five types of head and neck (H&N) cancers treated by IMRT. Methods Five plans of different beam arrangement methods were optimized for 119 H&N cancer patients with the prescription of 66–70 Gy for high‐risk planning target volume (PTV), 60 Gy for intermediate risk PTV, 54 Gy for low‐risk PTV using a simultaneously integrated boost method. The five‐beam arrangement methods were: ESB, coplanar BAO (BAOc), noncoplanar BAO (BAOnc), two‐arc VMAT (VMAT2), and three‐arc VMAT (VMAT3). The H&N cancers included cancers of nasopharynx, oral cavity, larynx, maxillary sinus, and parotid. Although the partial arc VMAT could be used in cases where the PTVs were situated at one side of the head such as the parotid, this arrangement was not included because it was intended to include only the beam arrangements that were applicable to all the types of head and neck cancers in the study. The plans were evaluated using a “figure‐of‐merit” known as uncomplicated target conformity index (UTCI). In addition, PTV conformation number and homogeneity index, normal tissue integral dose, and organ at risk (OAR) doses were also used. The mean values of these parameters were compared among the five plans. Results All treatment plans met the preset dose requirements for the target volumes and OARs. For nasopharyngeal cancer, VMAT3 and BAOnc demonstrated significantly higher UTCI. For cancer of oral cavity, most beam arrangement showed similar UTCI except ESB, which was relatively lower. For cancer of larynx, there was no significant difference in UTCI among the five‐beam arrangement methods. For cancers of maxillary sinus and parotid gland, the two BAO methods showed marginally higher UTCI among all the five methods. Conclusion Individual methods showed dosimetric advantages on certain aspects, and the UTCI of the BAO treatment plans are marginally greater in the case of maxillary sinus and parotid gland. However, if treatment time was included into consideration, VMAT plans would be recommended for cancers of the nasopharynx, oral cavity, and larynx.
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Affiliation(s)
- Wan Shun Leung
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Vincent W C Wu
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Clarie Y W Liu
- Department of Oncology, Princess Margaret Hospital, Kowloon, Hong Kong
| | - Ashley C K Cheng
- Department of Oncology, Princess Margaret Hospital, Kowloon, Hong Kong
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Lapeyre M, Biau J, Racadot S, Moreira J, Berger L, Peiffert D. Radiothérapie des cancers de la cavité buccale. Cancer Radiother 2016; 20 Suppl:S116-25. [DOI: 10.1016/j.canrad.2016.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Liang X, Zhang J, Peng G, Li J, Bai S. Radiation caries in nasopharyngeal carcinoma patients after intensity-modulated radiation therapy: A cross-sectional study. J Dent Sci 2015; 11:1-7. [PMID: 30894938 PMCID: PMC6395148 DOI: 10.1016/j.jds.2015.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 09/04/2015] [Indexed: 02/05/2023] Open
Abstract
Background/purpose The exact dose of intensity-modulated radiation therapy (IMRT) associated with tooth damage is mostly unknown. We aim to evaluate the severity of dental lesions after IMRT and the correlation with the radiation dose to the dentition in patients with nasopharyngeal carcinoma (NPC). Materials and methods This was a cross-sectional study of 42 patients with NPC who completed IMRT in 2011. Each premolar tooth was divided into 13 sites. Teeth were evaluated using a validated index and subsequently categorized at each divided site. The relationship between dose distribution and the caries severity score was analyzed using logistic models. The odds of developing caries damage were evaluated using odds ratios. Results A total of 4342 sites from 334 premolar teeth were evaluated. For sites exposed to 30–60 Gy, the odds of developing caries damage were 12–200 times greater compared with sites unexposed to IMRT. A new radiation caries lesion was likely to occur when the dose was >35.8 Gy after 17 days' radiation therapy (P < 0.05). Conclusion The findings suggest that new tooth damage was likely to occur at doses > 35.8 Gy, and care should be taken throughout the treatment planning process to limit tooth doses to < 50 Gy in NPC patients.
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Affiliation(s)
- Xue Liang
- State Key Laboratory of Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, China
- Department of Operative Dentistry and Endodontics, West China School of Stomatology, Sichuan University, Chengdu, China
- School and Hospital of Stomatology, Fujian Medical University, Fujian, China
| | - Jingyang Zhang
- State Key Laboratory of Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, China
- Department of Operative Dentistry and Endodontics, West China School of Stomatology, Sichuan University, Chengdu, China
| | - Guang Peng
- Radiation Physics Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jiyao Li
- State Key Laboratory of Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, China
- Department of Operative Dentistry and Endodontics, West China School of Stomatology, Sichuan University, Chengdu, China
- Corresponding authors. Jiyao Li, Department of Operative Dentistry and Endodontics, West China School of Stomatology, Number 14, Unit 3, Renmin Nan Road, Chengdu City, Sichuan 610041, China; Sen Bai, Radiation Physics Center, Cancer Center, West China Hospital, Sichuan University, Number 37 Guo Xue Xiang Chengdu, Sichuan 610041, China.
| | - Sen Bai
- Radiation Physics Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
- Corresponding authors. Jiyao Li, Department of Operative Dentistry and Endodontics, West China School of Stomatology, Number 14, Unit 3, Renmin Nan Road, Chengdu City, Sichuan 610041, China; Sen Bai, Radiation Physics Center, Cancer Center, West China Hospital, Sichuan University, Number 37 Guo Xue Xiang Chengdu, Sichuan 610041, China.
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Servagi-Vernat S, Ali D, Espinoza S, Houle A, Laccourreye O, Giraud P. Organes à risque en radiothérapie conformationnelle des tumeurs de la tête et du cou : aspect pratique de leur délinéation et des contraintes de dose. Cancer Radiother 2013; 17:695-704. [DOI: 10.1016/j.canrad.2013.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 03/25/2013] [Accepted: 03/28/2013] [Indexed: 01/17/2023]
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Délinéation des cancers de la cavité buccale et de l’oropharynx. Cancer Radiother 2013; 17:493-7. [DOI: 10.1016/j.canrad.2013.05.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 05/25/2013] [Indexed: 12/25/2022]
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Impact of Radiotherapy Dose on Dentition Breakdown in Head and Neck Cancer Patients. Pract Radiat Oncol 2011; 1:142-148. [PMID: 21857887 DOI: 10.1016/j.prro.2011.03.003] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE: To evaluate the severity of post-radiation dental lesions and possible correlation with radiation dose to the teeth in patients treated for head and neck cancers. METHODS AND MATERIALS: Data from 93 head and neck radiotherapy patients treated between 1997 and 2008 were analyzed retrospectively. The main effect, radiation dose to the individual teeth, was evaluated with covariates of elapsed time after radiation, xerostomia, topical fluoride use, and oral hygiene status included. Patients' radiotherapy plans were used to calculate cumulative exposure for each tooth. Patients' teeth were evaluated using a validated index and then categorized as having none/slight or moderate/severe post-radiation damage. RESULTS: Patients (31 females, 62 males) ranged in age from 18-82 yrs (mean=57). The number of teeth/patient ranged from 3-30 (mean=20) with a total of 1873 teeth evaluated. Overall, 51% of teeth had moderate/severe damage, with the remaining having little or none. Using odds ratios and 95% confidence intervals, the odds for moderate/severe damage were 2-3x greater for teeth exposed to between 30-60 Gy as compared to no radiation. However, for teeth exposed to ≥60 Gy as compared to no radiation the odds of moderate/severe tooth damage was greater by a magnitude of 10 times. CONCLUSIONS: The results indicate that there is minimal tooth damage below 30 Gy (salivary gland threshold), a greater than 1:1 increased dose-response between 30-60y likely related to salivary gland damage, and a critical threshold of ≥60Gy which may be linked to direct effects of radiation on tooth structure. These findings suggest that care should be taken during the treatment planning process to limit tooth dose, and when clinically possible to limit tooth dose to less than 60 Gy.
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